ABSTRACT: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=0.0.34), 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)
Santa-Bárbara et al. (Fri,) studied this question.