Lower Rates of Osteoarthritis Progression and Improved Knee Stability Are Observed With the Double‐Bundle Versus Single‐Bundle Posterior Cruciate Ligament Reconstruction Technique: A Systematic Review

PURPOSE: To compare osteoarthritis (OA) progression, graft rerupture rates, and posterior tibial translation following single-bundle (SB) versus double-bundle (DB) posterior cruciate ligament reconstruction (PCLR). METHODS: A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, with PubMed, Scopus, and Embase databases searched from inception through March 2025. Clinical studies reporting OA development and/or progression following SB and DB PCLR with ≥2-year follow-up were included. Exclusion criteria included nonclinical studies, revision PCLR, concomitant anterior cruciate ligament injuries, pediatric populations, and studies lacking OA outcomes. Posterior tibial translation measured by KT-2000 arthrometer, patient-reported outcomes, graft reruptures, and complications were recorded when available. Quality assessment was performed using the Methodological Index for Non-Randomized Studies criteria. RESULTS: A total of 14 clinical studies comprising 515 patients met the inclusion criteria, with 387 undergoing SB and 128 undergoing DB PCLR. In the SB group, 286 patients were male (73.9%) and 101 female (26.1%), compared with 104 males (81.3%) and 24 females (18.7%) in the DB group. Mean age ranged from 26.5 to 32.5 years in the SB group and 27.0 to 33.5 years in the DB group. Mean follow-up ranged from 24 to 148.2 months for SB PCLR and 24 to 153.4 months for DB PCLR. OA development ranged from 0% to 59.1% in the SB group and 0% to 31.3% in the DB group. OA progression was reported in 0% to 18.2% of SB cases, while only 1 study reported progression to OA (13.2%) following DB PCLR. Postoperative side-to-side differences in posterior tibial translation measured by KT-2000 arthrometer ranged from 1.1 to 9.1 mm in the SB group and 0.7 to 5.0 mm in the DB group. Included studies reported improved postoperative outcomes in the 2 study groups based on Lysholm, International Knee Documentation Committee, and Tegner scores. The proportion of knees graded as normal or nearly normal (International Knee Documentation Committee grades A and B) ranged from 57.9% to 94.1% in SB and 81.3% to 100% in DB cohorts. Reported complication rates ranged from 0% to 24.3% in SB and 0% to 15.8% in DB groups. Graft reruptures occurred in up to 17.4% of SB cases, while no reruptures were reported in the DB group. CONCLUSIONS: OA development was reported following both techniques, with SB technique showing higher rates of OA development and progression. DB PCLR was associated with lower OA progression, improved posterior knee stability, and a higher proportion of normal or nearly normal postoperative International Knee Documentation Committee grades compared with SB PCLR. LEVEL OF EVIDENCE: Level IV, systematic review of Level II to IV studies.