Tunnel Enlargement After Double-bundle Anterior Cruciate Ligament Reconstruction: a Prospective, Randomized Study

Purpose: The aim of this study was to compare tunnel enlargement in patients with double-bundle and single-bundle anterior cruciate ligament (ACL) reconstruction.

Methods: Sixty patients were randomized by closed envelopes into 2 different groups of ACL reconstruction with hamstring tendons: double-bundle technique with bioabsorbable screw fixation (n = 35) and single-bundle technique with bioabsorbable screw fixation (n = 25). Magnetic resonance imaging evaluation was performed in 53 patients (88%) (32 in double-bundle group and 21 in single-bundle group) for a mean of 27 months' follow-up (range, 24 to 36 months). Tunnel enlargement was determined by digital measurement of the widths perpendicular to the long axis of the tunnels on an oblique coronal and sagittal plane. The magnetic resonance imaging measurements were compared with the intraoperative drill diameter.

Results: No significant differences were found between the double-bundle group and the single-bundle group in tunnel enlargement on the femoral side. However, on the tibial side, tunnel enlargement was greater in the single-bundle group than in the double-bundle group in each tunnel (P = .051). In all knees, tunnel enlargement both on the tibial side and on the femoral side correlated significantly with the anterior and rotational laxity of the operated knee. In the double-bundle group, no tunnel communication between the anteromedial and posterolateral tunnels was seen in any of the patients on either the tibial side or femoral side.

Conclusions: This prospective, randomized study showed that our double-bundle ACL reconstruction technique results in less tunnel enlargement in each tunnel on the tibial side than the single-bundle technique with similar fixation methods, graft material, and rehabilitation. In addition, no tunnel communication was observed in the patients undergoing double-bundle ACL reconstruction. The clinical results were good in both groups. However, the patients who had more tunnel enlargement had significantly more anterior and rotational laxity of the operated knee as well.

Level Of Evidence: Level I, therapeutic randomized controlled trial.