双束前交叉韧带重建较单束可提供更优的短中期旋转稳定性但无临床重要功能改善：系统综述与Meta分析
简介
这项系统综述与Meta分析纳入13项RCT（1041例；单束536例、双束505例；随访24–122个月），按随访24–48个月和>48个月分层比较单束与双束ACL重建。24–48个月时，双束组轴移试验阳性风险显著降低（RR 0.60，95%CI 0.43–0.84；NNT=10），主观IKDC和Lysholm评分分别高5.88分和7.47分，但均未达到MC…
英文摘要
PURPOSE: To compare the biomechanical and functional outcomes between single-bundle and double-bundle (DB) anterior cruciate ligament reconstruction techniques using the most current evidence, stratified by follow-up duration. METHODS: PubMed, Embase, and Cochrane databases were searched from 2013 to September 2025 for randomized controlled trials comparing single-bundle versus DB anterior cruciate ligament reconstruction with a minimum follow-up of 24 months. Primary outcomes included anterior tibial translation, rotational stability (pivot shift), and patient-reported outcomes (subjective International Knee Documentation Committee, Lysholm score). Secondary outcomes included return-to-sport and graft failure rate. Continuous outcomes were pooled using inverse-variance random-effects models (DerSimonian-Laird) and dichotomous outcomes using Mantel-Haenszel fixed-effect models, with stratification by follow-up duration (24-48 months vs >48 months). Heterogeneity was assessed using the I 2 statistic. RESULTS: Thirteen randomized controlled trials (1041 patients; 536 single-bundle, 505 DB; mean age 30.2 years; 68% men; follow-up 24-122 months) were included. At 24 to 48 months, DB reconstruction significantly reduced the risk of a positive pivot shift (risk ratio 0.60, 95% confidence interval [CI] 0.43-0.84, P = .003; number needed to treat = 10) and showed statistically higher subjective International Knee Documentation Committee (mean difference 5.88 points, 95% CI 0.44-11.33) and Lysholm (mean difference 7.47 points, 95% CI 0.06-14.88) 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 -0.34 mm, 95% CI -1.04 to 0.35, P = .327). No study reported sex-disaggregated outcomes or individual-level minimal clinically important difference attainment. Beyond 48 months, no significant differences were observed for any outcome. CONCLUSIONS: DB reconstruction shows statistically significant improvements in rotational stability and patient-reported functional scores at 24 to 48 months, but functional differences do not reach established minimal clinically important difference thresholds. No significant differences were observed beyond 48 months, 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-making based on patient activity demands and surgeon experience remains essential. LEVEL OF EVIDENCE: Level I, systematic review and meta-analysis of randomized controlled trials.