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Am J Sports Med. 2013 Nov;41(11):2484-91. doi: 10.1177/0363546513497926. Epub 2013 Aug 6.

A prospective randomized study comparing double- and single-bundle techniques for anterior cruciate ligament reconstruction.

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  • 1Mattias Ahldén, Department of Orthopaedics, Sahlgrenska University Hospital/Mölndal, SE-431 80, Mölndal, Sweden.



The aim of the study was to compare the results after arthroscopic anterior cruciate ligament (ACL) reconstruction using either the double-bundle or single-bundle technique with hamstring tendon autografts in an unselected group of patients.


Double-bundle ACL reconstruction will render a better outcome on the pivot-shift test.


Randomized controlled trial; Level of evidence, 1.


A randomized series of 103 patients (33 women, 70 men; median age, 27 years; range, 18-52 years) with a unilateral ACL rupture underwent anatomic ACL reconstruction. The double-bundle technique was used in 53 patients, and the single-bundle technique was used in 50 patients. The ACL footprint was visualized, and the femoral tunnel was drilled through the anteromedial portal; interference screw fixation was used at both ends. The patients were examined preoperatively and at a median of 26 months (range, 22-42 months) after the reconstruction by a blinded observer. The primary variable was the pivot-shift test.


At 2-year follow-up, 98 patients (93%) were examined. Clinical assessments at follow-up revealed no significant differences between the double-bundle and single-bundle groups in terms of the pivot-shift test, KT-1000 arthrometer laxity measurements, manual Lachman test, range of motion, Lysholm knee scoring scale, Tegner activity scale, Knee Injury and Osteoarthritis and Outcome Score (KOOS), 1-legged hop test, and square hop test. A significant improvement was seen in both groups compared with the preoperative values in terms of most clinical assessments.


In this prospective randomized study, the primary variable, the pivot-shift test, and other subjective and objective outcome variables revealed no significant differences between the double-bundle and single-bundle techniques at 2 years after ACL reconstruction in an unselected group of patients.


anterior cruciate ligament; double-bundle; randomized controlled trial; reconstruction; single-bundle

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