Double-bundle versus single-bundle anterior cruciate ligament reconstruction in preventing the progression of osteoarthritis: A protocol for systematic review and meta-analysis of randomized controlled trials

Background: The knee has a high incidence of osteoarthritis (OA) following the anterior cruciate ligament (ACL) injury, which was reduced by ACL reconstruction including double-bundle (DB) techniques and single-bundle (SB) techniques. However, the effectiveness of preventing the progression of OA after the ACL reconstruction using DB and SB techniques is controversial. Methods: This meta-analysis was performed following the preferred reporting items for systematic reviews and meta-analyses guidelines. The databases, including PubMed, Embase, and Cochrane Library, were searched. Randomized controlled trials comparing DB with SB ACL reconstruction and reporting clinical outcomes of radiological OA were included. Quality of the included studies was assessed using the Cochrane Collaboration’s risk of bias tool. The outcome was analyzed using the risk ratio (RR) and its corresponding 95% confidence interval (CI). Results: Ten Randomized controlled trials studies were included in this meta-analysis (accounting 1062 knees: 475 SB and 587 DB). The rate of radiological OA after the ACL reconstruction was 39% in SB group and 34% in DB group. The results of meta-analysis showed no difference in the occurrence of radiological OA between DB group and in SB group (RR, 1.05; 95% CI, 0.85–1.30, P = .63), including subgroup of radiological scores of OA (subgroup of Minimal OA: RR, 0.95; 95% CI, 0.61–1.48; P = .82; subgroup of Notable OA: RR, 1.16; 95% CI, 0.75–1.78; P = .51), subgroup of follow-up time in 5 years and more than 5 years (RR, 0.98; 95% CI, 0.80–1.20; P = .85), and subgroup of autograft graft for ACL (RR, 0.97; 95% CI, 0.79–1.19; P = .77). However, the DB group had less incidences of knee OA than the SB group in subgroup of less than 5 years (RR, 1.48; 95% CI, 1.13–1.92; P = .004) and subgroup of allograft type (RR, 1.42; 95% CI, 1.06–1.91; P = .02). Conclusion: Overall, this meta-analysis showed that the DB technique was no more effective in preventing the progression of OA than the SB technique in ACL reconstruction at midterm follow-up.