Introduction

Bicruciate ligament (BL) injuries are rare and not well documented in literature. Furthermore, outcomes following BL reconstruction without concomitant collateral ligament, posterolateral, or posteromedial repair are not well reported. We performed a systematic review of the available literature to summarize outcomes of isolated BL reconstruction.

Methods

A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, EMBASE, and MEDLINE databases were searched from inception to February 2024. Search terms included “anterior cruciate ligament”, “posterior cruciate ligament”, “treatment outcome”, and “bicruciate ligament reconstruction”. Manual retrieval via reference review was performed after the initial search. English publications on outcomes of isolated BL reconstruction were included. Studies involving repair or reconstruction of the medial collateral ligament, lateral collateral ligament, posterolateral corner, or posteromedial corner were excluded. Data was collected regarding study characteristics, surgical technique, clinical outcomes, and patient reported outcome measures (PROMs). The methodological index for non-randomized studies (MINORS) scale was also used to assess the quality of each study. Weighted averages of reported outcomes based on a random-effects model were used to account for the low number of studies, small sample sizes, and heterogeneity across studies.

Results

7682 studies were reviewed, and the final number of eligible studies was seven. Clinical outcomes were not consistently reported among the seven studies thereby precluding analysis. One study reported the Knee Injury and Osteoarthritis Outcome Score (KOOS) and was subsequently excluded from analysis as it was the only study in our review that used this PROM. Otherwise, six studies reported a postoperative Lysholm score; four studies reported pre-injury and postoperative Tegner activity scores; and six studies reported a grade according to the International Knee Documentation Committee Subjective Knee score (IKDC). The weighted averages of postoperative Lysholm and Tegner scores were 88.5 and 5.8, respectively (95% CI); this indicates that postoperatively patients reported a “good” Lysholm score across eight predetermined sections of Activities of Daily Living (ADLs), and that patients were also able to perform heavy labour with some variance in the level of sport. The change in pre-injury to postoperative Tegner scores decreased by -0.74 (p=0.025). Finally, the weighted average of patients with either a postoperative IKDC Grade A or B knee compared to Grade C was 0.91, indicating that patients reported either a “normal” (Grade A) or “nearly normal” (Grade B) knee.

Conclusions

Isolated BL reconstruction results in favourable patient reported outcomes following reconstruction; however, patients have lower Tegner activity level scores postoperatively compared to their pre-injured state.