# No difference in osteoarthritis, but less graft failures after 5 years, comparing anatomic double‐bundle to anatomic single‐bundle ACL reconstruction

## TL;DR

After five years, anatomic double-bundle ACL reconstruction had fewer graft failures but no difference in osteoarthritis compared to single-bundle.

## Contribution

Shows that double-bundle ACL reconstruction reduces graft failure rates without increasing osteoarthritis risk.

## Key findings

- No significant difference in osteoarthritis incidence between single-bundle and double-bundle groups.
- Double-bundle ACL reconstruction had significantly fewer graft failures compared to single-bundle.
- Patient-reported outcomes and clinical measures were similar between the two groups.

## Abstract

The purpose of this study was to compare the incidence of knee osteoarthritis (OA) between the anatomic single‐bundle (SB) and anatomic double‐bundle (DB) anterior cruciate ligament (ACL) reconstruction technique after 5‐year follow‐up (FU). Secondary objectives were to compare patient‐reported outcome measures (PROMs), clinical examination, activity level, functional tests and graft failures between the two groups.

The study was a secondary analysis after 5‐year FU of a randomized controlled trial (RCT) (Clinical Trials NCT01033188). One hundred and twenty patients between 18 and 40 years were randomized to either anatomic SB or anatomic DB reconstruction. The Kellgren–Lawrence (KL) classification grade ≥2 and the Osteoarthritis Research Society International (OARSI) atlas criteria score ≥2 were used for defining OA. Additionally, PROMs were obtained and clinical examinations of the knees were performed. Finally, the number of patients experiencing graft failure in each group was recorded.

Radiographic imaging was performed in 39 patients in the SB group and in 37 patients in the DB group. Four patients (10%) in the SB group and two (5%) in the DB group developed osteoarthritis according to the KL classification (p = 0.28). Five (13%) in the SB group and three (8%) in the DB group developed osteoarthritis according to the OARSI atlas criteria (p = 0.59; difference 5.0% [95% confidence interval, CI: −0.10 to 0.20]). There were no significant differences in the PROMs, clinical examinations, activity levels, or functional tests when comparing the two groups. Of initially 62 SB patients, 14 (23%) experienced graft failure compared to 4 (7%) of the 58 DB patients (p = 0.015; difference 0.016 [95% CI: 0.03–0.29]).

At 5‐year FU, there were no significant differences in the incidence of OA, PROMS, or other clinical findings comparing the anatomic DB to anatomic SB ACL reconstructed patients. There were fewer graft failures among patients treated with anatomic DB ACL reconstruction.

Level II.