Knee Osteoarthritis After Single-Bundle Versus Double-Bundle Anterior Cruciate Ligament Reconstruction: A Systematic Review of Randomized Controlled Trials

Purpose: To systematically review high-quality studies in the literature to compare the postoperative radiographic incidence of knee osteoarthritis (OA) after anterior cruciate ligament reconstruction (ACLR) with a single-bundle (SB) versus double-bundle (DB) graft. Methods: A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to locate randomized controlled trials that compared the postoperative progression of knee OA in SB versus DB ACLR patients. The search terms used were anterior cruciate ligament reconstruction, single-bundle, double-bundle, randomized, and osteoarthritis. Patients were assessed based on radiographic evaluation (Kellgren-Lawrence [K-L] and objective International Knee Documentation Committee scales) and graft failure. Results: A total of 7 studies (5 Level I and 2 Level II) met the inclusion criteria, including 375 SB and 477 DB ACLR patients with a mean follow-up period of 5.3 years. Graft failure occurred in 3.2% of patients overall (27 of 852), with no significant difference between groups (P = .10). No significant difference in overall K-L grade distribution was found between groups (P = .90). Overall, 15.1% of patients (58 of 383) were given a K-L grade of 2 or greater, including 14.4% in the SB group (31 of 215) and 16.1% in the DB group (27 of 168) (P = .65). Using other, unconventional grading schemes, 2 studies found DB ACLR patients to have significantly fewer signs of radiographic knee OA at follow-up compared with SB ACLR patients (P < .05). Conclusions: Patients undergoing ACLR with either an SB or DB graft can be expected to experience a similar incidence of postoperative knee OA at midterm follow-up according to the K-L grading system.