Arthroscopic Double-bundle versus Single-bundle Posterior Cruciate Ligament Reconstruction: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 XIONGWei ¹ , ZHANGJin-song ¹ , LIUJia-guo ¹ , ZHANGChao ² , XUSheng-kang ¹

1. Department of Orthopedics and Trauma, Taihe Hospital of Shiyan City, Hubei University of Medicine, Shiyan 442000, China;
2. Center for Evidence-based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China;

Corresponding?author：

Keywords：

Posterior cruciate ligament; Double-bundle; Single-bundle; Arthroscopy; Meta-analysis; Systematic review; Randomized controlled trial

DOI：

10.7507/1672-2531.20150093

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Objective To systematically review the effectiveness of double-bundle versus single-bundle for arthroscopic transtibial reconstruction of posterior cruciate ligament (PCL). Methods We searched PubMed, The Cochrane Library, EMbase, VIP and WanFang Data to collect randomized controlled trials (RCTs) of PCL reconstruction treated with double-bundle versus single-bundle arthroscopic transtibial technique. Two reviewers screened literature according to the inclusion and exclusion criteria, extracted data and assessed the methodological quality of included studies, and then meta-analysis was performed by using RevMan 5.3 software. Results A total of 4 RCTs involving 186 patients were included. The results of meta-analysis showed that double-bundle was superior to single-bundle in Lysholm score (MD=2.17, 95%CI 0.29 to 4.05, P=0.02), Tegner score (MD=0.62, 95%CI 0.09 to 1.16, P=0.02), IKDC objective score (A:RR=1.57, 95%CI 1.09 to 2.26, P=0.02; A+B:RR=1.15, 95%CI 1.01 to 1.32, P=0.04). However, there was no significant difference in the KT-1000 posterior between both groups (MD=-0.65, 95%CI -3.29 to 1.99, P=0.63). Conclusion The current evidence shows that the double bundle arthroscopic transtibial is superior to the single bundle PCL reconstruction. Due to the limited quality and quantity of the included studies, more high quality studies with large sample-size are needed to validate the conclusion.

Citation： XIONGWei, ZHANGJin-song, LIUJia-guo, ZHANGChao, XUSheng-kang. Arthroscopic Double-bundle versus Single-bundle Posterior Cruciate Ligament Reconstruction: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2015, 15(5): 559-564. doi: 10.7507/1672-2531.20150093 Copy

1.	Voos JE, Mauro CS, Wente T, et al. Posterior cruciate ligament, b anatomy iomechanics, and outcomes. Am Sports Med, 2012, 40(1):222-231.
2.	Butler DL, Noyes FR, Grood ES. Ligamentous restraints to anterior-posterior drawer in the human knee. A biomechanical study. J Bone Joint Surg Am, 1980, 62(2):259-270.
3.	Keller PM, Shelbourne KD, McCarroll JR, et al. Nonoperatively treated isolated posterior cruciate ligament injuries. Am J Sports Med, 1993, 21 (1):132-136.
4.	Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration, 2011. Available at:www.cochrane-handbook.org.
5.	Wang CJ, Weng LH, Hsu CC, et al. Arthroscopic single-versus double-bundle posterior cruciate ligament reconstructions using hamstring autograft. Injury, 2004, 35(12):1293-1299.
6.	Yoon KH, Bae DK, Song SJ, et al. A Prospective Randomized Study Comparing Arthroscopic Single-Bundle and Double-Bundle Posterior Cruciate Ligament Reconstructions Preserving Remnant Fibers. Am J Sports Med, 2011, 39(3):474-480.
7.	張其亮, 滕學仁. 關節鏡下異體跟腱單雙束重建后交叉韌帶的隨機對照. 中國組織工程研究與臨床康復, 2011, 15(31):5747-5750.
8.	Li Y, Li J, Wang J, et al. Comparison of single-bundle and double-bundle isolated posterior cruciate ligament reconstruction with allograft:a prospective, randomized study. Arthroscopy, 2014, 30(6):695-700.
9.	Chwaluk A, Ciszek B. Anatomy of the posterior cruciate ligament. Folia Morphol, 2009, 68(1):8-12.
10.	Race A, Amis AA. The mechanical properties of the two bundles of the human posterior cruciate ligament. J Biomech, 1994, 27(1):13-24.
11.	Kim YM, Lee CA, Matava MJ, et al. Clinical Results of Arthroscopic Single-Bundle Transtibial Posterior Cruciate Ligament Reconstruction:A Systematic Review. Am J Sports Med, 2011, 39(2):425-434.
12.	Harner CD, Janaushek MN, Kanamori A, et al. Biomechanical Analysis of a Double-Bundle Posterior Cruciate Ligament Reconstruction. Am J Sports Med, 2000, 28(2):144-151.
13.	McGuire DA, Hendricks SD. Comparison of Anatomic Versus Nonanatomic Placement of Femoral Tunnels in Achilles Double-Bundle Posterior Cruciate Ligament Reconstruction. Arthroscopy, 2010, 26(5):658-666.
14.	Papannagari R, DeFrate LE, Nha KW, et al. Function of Posterior Cruciate Ligament Bundles During In Vivo Knee Flexion. Am J Sports Med, 2007, 35(9):1507-1512.
15.	Kohen RB, Sekiya JK. Single-Bundle Versus Double-Bundle Posterior Cruciate Ligament Reconstruction. Arthroscopy, 2009, 25(12):1470-1477.
16.	Min BH, Lee YS, Lee YS, et al. Evaluation of Transtibial Double-Bundle Posterior Cruciate Ligament Reconstruction Using a Single-Sling Method With a Tibialis Anterior Allograft. Am J Sports Med, 2011, 39(2):374-379.
17.	Cury RP, Mestriner MB, Kaleka CC, et al. Double-bundle PCL reconstruction using autogenous quadriceps tendon and semitendinous graft:surgical technique with 2-year follow-up clinical results. Knee, 2014, 21(3):763-768.
18.	Zhao J, Xiaoqiao H, He Y, et al. Sandwich-Style Posterior Cruciate Ligament Reconstruction. Arthroscopy, 2008, 24(6):650-659.
19.	Nyland J, Hester P, Caborn DN. Double-bundle posterior cruciate ligament reconstruction with allograft tissue:2-year postoperative outcomes. Knee Surg Sports Traumatol Arthrosc, 2002, 10(5):274-279.
20.	Zhao J, Huang X. Arthroscopic single-bundle posterior cruciate ligament reconstruction:Retrospective review of 4-versus 7-strand hamstring tendon graft. Knee, 2007, 14(4):301-305.

1. Voos JE, Mauro CS, Wente T, et al. Posterior cruciate ligament, b anatomy iomechanics, and outcomes. Am Sports Med, 2012, 40(1):222-231.
2. Butler DL, Noyes FR, Grood ES. Ligamentous restraints to anterior-posterior drawer in the human knee. A biomechanical study. J Bone Joint Surg Am, 1980, 62(2):259-270.
3. Keller PM, Shelbourne KD, McCarroll JR, et al. Nonoperatively treated isolated posterior cruciate ligament injuries. Am J Sports Med, 1993, 21 (1):132-136.
4. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration, 2011. Available at:www.cochrane-handbook.org.
5. Wang CJ, Weng LH, Hsu CC, et al. Arthroscopic single-versus double-bundle posterior cruciate ligament reconstructions using hamstring autograft. Injury, 2004, 35(12):1293-1299.
6. Yoon KH, Bae DK, Song SJ, et al. A Prospective Randomized Study Comparing Arthroscopic Single-Bundle and Double-Bundle Posterior Cruciate Ligament Reconstructions Preserving Remnant Fibers. Am J Sports Med, 2011, 39(3):474-480.
7. 張其亮, 滕學仁. 關節鏡下異體跟腱單雙束重建后交叉韌帶的隨機對照. 中國組織工程研究與臨床康復, 2011, 15(31):5747-5750.
8. Li Y, Li J, Wang J, et al. Comparison of single-bundle and double-bundle isolated posterior cruciate ligament reconstruction with allograft:a prospective, randomized study. Arthroscopy, 2014, 30(6):695-700.
9. Chwaluk A, Ciszek B. Anatomy of the posterior cruciate ligament. Folia Morphol, 2009, 68(1):8-12.
10. Race A, Amis AA. The mechanical properties of the two bundles of the human posterior cruciate ligament. J Biomech, 1994, 27(1):13-24.
11. Kim YM, Lee CA, Matava MJ, et al. Clinical Results of Arthroscopic Single-Bundle Transtibial Posterior Cruciate Ligament Reconstruction:A Systematic Review. Am J Sports Med, 2011, 39(2):425-434.
12. Harner CD, Janaushek MN, Kanamori A, et al. Biomechanical Analysis of a Double-Bundle Posterior Cruciate Ligament Reconstruction. Am J Sports Med, 2000, 28(2):144-151.
13. McGuire DA, Hendricks SD. Comparison of Anatomic Versus Nonanatomic Placement of Femoral Tunnels in Achilles Double-Bundle Posterior Cruciate Ligament Reconstruction. Arthroscopy, 2010, 26(5):658-666.
14. Papannagari R, DeFrate LE, Nha KW, et al. Function of Posterior Cruciate Ligament Bundles During In Vivo Knee Flexion. Am J Sports Med, 2007, 35(9):1507-1512.
15. Kohen RB, Sekiya JK. Single-Bundle Versus Double-Bundle Posterior Cruciate Ligament Reconstruction. Arthroscopy, 2009, 25(12):1470-1477.
16. Min BH, Lee YS, Lee YS, et al. Evaluation of Transtibial Double-Bundle Posterior Cruciate Ligament Reconstruction Using a Single-Sling Method With a Tibialis Anterior Allograft. Am J Sports Med, 2011, 39(2):374-379.
17. Cury RP, Mestriner MB, Kaleka CC, et al. Double-bundle PCL reconstruction using autogenous quadriceps tendon and semitendinous graft:surgical technique with 2-year follow-up clinical results. Knee, 2014, 21(3):763-768.
18. Zhao J, Xiaoqiao H, He Y, et al. Sandwich-Style Posterior Cruciate Ligament Reconstruction. Arthroscopy, 2008, 24(6):650-659.
19. Nyland J, Hester P, Caborn DN. Double-bundle posterior cruciate ligament reconstruction with allograft tissue:2-year postoperative outcomes. Knee Surg Sports Traumatol Arthrosc, 2002, 10(5):274-279.
20. Zhao J, Huang X. Arthroscopic single-bundle posterior cruciate ligament reconstruction:Retrospective review of 4-versus 7-strand hamstring tendon graft. Knee, 2007, 14(4):301-305.

Chinese Journal of Evidence-Based Medicine

Arthroscopic Double-bundle versus Single-bundle Posterior Cruciate Ligament Reconstruction: A Meta-analysis

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