Journal of ISAKOS : joint disorders & orthopaedic sports medicine · 2026
Double femoral-double tibial tunnel configuration improves long-term return to activity compared to anatomic single bundle and double femoral-single tibial tunnel configurations in anterior cruciate ligament reconstruction: a 12-year retrospective cohort study.
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Almirón-Santa Bárbara Rafael, Espejo-Reina Alejandro, Espejo-Reina María Josefa, Rius-Díaz Francisca, Espejo-Baena Alejandro
Аннотация
INTRODUCTION/OBJECTIVES: Double-bundle (DB) anterior cruciate ligament (ACL) reconstruction has demonstrated biomechanical advantages over anatomic single-bundle (ASB) techniques; however, long-term clinical superiority remains controversial, and the potential influence of tibial tunnel configuration has not been well established. This study aims to compare long-term clinical outcomes of ASB ACL reconstruction with two DB configurations-double femoral-single tibial tunnel (DFST) and double femoral-double tibial tunnel (DFDT)-and to evaluate return to preinjury activity.
METHODS: Patients undergoing primary ACL reconstruction with hamstring autograft by a single surgeon between 2007 and 2011 were retrospectively reviewed using prospectively collected data. Surgical technique selection was based on surgeon preference and chronological evolution of practice. Clinical outcomes at a mean follow-up of 12.6 years included the International Knee Documentation Committee (IKDC), Lysholm, and Tegner scores. Return to preinjury activity was defined as postoperative Tegner ≥ preinjury Tegner. Groups were compared using univariate analyses, and effect sizes were calculated for key comparisons.
RESULTS: Eighty-three patients were available for final follow-up (30 ASB, 34 DFST, and 19 DFDT). When DB techniques were analyzed as a single group, only Tegner score was modestly higher compared with ASB (6.26 vs 5.20; p = 0.049). Subgroup analysis demonstrated that DFDT was superior to DFST and ASB in Tegner (6.95 vs 5.88 and 5.2 respectively; p = 0.34), Lysholm (85.42 vs 74.03 and 75.47 respectively; p = 0.012) and IKDC (84.95 vs 73.65 and 75.7 respectively; p = 0.018) scores.
CONCLUSION: At more than 12 years of follow-up, DFDT was associated with modestly improved patient-reported outcomes compared with ASB and DFST techniques. These findings suggest that tunnel configuration may influence long-term functional activity restoration after ACL reconstruction.
LEVEL OF EVIDENCE: III (Retrospective Comparative study without negative criteria).
METHODS: Patients undergoing primary ACL reconstruction with hamstring autograft by a single surgeon between 2007 and 2011 were retrospectively reviewed using prospectively collected data. Surgical technique selection was based on surgeon preference and chronological evolution of practice. Clinical outcomes at a mean follow-up of 12.6 years included the International Knee Documentation Committee (IKDC), Lysholm, and Tegner scores. Return to preinjury activity was defined as postoperative Tegner ≥ preinjury Tegner. Groups were compared using univariate analyses, and effect sizes were calculated for key comparisons.
RESULTS: Eighty-three patients were available for final follow-up (30 ASB, 34 DFST, and 19 DFDT). When DB techniques were analyzed as a single group, only Tegner score was modestly higher compared with ASB (6.26 vs 5.20; p = 0.049). Subgroup analysis demonstrated that DFDT was superior to DFST and ASB in Tegner (6.95 vs 5.88 and 5.2 respectively; p = 0.34), Lysholm (85.42 vs 74.03 and 75.47 respectively; p = 0.012) and IKDC (84.95 vs 73.65 and 75.7 respectively; p = 0.018) scores.
CONCLUSION: At more than 12 years of follow-up, DFDT was associated with modestly improved patient-reported outcomes compared with ASB and DFST techniques. These findings suggest that tunnel configuration may influence long-term functional activity restoration after ACL reconstruction.
LEVEL OF EVIDENCE: III (Retrospective Comparative study without negative criteria).