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SportsMeta-analysis

Double‐Bundle Anterior Cruciate Ligament Reconstruction Provides Superior Short‐to‐Midterm Rotational Stability But Not Clinically Important Functional Gains Over Single‐Bundle: A Systematic Review and Meta‐analysis

Arthroscopy Sports Medicine and Rehabilitation · 16 Oct 2026

Rigour88/100
Clinical57/100
Impact†49/100

† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.

Why it matters

Double- versus single-bundle ACL reconstruction is a classic sports medicine debate, and this review suggests any rotational stability advantage is modest, early, and does not clearly translate into function, return to sport, or graft survival.

The evidence

This meta-analysis pooled 13 randomised trials (1041 patients) comparing double-bundle with single-bundle ACL reconstruction, with results split by follow-up length. At 24 to 48 months, double-bundle grafts lowered the risk of a positive pivot shift (risk ratio 0.60, 95% CI 0.43 to 0.84; 43 vs 75 events). IKDC and Lysholm scores were statistically higher but below the clinically important thresholds, and no outcome differed beyond 48 months.

Rotational stability (positive pivot shift) at 24-48 months: Risk ratio 0.6 (95% CI 0.43 to 0.84; pivot shift test). The interval favours the first group; the size of the benefit needs clinical interpretation.

Why this rigour score?

Meta-analysis of RCTsDesign starting point: 60.8

88/ 100

Raised the score

  • Prospectively registered+5.1
  • Pools randomised trials+5.1

Lowered the score

    No negative adjustments recorded.

    Methods at a glance

    Recorded assessment
    • Comprehensive literature searchMet
    • Risk of bias assessedMet
    • Bias considered in synthesisMet
    • Publication bias assessedMet
    • Study exclusions justifiedMet
    • Prospective registrationMet

    Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.

    See the full score breakdown
    Study design starting point
    60.8
    Compared against current standard of care
    +3.4
    Prospectively registered
    +5.1
    Pools randomised trials
    +5.1
    Comprehensive literature search
    +3.4
    Risk of bias assessed in the included studies
    +3.4
    Risk of bias carried into the synthesis
    +2.5
    Excluded studies listed and justified
    +1.7
    Publication bias assessed
    +2.5
    Final rigour score rounded
    88 / 100

    Study design sets the starting point and a ceiling of 96. Recorded methods then adjust the score. Points are shown to one decimal place; the final score uses unrounded values.

    Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.

    For journal club

    1.For a young athlete in a pivoting sport, does an early reduction in pivot shift with double-bundle reconstruction justify the added operative complexity, or would single-bundle reconstruction plus lateral extra-articular tenodesis be a better way to control rotation?

    2.How would you counsel a recreational or older patient about graft technique when return to sport and graft failure rates appear similar between the two approaches?

    Original publication title

    Double‐Bundle Anterior Cruciate Ligament Reconstruction Provides Superior Short‐to‐Midterm Rotational Stability But Not Clinically Important Functional Gains Over Single‐Bundle: A Systematic Review and Meta‐analysis

    Read original paper