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No clinically significant difference in pivot shift, laxity seen between one- vs. two-bundle ACL repair
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LAS VEGAS — A meta-analysis of studies comparing single-bundle and double-bundle ACL reconstruction shows no clinically significant differences between the techniques regarding KT-1000 and pivot shift results.
“There is really no clinically significant difference in KT-1000 and no statistical difference in pivot shift comparing the results of single- versus double-bundle ACL,” James H. Lubowitz, MD, said during his presentation here.
To compare the clinical outcomes of single-bundle and double-bundle ACL reconstruction, Lubowitz and colleagues performed a literature search of three databases to identify studies comparing the techniques. Of the nine studies that met their inclusion criteria, the investigators discovered four Level I studies comparing single- and double-bundle ACL reconstruction. All four studies evaluated KT-1000 results and three assessed pivot shift.
An analysis of the four Level I studies revealed a statistically significant difference in KT-1000 results, showing better outcomes with the double-bundle technique. On average, the side-to-side difference was .52 mm, Lubowitz said. The analysis also showed no statistical differences between the techniques regarding pivot shift.
A secondary analysis using the remaining five Level II and III studies also showed statistically better KT-1000 results with double-bundle reconstruction and no significant differences between the groups for pivot shift.
Lubowitz noted that the statistically significant difference in KT-1000 results may not be clinically significant.
“I argue that that is not clinically significant because a normal knee the side-to-side difference can be 0.8 mm, and even [in] the International Knee Documentation Committee, a 2-mm difference from side to side is included as a normal result,” he said.
He also acknowledged that the study looked at normal or nearly normal pivot shift patients and noted that other researchers have said that better results might have been seen with double-bundle reconstruction if the investigators only looked at the normal results.
Reference:
Lubowitz JH, Meredick RB, Vance K, et al. Meta-analysis of ACL single-versus double-bundle reconstruction outcomes. Paper #136. Presented at the American Academy of Orthopaedic Surgeons 76th Annual Meeting. Feb. 25-28, 2009. Las Vegas.