Single-Bundle Versus Double-Bundle Anterior Cruciate Ligament Reconstruction: Assessment With Vertical Jump Test


      The study was designed to compare the clinical results of traditional single-bundle (SB) anterior cruciate ligament (ACL) reconstruction with those of double-bundle (DB) ACL reconstruction.


      This study comprised 80 patients aged 18 to 45 years with an isolated ACL lesion: 40 patients underwent SB reconstruction, and 40 patients underwent DB reconstruction. Patients were assessed preoperatively with functional assessment including the International Knee Documentation Committee 2000 knee subjective form and visual analog scale, as well as physical examination (including the pivot-shift test and instrumented knee laxity measurement). Vertical jump assessment with the Optojump system (Microgate, Bolzano, Italy) has been introduced as a method to compare functional ability between the 2 surgical techniques. The same protocol was repeated 6 months, 12 months, and 2 years after surgery.


      No statistically significant differences were noted between the groups concerning subjective evaluation, thigh girth difference, mean visual analog scale score, range of motion, and Lachman and anterior drawer tests (P = not significant). A statistically higher number of patients in the SB group showed a positive pivot-shift test and a higher side-to-side difference when measured with the KT-1000 arthrometer (MEDmetric, San Diego, CA) than in the DB group (P < .001). Better mean jumping performance results were reported in the DB group compared with the SB group (P < .001). The average performance results for the injured limb were not significantly reduced compared with those of the uninjured limb in the DB group 12 months after surgery. At 2 years, a restoration of jumping ability in the ACL-reconstructed limb was achieved in both groups regardless of the technique used.


      DB ACL reconstruction has been proven to be superior to the SB technique with regard to knee stability and vertical jump performance.

      Level of Evidence

      Level II, prospective comparative study.
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        • Harner C.D.
        • Baek G.H.
        • Vogrin T.M.
        • Carlin G.J.
        • Kashiwaguchi S.
        • Woo S.L.
        Quantitative analysis of human cruciate ligament insertions.
        Arthroscopy. 1999; 15: 741-749
        • Pombo M.W.
        • Shen W.
        • Fu F.H.
        Anatomic double-bundle anterior cruciate ligament reconstruction: Where are we today?.
        Arthroscopy. 2008; 24: 1168-1177
        • Woo S.L.
        • Kanamori A.
        • Zeminski J.
        • Yagi M.
        • Papageorgiou C.
        • Fu F.H.
        The effectiveness of reconstruction of the anterior cruciate ligament with hamstrings and patellar tendon: A cadaver study comparing anterior tibial and rotational loads.
        J Bone Joint Surg Am. 2002; 84: 907-914
        • Aglietti P.
        • Giron F.
        • Buzzi R.
        • Biddau F.
        • Sasso F.
        Anterior cruciate ligament reconstruction: Bone-patellar tendon-bone compared to double semitendinosus and gracilis tendon grafts. A prospective, randomized clinical trial.
        J Bone Joint Surg Am. 2004; 86: 2143-2155
        • Tashman S.
        • Collon D.
        • Anderson K.
        • Kolowich P.
        • Anderst W.
        Abnormal rotational knee motion during running after anterior cruciate ligament reconstruction.
        Am J Sports Med. 2004; 32: 975-983
        • Zantop T.
        • Herbort M.
        • Raschke M.J.
        • Fu F.H.
        • Petersen W.
        The role of the anteromedial and posterolateral bundles of the anterior cruciate ligament in anterior tibial translation and internal rotation.
        Am J Sports Med. 2007; 35: 223-227
        • Ristanis S.
        • Stergiou N.
        • Patras K.
        • et al.
        Excessive tibial rotation during high-demand activities is not restored by anterior cruciate ligament reconstruction.
        Arthroscopy. 2005; 21: 1323-1329
        • Fu F.H.
        • Shen W.
        • Starman J.S.
        • Okeke N.
        • Irrgang J.J.
        Primary anatomic double-bundle anterior cruciate ligament reconstruction: A preliminary 2-year prospective study.
        Am J Sports Med. 2008; 36: 1263-1274
        • Yagi M.
        • Kuroda R.
        • Nagamune K.
        • Yoshiya S.
        • Kurosaka M.
        Double-bundle ACL reconstruction can improve rotational stability.
        Clin Orthop Relat Res. 2007; 454: 100-107
        • Muneta T.
        • Koga H.
        • Mochizuki T.
        • et al.
        A prospective randomized study of 4-strand semitendinosus tendon anterior cruciate ligament construction comparing single-bundle and double-bundle techniques.
        Arthroscopy. 2007; 23: 618-628
        • Siebold R.
        • Dehler C.
        • Ellert T.
        Prospective randomized comparison of double-bundle versus single bundle anterior cruciate ligament reconstruction.
        Arthroscopy. 2008; 24: 137-145
        • Yasuda K.
        • Kondo E.
        • Ichiyama H.
        • Tanabe T.
        • Tohyama H.
        Clinical evaluation of the anatomic double bundle ACL reconstruction procedure using hamstring tendon grafts: Comparison among 3 different procedures.
        Arthroscopy. 2006; 22: 250-251
        • Toritsuka Y.
        • Amano H.
        • Kuwano M.
        • et al.
        Outcome of double bundle ACL reconstruction using hamstring tendons.
        Knee Surg Sports Traumatol Arthrosc. 2009; 17: 456-463
        • Buoncristiani A.M.
        • Tjoumakaris P.F.
        • Starman J.S.
        • Ferretti B.S.M.
        • Fu F.H.
        Anatomic double-bundle anterior cruciate ligament reconstruction.
        Arthroscopy. 2006; 22: 1000-1006
        • Järvelä T.
        Double-bundle versus single-bundle anterior cruciate ligament reconstruction: A prospective, randomized clinical study.
        Knee Surg Sports Traumatol Arthrosc. 2007; 15: 500-507
        • Adachi N.
        • Ochi M.
        • Uchio Y.
        • Iwasa J.
        • Kurikawa M.
        • Ito Y.
        Reconstruction of the anterior cruciate ligament. Single- versus double-bundle multistranded hamstring tendons.
        J Bone Joint Surg Br. 2004; 86: 515-520
        • Park S.J.
        • Jung Y.B.
        • Jung H.J.
        • et al.
        Outcome of arthroscopic single-bundle versus double-bundle reconstruction of the anterior cruciate ligament: A preliminary 2-year prospective study.
        Arthroscopy. 2010; 26: 630-636
        • Maulder P.
        • Cronin J.
        Horizontal and vertical jump assessment: Reliability, symmetry, discriminative and predictive ability.
        Phys Ther Sport. 2005; 6: 74-82
        • Katayama M.
        • Higuchi H.
        • Kimura M.
        • et al.
        Proprioception and performance after anterior cruciate ligament rupture.
        Int Orthop. 2004; 28: 278-281
        • Lange B.
        • Bury T.
        Preliminary study of jumping ability using the optojump system.
        Biom Hum Anthropol. 2002; 20: 17-22
        • Lehance C.
        • Croisier J.L.
        • Bury T.
        Optojump system efficiency in the assessment of lower limbs explosive strength.
        Sci Sports. 2005; 20: 131-135
        • Glatthorn J.F.
        • Gouge S.
        • Nussbaumer S.
        • Stauffacher S.
        • Impellizzeri F.M.
        • Maffiuletti N.A.
        Validity and reliability of Optojump photoelectric cells for estimating vertical jump height.
        J Stength Cond Res. 2011; 25: 556-560
        • Bosco C.
        • Tihanyi J.
        • Komi P.V.
        • Fekete G.
        • Apor P.
        Store and recoil of elastic energy in slow and fast type of human skeletal muscles.
        Acta Physiol Scand. 1982; 116: 343-349
        • Renstrom P.
        • Kannus P.
        Prevention of sports injuries.
        in: Strauss R.H. Sports medicine. WB Saunders, Philadelphia1991: 307-329
        • Tsuda E.
        • Ishibashi Y.
        • Fukuda A.
        • Tsukada H.
        • Toh S.
        Comparable results between lateralized single and double-bundle ACL reconstructions.
        Clin Orthop Relat Res. 2009; 467: 1042-1055
        • Aglietti P.
        • Giron F.
        • Losco M.
        • Cuomo P.
        • Ciardullo A.
        • Mondanelli N.
        Comparison between single- and double-bundle anterior cruciate ligament reconstruction. A prospective, randomized, single-blinded clinical trial.
        Am J Sports Med. 2009; 38: 25-34
        • Fu F.H.
        • Bennett C.H.
        • Lattermann C.
        • Ma C.B.
        Current trends in anterior ligament reconstruction.
        Am J Sports Med. 1999; 27: 821-830
        • Biau D.J.
        • Tournoux C.
        • Katsahian S.
        • et al.
        ACL reconstruction: A meta-analysis of functional scores.
        Clin Orthop Relat Res. 2007; 458: 180-187
        • Gabriel M.T.
        • Wong E.K.
        • Woo S.L.
        • Yagi M.
        • Debski R.E.
        Distribution of in situ forces in the anterior cruciate ligament in response to rotatory loads.
        J Orthop Res. 2004; 22: 85-89
        • Sakana M.
        • Fox R.J.
        • Woo S.L.
        • et al.
        In situ forces in the anterior cruciate ligament and its bundles in response to anterior tibial loads.
        J Orthop Res. 1997; 15: 285-289
        • Van de Velde S.K.
        • Gill T.J.
        • Li G.
        Evaluation of kinematics of anterior cruciate ligament-deficient knees with use of advanced imaging techniques, three-dimensional modeling techniques, and robotics.
        J Bone Joint Surg Am. 2009; 91: 108-114
        • Plaweski S.
        • Grimaldi M.
        • Courvoisier A.
        • Wimsey S.
        Intraoperative comparisons of knee kinematics of double-bundle versus single-bundle anterior cruciate ligament reconstruction.
        Knee Surg Sports Traumatol Arthrosc. 2011; 19: 1277-1286
        • Branch T.P.
        • Siebold R.
        • Freedberg H.I.
        • Jacobs C.A.
        Double-bundle ACL reconstruction demonstrated superior clinical stability to single-bundle ACL reconstruction: A matched-pairs analysis of instrumented tests of tibial anterior translation and internal rotation laxity.
        Knee Surg Sports Traumatol Arthrosc. 2011; 19: 432-440
        • Izawa T.
        • Okazaki K.
        • Tashiro Y.
        • et al.
        Comparison of rotatory stability after anterior cruciate ligament reconstruction between single-bundle and double-bundle techniques.
        Am J Sports Med. 2011; 39: 1470-1477
        • Yamazaki S.
        • Yasuda K.
        • Tomita F.
        • et al.
        The effect of graft-tunnel diameter disparity on intraosseous healing of the flexor tendon graft in anterior cruciate ligament reconstruction.
        Am J Sports Med. 2002; 30: 498-505
        • Lohmander L.S.
        • Ostenberg A.
        • Englund M.
        • et al.
        High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury.
        Arthritis Rheum. 2004; 50: 3145-3152
        • Morimoto Y.
        • Ferretti M.
        • Ekdahl M.
        • Smolinski P.
        • Fu F.H.
        Tibiofemoral joint contact area and pressure after single- and double-bundle anterior cruciate ligament reconstruction.
        Arthroscopy. 2009; 25: 62-69
        • Tiamklang T.
        • Sumanont S.
        • Foocharoen T.
        • Laopaiboon M.
        Double-bundle versus single-bundle reconstruction for anterior cruciate rupture in adults.
        Cochrane Database Syst Rev. 2012; 11: CD008413
        • Bosco C.
        • Luhtanen P.
        • Komi P.V.
        A simple method for measurement of mechanical power in jumping.
        Eur J Appl Physiol. 1983; 50: 273-282
        • Kibele A.
        Possibilities and limitations in the biomechanical analysis of countermovement jumps: A methodological study.
        J Appl Biomech. 1998; 14: 105-117
        • Palmieri-Smith R.M.
        • Thomas A.C.
        • Wojtys E.M.
        Maximizing quadriceps strength after ACL reconstruction.
        Clin Sports Med. 2008; 27: 405-424
        • Urbach D.
        • Nebelung W.
        • Becker R.
        • Awiszus F.
        Effects of reconstruction of the anterior cruciate ligament on voluntary activation of quadriceps femoris. A prospective twitch interpolation study.
        J Bone Joint Surg Br. 2001; 83: 1104-1110
        • Järvelä T.
        • Kannus P.
        • Latvala K.
        • Järvinen M.
        Simple measurements in assessing muscle performance after an ACL reconstruction.
        Int J Sports Med. 2002; 23: 196-201
        • Gerber J.P.
        • Marcus R.L.
        • Dibble L.E.
        • Greis P.E.
        • Burks R.T.
        • LaStayo P.C.
        Effects of early progressive eccentric exercise on muscle size and function after anterior cruciate ligament reconstruction: A 1-year follow-up study of a randomized clinical trial.
        Phys Ther. 2009; 89: 51-59

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