Which technique provides more benefits in return to sports and clinical outcomes after anterior cruciate ligament reconstruction: Double-bundle or single-bundle? A randomized controlled study.
10.1097/CM9.0000000000003267
- Author:
Xinjie WANG
1
;
Zijie XU
2
;
Shitang SONG
3
;
Zimu MAO
1
;
Ximeng HUANG
1
;
Michael LUO
1
;
Xiao ZHOU
1
;
Bingbing XU
1
;
Jing YE
4
;
Yifan SONG
4
;
Jiakuo YU
1
Author Information
1. Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing 100191, China.
2. Institute of Sports Medicine, Peking University, Beijing 100191, China.
3. Peking University Health Science Center, Beijing 100191, China.
4. Orthopaedic Sports Medicine Center, Beijing Tsinghua Changgung Hospital, Affiliated Hospital of Tsinghua University, Beijing 102218, China.
- Publication Type:Randomized Controlled Trial
- Keywords:
Anatomical single-bundle reconstruction;
Anterior cruciate ligament reconstruction;
Central axial single-bundle reconstruction;
Double-bundle reconstruction;
Return to sport
- MeSH:
Humans;
Anterior Cruciate Ligament Reconstruction/methods*;
Male;
Female;
Adult;
Anterior Cruciate Ligament Injuries/surgery*;
Young Adult;
Return to Sport;
Adolescent;
Anterior Cruciate Ligament/surgery*;
Treatment Outcome
- From:
Chinese Medical Journal
2025;138(18):2283-2292
- CountryChina
- Language:English
-
Abstract:
BACKGROUND:The achievement of an optimal return to sport (RTS) has remained a key goal after sports-related injuries, with the ongoing debate on the effectiveness of different surgical approaches for anterior cruciate ligament (ACL) rupture. This study aims to assess clinical outcomes and RTS across various surgical methods, such as anatomical single-bundle reconstruction (ASBR), central-axial single-bundle reconstruction (CASBR), and double-bundle reconstruction (DBR).
METHODS:A randomized clinical trial was conducted, comprising 191 patients who underwent ACL rupture. These patients were divided into three groups based on the ACL reconstruction techniques they received (ASBR, CASBR, DBR). Over the 2-year follow-up period, the study assessed RTS through four single-hop tests, isokinetic extension tests, and limb asymmetry indices. Postoperative graft status was determined using the signal-to-noise quotient (SNQ), while knee function was evaluated using the International Knee Documentation Committee 2000 (IKDC-2000) score, Lysholm score, Tegner score, and degree of knee laxity. A binary logistic regression model was developed to forecast the factors influencing ideal RTS.
RESULTS:DBR (67.63%) and CASBR (58.00%) exhibited higher RTS passing rates compared to ASBR (30.39%; χ2 = 19.57, P <0.05). Quadriceps strength symmetry in the lower limbs was identified as the key determinant of RTS ( χ2 = 17.08, P <0.05). The RTS rate was influenced by SNQs of the graft's tibial site (odds ratio: 0.544) and quadriceps strength of the reconstructed knee joint at 60°/s (odds ratio: 6.346). Notably, the DBR group showed enhanced knee stability, evidenced by superior results in the Lachman test ( χ2 = 13.49, P <0.01), objective IKDC-2000 ( χ2 = 27.02, P = 0.002), and anterior instability test ( χ2 = 9.46, P <0.01). Furthermore, DBR demonstrated superior clinical outcomes based on the Lysholm score (DBR: 89.57 ± 7.72, CASBR: 83.00 ± 12.71, ASBR: 83.21 ± 11.95; F = 10.452, P <0.01) and IKDC-2000 score (DBR: 90.95 ± 7.00, CASBR: 84.64 ± 12.68, ASBR: 83.63 ± 11.41; F = 11.78, P <0.01).
CONCLUSION:For patients with ACL rupture, more ideal RTS rate and clinical outcomes were shown in the DBR group than in the ASBR and CASBR groups. Autograft status and quadriceps strength are postively related to RTS.
TRIAL REGISTRATION:ClinicalTrials.gov (NCT05400460).
