Nikolas L Krott1, Lawrence Wengle2, Daniel Whelan2, Michael Wild3, Marcel Betsch4. 1. Department of Orthopaedics, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany. niko.krott@gmx.de. 2. Women's College Hospital, University of Toronto Orthopaedic Sports Medicine Program (UTOSM), Toronto, ON, Canada. 3. Department of Orthopaedics Trauma and Hand Surgery, Klinikum Darmstadt, Darmstadt, Germany. 4. Department of Orthopedics and Trauma Surgery, University Hospital Mannheim, Medical Faculty of the University Heidelberg, Mannheim, Germany.
Abstract
PURPOSE: To perform a systematic review and compare the functional and objective outcomes after single-bundle (SB) vs. double-bundle (DB) posterior cruciate ligament reconstruction (PCLR). Where possible to pool outcomes and arrive at summary estimates of treatment effect for DB PCLR vs. SB PCLR via an embedded meta-analysis. METHODS: A comprehensive PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) literature search identified 13 eligible studies evaluating clinical outcomes of both techniques for PCLR. Clinical outcome measures included in the meta-analysis were functional outcomes (Lysholm Score, Tegner Activity Scale) and objective measurements of posterior laxity of the operated knee (arthrometer and stress radiographs). RESULTS: The meta-analysis included 603 patients. Three hundred and fifteen patients were treated with SB and two hundred and eighty-eight patients with DB PCLR. There were no significant differences between SB and DB PCLR in postoperative functional Lysholm Scores (CI [- 0.18, 0.17]), Tegner Activity Scales (CI [- 0.32, 0.12]) and IKDC objective grades (CI [- 0.13, 1.17]). Regarding posterior stability using KT-1000 and Kneelax III arthrometer measurements, there were no differences between the SB and DB group. However, double-bundle reconstruction provided better objective outcome of measurement of posterior laxity (CI [0.02, 0.46]) when measured with Telos stress radiography. CONCLUSION: A systematic review was conducted to identify current best evidence pertaining to DB and SB PCLR. An embedded meta-analysis arrived at similar summary estimates of treatment effect for motion, stability and overall function for both techniques. There is no demonstrable clinically relevant difference between techniques based on the currently available evidence. LEVEL OF EVIDENCE: III.
PURPOSE: To perform a systematic review and compare the functional and objective outcomes after single-bundle (SB) vs. double-bundle (DB) posterior cruciate ligament reconstruction (PCLR). Where possible to pool outcomes and arrive at summary estimates of treatment effect for DB PCLR vs. SB PCLR via an embedded meta-analysis. METHODS: A comprehensive PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) literature search identified 13 eligible studies evaluating clinical outcomes of both techniques for PCLR. Clinical outcome measures included in the meta-analysis were functional outcomes (Lysholm Score, Tegner Activity Scale) and objective measurements of posterior laxity of the operated knee (arthrometer and stress radiographs). RESULTS: The meta-analysis included 603 patients. Three hundred and fifteen patients were treated with SB and two hundred and eighty-eight patients with DB PCLR. There were no significant differences between SB and DB PCLR in postoperative functional Lysholm Scores (CI [- 0.18, 0.17]), Tegner Activity Scales (CI [- 0.32, 0.12]) and IKDC objective grades (CI [- 0.13, 1.17]). Regarding posterior stability using KT-1000 and Kneelax III arthrometer measurements, there were no differences between the SB and DB group. However, double-bundle reconstruction provided better objective outcome of measurement of posterior laxity (CI [0.02, 0.46]) when measured with Telos stress radiography. CONCLUSION: A systematic review was conducted to identify current best evidence pertaining to DB and SB PCLR. An embedded meta-analysis arrived at similar summary estimates of treatment effect for motion, stability and overall function for both techniques. There is no demonstrable clinically relevant difference between techniques based on the currently available evidence. LEVEL OF EVIDENCE: III.
Authors: Christopher S Ahmad; Zohara A Cohen; William N Levine; Thomas R Gardner; Gerard A Ateshian; Van C Mow Journal: Am J Sports Med Date: 2003 Mar-Apr Impact factor: 6.202
Authors: Joshua L Hudgens; Blake P Gillette; Aaron J Krych; Michael J Stuart; Jedediah H May; Bruce A Levy Journal: J Knee Surg Date: 2012-06-28 Impact factor: 2.757