Single-Bundle Versus Double-Bundle Posterior Cruciate Ligament Reconstruction

Purpose: The purpose of this report is to present a systematic review of the literature to compare knee kinematics and clinical outcomes after single-bundle versus double-bundle posterior cruciate ligament reconstruction. Methods: Systematic review of the literature by PubMed search, reference review, and search of Arthroscopy identified the relevant biomechanical and clinical studies. The studies were critically evaluated to determine potential advantages of single-bundle or double-bundle reconstructions in anteroposterior stability, graft tension, rotational stability, and functional outcome. Results: Biomechanical comparisons evaluating anteroposterior stability described either no difference or increased stability with double-bundle reconstructions. Comparing these results is complicated by differential graft choices, tensioning techniques, and tunnel anatomy. Biomechanical studies of graft tension describe conflicting results regarding the optimal reconstruction technique. Recent studies of rotational stability suggest no advantage of double-bundle reconstruction in the setting of concomitant posterolateral corner repair but suggest a possible advantage in the setting of subtle posterolateral corner injury. Three retrospective clinical studies of single- and double-bundle reconstructions with methodologic limitations described no difference in clinical outcome. Conclusions: The superiority of single-bundle or double-bundle posterior cruciate ligament reconstruction remains uncertain.