Long-Term Outcomes Following Anatomic Double-Bundle Versus Single-Bundle Anterior Cruciate Ligament Reconstruction Using Hamstring Autograft: A Randomized Controlled Trial With an Average 14-Year Follow-Up.

PURPOSE: To compare the clinical and radiographic outcomes-particularly the long-term development of osteoarthritis-14 years after anterior cruciate ligament (ACL) reconstruction between anatomic double-bundle (DB) and anatomic single-bundle (SB) techniques.

METHODS

One hundred and five patients (33 women and 72 men; median age, 27 years [range, 18-52 years]) were randomized and underwent ACL reconstruction (DB group, n = 53; SB group, n = 52). All ACL reconstruction procedures were performed anatomically, with femoral tunnel drilling via the anteromedial portal and the use of a hamstring autograft. One blinded observer examined the patients preoperatively and at average 14-year follow-up. Subjective, objective, and radiographic evaluations were used to assess the outcomes.

RESULTS

At 14-year follow-up (median, 173 months [range, 165-187 months]), 64 patients (61% overall; DB, n = 35 [66%]; SB, n = 29 [56%]) were available for final analysis. No significant differences were found between the groups in terms of the pivot-shift and manual Lachman grades, KT-1000 arthrometer laxity measurements, single-leg-hop test, range of motion, Lysholm knee and Tegner activity scores, and Knee injury and Osteoarthritis Outcome Score. Minimal clinically important difference for both the sport/recreation and quality of life subscales showed no significant difference between the groups. Correspondingly, no differences were found between the groups regarding the presence of radiographic osteoarthritis. Both groups showed significant improvement at follow-up compared with preoperative data in all objective and subjective outcomes. Moreover, no significant differences were found between the SB and DB groups in Ahlbäck grades for either the medial (P = .94) or lateral (P = .67) knee compartments, in Fairbank grades (P = .91), or in Kellgren-Lawrence grades (P = .69) at the 14-year follow-up. The cumulative Fairbank score indicated no significant differences between the groups at the 14-year follow-up (SB, mean 2.7 ± 2.4; DB, mean 2.7 ± 2.3; P = .91).

CONCLUSIONS

At an average 14-year follow-up, the anatomic DB technique showed no clear superiority over the anatomic SB technique in terms of clinical outcomes or in the development of osteoarthritis.

LEVEL OF EVIDENCE: Level II, randomized controlled trial.