• Carola F van Eck, Sebastian Kopf, James J Irrgang, Leendert Blankevoort, Mohit Bhandari, Freddie H Fu, and Rudolf W Poolman.
• Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
• Arthroscopy. 2012 Mar 1; 28 (3): 405-24.

PurposeTo determine whether double-bundle anterior cruciate ligament reconstruction leads to better restoration of anterior and rotational laxity and range of motion than single-bundle reconstruction.MethodsA search was performed in the Medline, Embase, CINAHL, and Cochrane databases. All randomized, quasi-randomized, and observational clinical trials that reported the outcome of double- versus single-bundle anterior cruciate ligament reconstruction were included in our meta-analysis. The primary outcomes were anterior laxity (KT arthrometer; MEDmetric, San Diego, CA), pivot shift, and range of motion. Subgroup analyses were performed for more than 2 years' follow-up, anatomic reconstruction, and nonanatomic reconstruction. The quality of the included studies was scored by use of the GRADE Checklist.ResultsIncluded 12 studies in this meta-analysis, 5 of which were randomized. There was a statistically significant difference in favor of double-bundle reconstruction for anterior laxity (KT arthrometer difference, -0.6 mm), Lachman test (64% risk reduction of positive Lachman), and pivot-shift test (69% risk reduction of positive shift). Similar results were found for the subgroup with more than 2 years' follow-up and anatomic reconstructions. There were no significant differences for the subgroup with nonanatomic reconstructions, except a 2.6 times risk increase of extension deficit with nonanatomic double-bundle reconstruction compared with nonanatomic single-bundle reconstruction. Most of the included studies were found to have at least one serious limitation in study design.ConclusionsIn comparison with single-bundle reconstruction, double-bundle reconstruction showed less anterior laxity, as measured by the KT arthrometer and Lachman test, and better rotational laxity, as measured by the pivot-shift test. The majority of the included studies had at least one major limitation in study design that decreased the quality of the study.Level Of EvidenceLevel I, meta-analysis.Copyright © 2012 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

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