Anterior Cruciate Ligament Reconstruction - Does the Surgeon Risk Worsening of the Clinical Outcome During the Learning Curve if He Switches from Single Bundle Technique to Double Bundle Technique?

Background: Anatomical reconstruction of the anterior cruciate ligament (ACL) using the double-bundle (DB) technique is becoming increasingly popular. Despite its proved biomechanical and anatomical superiority, clinical studies have found little advantage for the DB technique. The aim of this study was therefore to evaluate whether an experienced surgeon is able to obtain his usual good results with ACL reconstruction with the single-bundle (SB) technique directly after changing to the DB technique. Patients/Material and Methods: In a prospective, non-randomised and controlled interventional study, we compared the first 19 patients in our clinic who had an anterior cruciate ligament reconstruction using the DB technique with 31 patients who underwent a SB ACL reconstruction performed by the same surgeon during the same period of investigation. The visual analog scale (VAS) for pain and function, the Tegner activity score, the International Knee Documentation Committee (IKDC), the Lysholm and the Marshall scores were used as evaluation methods, the anterior stability (KT-1000-arthrometer measurement) and the deficits in muscle strength in extension and flexion of both knees were measured in a standard manner one year after operation. Results: The Lysholm scores in the SB group (93.6 [± 3.8] points) and in the DB group (93.1 [± 4.2] points) were not significantly different (p > 0.05). Neither the VAS for pain (1 [± 2] points for both techniques), nor the VAS for function (8 [± 2] versus 7 [± 2] points) were significantly different (p > 0.05). For the anterior stability under Maximum Measurement Displacement (MMD), the SB group achieved a difference of 1.75 (± 1.94) mm, in comparison with 1.32 (± 1.89) mm for the DB group (p > 0.05). There was a trend to less deficit in muscle strength after DB ACL reconstruction. No complications were recorded in either group. Conclusion: Experienced surgeons in ACL reconstruction can change from the popular SB ACL reconstruction to the DB ACL reconstruction without causing clinical problems or additional complications. The well-known good results of the DB technique were attained in the first operations performed by an experienced surgeon and are compareable to the results of the SB technique.