Meredick Richard B, Vance Kennan J, Appleby David, Lubowitz James H
Taos Orthopaedic Institute Research Foundation, Taos, NM 87571, USA.
Am J Sports Med. 2008 Jul;36(7):1414-21. doi: 10.1177/0363546508317964. Epub 2008 May 28.
The anterior cruciate ligament (ACL) has 2 anatomic bundles. Standard ACL reconstruction is with a single-bundle graft, but double-bundle reconstruction may better control knee rotational torque, a potential cause of failure after single-bundle reconstruction. The authors investigated outcomes of single-bundle versus double-bundle ACL reconstruction.
There is no difference in outcomes of single-bundle versus double-bundle reconstruction.
Meta-analysis.
The authors systematically identified randomized controlled trials (RCTs) comparing single-bundle versus double-bundle ACL reconstruction (secondary analysis includes nonrandomized trials). Outcomes reported in a majority of included trials were meta-analyzed.
Four RCTs were included (secondary analysis including 5 additional trials yielded reassuringly similar results). Two outcome measures were reported (in a manner permitting meta-analysis) in at least 3 of 4 trials: KT-1000 arthrometer and pivot-shift testing. On average, KT-1000 arthrometer side-to-side difference was 0.52 mm closer to normal in patients treated with double-bundle reconstruction. This difference is demonstrated to be clinically insignificant. In addition, there was no statistical difference in the odds of having a normal or nearly normal pivot-shift result in patients treated with double-bundle versus single-bundle reconstruction.
Double-bundle reconstruction does not result in clinically significant differences in KT-1000 arthrometer or pivot-shift testing. The pivot-shift results have particular clinical relevance because the test is designed to evaluate knee rotational instability; the results do not support the theory that double-bundle reconstruction better controls knee rotation. Improved quality of future RCTs would allow meta-analysis of a greater number of outcome measures including measures of symptoms and disabilities most important to patients.
前交叉韧带（ACL）有两个解剖束。标准的ACL重建采用单束移植物，但双束重建可能能更好地控制膝关节旋转扭矩，这是单束重建后潜在的失败原因。作者研究了单束与双束ACL重建的结果。
单束与双束重建的结果没有差异。
荟萃分析。
作者系统地识别比较单束与双束ACL重建的随机对照试验（RCT）（二次分析包括非随机试验）。对大多数纳入试验中报告的结果进行荟萃分析。
纳入了4项RCT（二次分析包括另外5项试验，结果令人放心地相似）。4项试验中至少3项报告了两种结果测量指标（以允许进行荟萃分析的方式）：KT-1000关节测量仪和轴移试验。平均而言，双束重建治疗的患者中，KT-1000关节测量仪的左右差异比正常情况小0.52毫米。这一差异在临床上被证明无显著意义。此外，双束重建与单束重建治疗的患者获得正常或接近正常轴移结果的几率没有统计学差异。
双束重建在KT-1000关节测量仪或轴移试验方面不会导致临床上的显著差异。轴移试验结果具有特殊的临床相关性，因为该试验旨在评估膝关节旋转不稳定；结果不支持双束重建能更好地控制膝关节旋转的理论。未来RCT质量的提高将允许对更多结果测量指标进行荟萃分析，包括对患者最重要的症状和残疾测量指标。
