Comparison of Single- and Double-Bundle Anterior Cruciate Ligament Reconstruction Using Quadriceps Tendon–Bone Autografts

Purpose

The purpose of this study was to evaluate and compare postoperative knee stability and functional scores between single- and double- bundle anterior cruciate ligament (ACL) reconstruction with the use of quadriceps tendon–bone autografts at a 2-year follow-up.

Methods

The records of 59 patients who had ACL reconstruction between January 2005 and April 2006 were analyzed retrospectively. Twenty-eight patients had single-bundle reconstruction (group S) and 31 received double-bundle reconstruction (group D). Ligament stability was assessed with the Lachman and pivot-shift tests and a KT-2000 arthrometer. International Knee Documentation Committee (IKDC) and Lysholm scores were employed to evaluate the functional outcomes.

Results

The postoperative mean side-to-side difference for group S was 2.64 mm and 1.79 mm for group D, a difference that was found to be statistically significant (P = .020). Regarding the pivot-shift test, 3 patients had grade 1+ and 1 patient had grade 2+ pivot-shift in group S, while no patients had abnormal pivot-shift in group D (P = .093). The patients who reported grade A or B on IKDC scores were 24 and 28 in group S and D, respectively (P > .1). On the questionnaire of the twisting activity, although statistical difference was not found between the groups, there was a trend toward more restriction in twisting activity in group S (P = .096). We found significant correlation between the twisting activity and instability questionnaire of the Lysholm score (Spearman coefficient, 0.737; P < .001).

Conclusions

Double-bundle ACL reconstruction using quadriceps tendon–bone autografts provide less laxity (1.79 mm) than single-bundle ACL reconstruction (2.64 mm) as measured by the KT-2000. However, we could not find any significant differences in the functional measurements between the 2 groups.

Level of Evidence

Level III, retrospective comparative study.

Key Words: Anterior cruciate ligament, Double-bundle reconstruction, Functional outcomes, Knee stability, Quadriceps tendon–bone autograft