{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T13:50:02Z","timestamp":1792158602700,"version":"4.4.0"},"reference-count":26,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["arthroscopyjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthroscopy, Sports Medicine, and Rehabil."],"abstract":"\n Purpose<\/jats:title>\n To compare the biomechanical and functional outcomes between single\u2010bundle and double\u2010bundle (DB) anterior cruciate ligament reconstruction techniques using the most current evidence, stratified by follow\u2010up duration.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n PubMed, Embase, and Cochrane databases were searched from 2013 to September 2025 for randomized controlled trials comparing single\u2010bundle versus DB anterior cruciate ligament reconstruction with a minimum follow\u2010up of 24\u2009months. Primary outcomes included anterior tibial translation, rotational stability (pivot shift), and patient\u2010reported outcomes (subjective International Knee Documentation Committee, Lysholm score). Secondary outcomes included return\u2010to\u2010sport and graft failure rate. Continuous outcomes were pooled using inverse\u2010variance random\u2010effects models (DerSimonian\u2010Laird) and dichotomous outcomes using Mantel\u2010Haenszel fixed\u2010effect models, with stratification by follow\u2010up duration (24\u201048\u2009months vs >48\u2009months). Heterogeneity was assessed using the\n I<\/jats:italic>\n 2<\/jats:sup>\n statistic.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Thirteen randomized controlled trials (1041 patients; 536 single\u2010bundle, 505 DB; mean age 30.2\u2009years; 68% men; follow\u2010up 24\u2010122\u2009months) were included. At 24 to 48\u2009months, DB reconstruction significantly reduced the risk of a positive pivot shift (risk ratio 0.60, 95% confidence interval [CI] 0.43\u20100.84,\n P<\/jats:italic>\n \u2009=\u2009.003; number needed to treat\u2009=\u200910) and showed statistically higher subjective International Knee Documentation Committee (mean difference 5.88 points, 95% CI 0.44\u201011.33) and Lysholm (mean difference 7.47 points, 95% CI 0.06\u201014.88) scores; however, neither reached established minimal clinically important difference thresholds (11.5 and 8.9 points, respectively). Anterior tibial translation did not differ significantly between techniques (mean difference \u22120.34\u2009mm, 95% CI \u22121.04 to 0.35,\n P<\/jats:italic>\n \u2009=\u2009.327). No study reported sex\u2010disaggregated outcomes or individual\u2010level minimal clinically important difference attainment. Beyond 48\u2009months, no significant differences were observed for any outcome.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n DB reconstruction shows statistically significant improvements in rotational stability and patient\u2010reported functional scores at 24 to 48\u2009months, but functional differences do not reach established minimal clinically important difference thresholds. No significant differences were observed beyond 48\u2009months, a finding likely influenced by substantial study heterogeneity and graft selection. The current evidence does not support a universal clinical advantage for the DB technique; shared decision\u2010making based on patient activity demands and surgeon experience remains essential.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence<\/jats:title>\n Level I, systematic review and meta\u2010analysis of randomized controlled trials.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/ars2.70102","type":"journal-article","created":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T13:05:19Z","timestamp":1792155919000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Double\u2010Bundle Anterior Cruciate Ligament Reconstruction Provides Superior Short\u2010to\u2010Midterm Rotational Stability But Not Clinically Important Functional Gains Over Single\u2010Bundle: A Systematic Review and Meta\u2010analysis"],"prefix":"10.1002","author":[{"given":"Manuel Alberto","family":"Gutierrez\u2010Moreno","sequence":"first","affiliation":[{"name":"Autonomous University of Chihuahua Chihuahua Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0755-0570","authenticated-orcid":false,"given":"Luis Eduardo","family":"Ar\u00e1mbula\u2010Torres","sequence":"additional","affiliation":[{"name":"Autonomous University of Chihuahua Chihuahua Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramon Alonso","family":"Prieto\u2010Baeza","sequence":"additional","affiliation":[{"name":"Autonomous University of Chihuahua Chihuahua Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4988-5044","authenticated-orcid":false,"given":"Carlos","family":"Leal\u2010Contreras","sequence":"additional","affiliation":[{"name":"El Bosque University Bogot\u00e1 Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina Alejandra","family":"Fuentes\u2010Flores","sequence":"additional","affiliation":[{"name":"Autonomous University of Chihuahua Chihuahua Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edmundo","family":"Berumen\u2010Nafarrate","sequence":"additional","affiliation":[{"name":"Autonomous University of Chihuahua Chihuahua Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,16]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"crossref","first-page":"1502","DOI":"10.1177\/0363546516629944","article-title":"Incidence of anterior cruciate ligament tears and reconstruction: A 21\u2010year population\u2010based study","volume":"44","author":"Sanders TL","year":"2016","journal-title":"Am J Sports Med."},{"key":"e_1_2_8_3_1","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1302\/0301-620X.73B2.2005151","article-title":"Functional anatomy of the anterior cruciate ligament. Fiber bundle actions related to ligament replacements and injuries","volume":"73","author":"Amis AA","year":"1991","journal-title":"J Bone Joint Surg Br."},{"key":"e_1_2_8_4_1","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1177\/0363546503261722","article-title":"Relationships between objective assessment of ligament stability and subjective assessment of symptoms and function after anterior cruciate ligament reconstruction","volume":"32","author":"Kocher MS","year":"2004","journal-title":"Am J Sports Med."},{"key":"e_1_2_8_5_1","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1097\/00003086-198301000-00017","article-title":"Semitendinosus anatomic reconstruction for cruciate ligament insufficiency","volume":"172","author":"Mott HW","year":"1983","journal-title":"Clin Orthop Relat Res."},{"key":"e_1_2_8_6_1","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1177\/0363546510392350","article-title":"Biomechanical comparison of anatomic double\u2010bundle, anatomic single\u2010bundle, and nonanatomic single\u2010bundle anterior cruciate ligament reconstruction","volume":"39","author":"Kondo E","year":"2011","journal-title":"Am J Sports Med."},{"key":"e_1_2_8_7_1","first-page":"245","article-title":"A meta\u2010analysis comparing double\u2010bundle and single\u2010bundle anterior cruciate ligament reconstruction","volume":"21","author":"Xu Y","year":"2021","journal-title":"Chin J Evid Based Med."},{"key":"e_1_2_8_8_1","first-page":"1892","article-title":"All\u2010inside quadrupled semitendinosus autograft shows stability equivalent to patellar tendon autograft anterior cruciate ligament reconstruction: Randomized controlled trial in athletes 24 years or younger","volume":"38","author":"Smith PA","year":"2022","journal-title":"Arthroscopy."},{"key":"e_1_2_8_9_1","first-page":"123","article-title":"Double\u2010bundle versus single\u2010bundle anterior cruciate ligament reconstruction: A systematic review and meta\u2010analysis","volume":"24","author":"Chen H","year":"2023","journal-title":"BMC Musculoskelet Disord."},{"key":"e_1_2_8_10_1","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page MJ","year":"2021","journal-title":"BMJ."},{"key":"e_1_2_8_11_1","doi-asserted-by":"crossref","first-page":"1567","DOI":"10.1177\/0363546506288855","article-title":"Responsiveness of the International Knee Documentation Committee subjetive knee form","volume":"34","author":"Irrgang JJ","year":"2006","journal-title":"Am J Sports Med"},{"key":"e_1_2_8_12_1","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1177\/0363546508330143","article-title":"The reliability, validity, and responsiveness of the Lysholm score and Tegner activity scale for anterior cruciate ligament injuries of the knee: 25 years later","volume":"37","author":"Briggs 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outcomes","volume":"29","author":"Irrgang JJ","year":"2021","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"key":"e_1_2_8_16_1","doi-asserted-by":"crossref","first-page":"2647","DOI":"10.1016\/j.arthro.2018.03.034","article-title":"Single\u2010bundle versus double\u2010bundle anterior cruciate ligament reconstruction\u20145\u2010year results","volume":"34","author":"Mayr HO","year":"2018","journal-title":"Arthroscopy."},{"key":"e_1_2_8_17_1","doi-asserted-by":"crossref","first-page":"2341","DOI":"10.1177\/0363546518782454","article-title":"No difference in the KOOS quality of life subscore between anatomic double\u2010bundle and anatomic single\u2010bundle anterior cruciate ligament reconstruction of the knee: A prospective randomized controlled trial with 2 years\u2019 follow\u2010up","volume":"46","author":"Aga C","year":"2018","journal-title":"Am J Sports 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hamstring tendon autografts with preserved insertions is an effective treatment for tibiofemoral instability","volume":"27","author":"Zhang Q","year":"2019","journal-title":"Knee Surg Sports Traumatol Arthrosc."},{"key":"e_1_2_8_27_1","doi-asserted-by":"crossref","first-page":"1225","DOI":"10.1177\/0363546515626543","article-title":"Comparison of anatomic double\u2010 and single\u2010bundle techniques for anterior cruciate ligament reconstruction using hamstring tendon autografts: A prospective randomized study with 5\u2010year clinical and radiographic follow\u2010up","volume":"44","author":"Karikis I","year":"2016","journal-title":"Am J Sports Med."}],"container-title":["Arthroscopy, Sports Medicine, and 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