Long-term Clinical Outcomes After Single- Versus Double-Bundle ACL Reconstruction: A Matched-Pair Analysis From the SANTI Study Group.

BACKGROUND

Anterior cruciate ligament (ACL) reconstruction (ACLR) techniques have evolved toward more "anatomic" approaches, including the double-bundle (DB) method, which theoretically offers superior rotational control compared with single-bundle (SB) reconstruction. However, few studies have investigated comparative outcomes at mid- to long-term follow-up.

PURPOSE/HYPOTHESIS: The purpose of this study was to compare the long-term clinical outcomes of SB and DB ACLR. It was hypothesized that both techniques would yield similar clinical results over an extended follow-up period.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

Primary ACLR cases using either a DB or SB hamstring autograft technique registered in the Santy database from 2003 through 2008 were eligible. Propensity score matching was used to adjust for covariates such as age, sex, body mass index, meniscal status, and sports participation. Clinical evaluations-graft survival, side-to-side laxity measurements, and reoperation rates-were analyzed using the Kaplan-Meier method and Cox proportional hazards model.

RESULTS

A total of 396 patients-198 in each group-were included, at a mean follow-up of 14.7 ± 0.6 years. In total, 40 patients (10.1%) experienced graft rupture, with no statistically significant difference between the 22 patients (11.1%) in the SB group and 18 patients (9.1%) in the DB group ( = .52). Reoperation rates, including for cyclops syndrome, arthrofibrosis, or meniscal pathology, were also comparable between groups. There was no statistically significant difference in anterior laxity measurements at 1 year ( = .11). Kaplan-Meier and Cox proportional hazards analyses showed no association between reconstruction technique and risk of graft failure (HR, 0.857; 95% CI, 0.457-1.609; = .63).

CONCLUSION

This study showed that over a mean follow-up of >14 years, the SB and DB ACLR techniques using hamstring autograft showed similar clinical results in terms of graft survival, reoperation rates, and stability. These results suggest that both techniques offer comparable efficacy in the long term.