A systematic review of double-bundle versus single-bundle posterior cruciate ligament reconstruction

BACKGROUND: Posterior Cruciate Ligament (PCL) ruptures are common sports injuries. One of the key controversies in PCL reconstruction is whether double-bundle reconstruction provides biomechanical and clinical outcomes superior to single-bundle reconstruction. METHODS: We performed a comprehensive search in multiple databases to evaluate the 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 in double-bundle reconstructions. Comparing these results is complicated by different graft choices, tensioning techniques, and tunnel positions. Biomechanical studies of graft tension demonstrated conflicting results regarding the optimal reconstruction technique. Seven retrospective clinical studies of single- and double-bundle reconstructions with methodological limitations reported no difference in clinical outcome. CONCLUSIONS: The superiority of single-bundle or double-bundle posterior cruciate ligament reconstruction remains uncertain.