Sports Clinic and Hospital Mehilainen, Tampere, Finland.
Phys Sportsmed. 2011 Feb;39(1):85-92. doi: 10.3810/psm.2011.02.1865.
Anatomical and biomechanical studies have shown that the anterior cruciate ligament (ACL) primarily consists of 2 distinct bundles, the anteromedial (AM) and posterolateral (PL), which act separately during the knee's range of motion. Conventional ACL reconstruction techniques have focused on restoration of the AM bundle only, while giving limited attention to the PL bundle. The outcomes of these single-bundle techniques have been relatively good in ACL reconstruction. In recent years, many authors have developed double-bundle ACL reconstruction techniques to better replicate ACL anatomy and its 2 bundles. The purpose of this article is to analyze the clinical results of the double-bundle ACL reconstruction according to the current literature. The review focuses primarily on randomized controlled trials. According to the 14 randomized controlled trials published in the literature and included in this review, 4 (29%) trials did not find any significant differences in the results between double-bundle and single-bundle ACL reconstruction. Ten (71%) trials reported significantly better results with double-bundle technique than with single-bundle technique, of which 7 (50%) reported better rotational stability, 6 (43%) reported better anterior stability, 3 (21%) reported better objective knee scores, 3 (21%) reported better subjective knee scores, 2 (14%) reported fewer graft failures, and 1 (7%) reported less degenerative changes of the knee. In addition, none of the trials found the single-bundle technique to have better results in any of these evaluations when compared with the double-bundle technique. However, 13 (93%) of the 14 trials had only a short-term follow-up (1-3 years), and only 1 (7%) trial conducted long-term follow-up (8-10 years). Therefore, only through long-term follow-up studies will we be able to determine whether the double-bundle reconstruction is really better than the single-bundle technique.
解剖学和生物力学研究表明，前交叉韧带（ACL）主要由两个不同的束组成，前内侧（AM）和后外侧（PL），它们在膝关节运动范围内分别发挥作用。传统的 ACL 重建技术仅侧重于重建 AM 束，而对 PL 束关注有限。这些单束技术在 ACL 重建中的效果相对较好。近年来，许多作者开发了双束 ACL 重建技术，以更好地复制 ACL 的解剖结构及其两个束。本文旨在根据现有文献分析双束 ACL 重建的临床结果。综述主要集中在随机对照试验上。根据文献中发表的 14 项随机对照试验并包含在本综述中，有 4 项（29%）试验发现双束和单束 ACL 重建的结果之间没有任何显著差异。10 项（71%）试验报告双束技术的结果明显优于单束技术，其中 7 项（50%）报告旋转稳定性更好，6 项（43%）报告前向稳定性更好，3 项（21%）报告客观膝关节评分更好，3 项（21%）报告主观膝关节评分更好，2 项（14%）报告移植物失败更少，1 项（7%）报告膝关节退行性改变更少。此外，与双束技术相比，在这些评估中，没有一项试验发现单束技术在任何方面具有更好的结果。然而，14 项试验中有 13 项（93%）只有短期随访（1-3 年），只有 1 项（7%）试验进行了长期随访（8-10 年）。因此，只有通过长期随访研究，我们才能确定双束重建是否真的优于单束技术。
