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2025 ISAKOS Biennial Congress Paper

Single Bundle Anterior Cruciate Ligament Reconstruction Has Less Graft Failure Than Double Bundle Anterior Cruciate Ligament Reconstruction: A Multicenter Retrospective Cohort Study In 1884 Patients

Ling Yang, MD, , Keelung, Taiwan TAIWAN
Yi-Sheng Chan, MD, Keelung, Keelung TAIWAN
Shih-Sheng Chang, MD, Taoyuan, --- Select One --- TAIWAN
Chih-Hao Chiu, MD, Taoyuan City TAIWAN
Department of Orthopedic Surgery, Keelung Chang Gung Memorial Hospital, Keelung, Keelung, TAIWAN

FDA Status Cleared

Summary

Single bundle technique may be more optimal than double bundle technique for anterior cruciate ligament reconstruction due to less graft failure and meniscectomy possibility.

Abstract

Introduction

ACL reconstruction is a widespread sports medicine surgery, varying studies on single vs. double bundles techniques. Some show biomechanical superiority for either technique; others find no significant differences. This study investigates outcomes between the two techniques.

Method

A retrospective cohort study was undertaken, identifying individuals aged 15 to 65 with an ACL tear in Taiwan's Chang Gung Research Database (CGRD) spanning January 2001 to December 2020. The study drew upon the CGRD, utilizing diagnostic registrations initially coded under the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) system, and transitioning to ICD-10 codes post-2016. Additional insights into the CGRD have been previously disseminated. For further analysis, clinical characteristics (age, sex, BMI, etc.), surgical interventions (single or double bundle reconstruction), and outcomes (osteoarthritis, knee arthroplasty, meniscectomy, graft failure) were retrospectively collected.
Result
The study initially included 1884 patients in the single-bundle ACL reconstruction and 454 in the double-bundle group. After propensity score matching (PSM), 453 patients for both single and double-bundle. Post-inverse probability of treatment weighting (IPTW), the groups comprised 1879 and 438 patients, respectively. The double-bundle group showed a higher likelihood of graft failure (HR 1.922 - 8.02, 95% CI) and meniscectomy (HR 1.727 - 4.077, 95% CI) compared to the single-bundle group.

Discussion

The choice between single or double-bundle depends on surgeon preference and patient characteristics. The double-bundle approach may be recommended for specific cases.

Conclusions