Double-Bundle Versus Single-Bundle Anterior Cruciate Ligament (ACL) Reconstruction: A Systematic Review and Meta-Analysis of Knee Stability Outcomes.

This systematic review and meta-analysis compares the effectiveness of single-bundle (SB) and double-bundle (DB) ACL reconstruction techniques in improving knee stability and functional outcomes in patients with ACL injuries. A structured search across PubMed, Scopus, Google Scholar, and the Cochrane Library identified studies comparing SB and DB ACL reconstructions. Ten studies met the inclusion criteria, including randomized controlled trials, prospective, and retrospective studies. The primary outcomes analyzed were the International Knee Documentation Committee (IKDC) subjective score, Lysholm score, Lachman test, and pivot-shift test results. Meta-analytic methods included calculating standardized mean differences (SMDs) and odds ratios (ORs) with 95% confidence intervals (CIs) alongside assessments of heterogeneity using the I² statistic. The meta-analysis showed no significant difference between SB and DB techniques for IKDC subjective scores (SMD: -0.14, 95% CI: -0.68 to 0.39, p = 0.59) or Lysholm scores (SMD: -0.18, 95% CI: -0.39 to 0.02, p = 0.08). Lachman test results also indicated no significant differences between techniques (pooled OR: 1.02, 95% CI: 0.70-1.47, p = 0.92). Pivot-shift test outcomes similarly revealed comparable rotational stability (OR: 1.00, 95% CI: 0.70-1.43, p = 1.00). Moderate heterogeneity was observed across analyses (I² = 37%-43%), reflecting variations in study designs and patient populations. SB and DB ACL reconstruction techniques achieve similar functional outcomes and knee stability, with no significant differences in Lachman test results, pivot-shift outcomes, or patient-reported measures. Further research with standardized methodologies is needed to verify these findings across diverse populations.
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