Minimum 10-Year Results of Single- Versus Double-Bundle Posterior Cruciate Ligament Reconstruction: Clinical, Radiologic, and Survivorship Outcomes

BACKGROUND: Biomechanical studies have shown that double-bundle (DB) posterior cruciate ligament reconstruction (PCLR) is better than single-bundle (SB) PCLR in restoring normal biomechanical function and stability. However, most clinical studies report no differences between the technical methods, and there is yet no long-term clinical comparative study. HYPOTHESIS: DB PCLR would show superior results and survivorship outcomes to those of SB PCLR in long-term follow-up. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: The authors retrospectively evaluated 64 patients who underwent primary PCLR between 2000 and 2008 and were followed up for a minimum of 10 years: 28 patients underwent SB PCLR (mean ± SD: age, 29.1 ± 12.2 years), and 36 underwent DB PCLR (age, 27.0 ± 9.2 years). Clinical scores (International Knee Documentation Committee subjective score, Lysholm score, Tegner activity score), side-to-side difference in stress radiographs, osteoarthritis progression, and survival rate were compared between the SB and DB groups at the last follow-up. RESULTS: At the final follow-up, all clinical scores showed no significant differences between the SB and DB groups. The mean side-to-side difference in stress radiographs (SB, 5.3 ± 3.5 mm; DB, 5.0 ± 3.8 mm; P = .828) and osteoarthritis progression (SB, 14.3%; DB, 13.9%; P = .964) were not different between the groups. The 15-year survival rate was 82.1% for SB PCLR and 83.7% for DB PCLR. CONCLUSION: Both the SB and DB techniques for PCLR showed satisfactory long-term clinical results and survivorship outcomes. There were no significant differences between SB and DB PCLR in clinical, radiologic, and survivorship outcomes at a minimum follow-up of 10 years. CLINICAL RELEVANCE: DB PCLR did not show superior clinical results to those of SB PCLR in the long-term follow-up. These results should be considered in the surgical planning for PCLR.