Comparison of subjective outcomes between single-bundle and double-bundle anterior cruciate ligament reconstruction in patients with flat lateral tibial slope

Objective: A high lateral tibial slope (LTS) has been associated with an increased risk of graft failure and inferior subjective outcomes following anterior cruciate ligament reconstruction (ACLR), but the impact of a flat LTS remains unclear. This study aimed to compare long-term subjective outcomes of single-bundle (SB) and double-bundle (DB) ACLR in patients with a flat LTS to determine the more favorable approach.

Methods: The study comprised 136 patients with an LTS less than 7.4 degrees who underwent SB-ACLR (64 cases) or DB-ACLR (72 cases). Lateral tibial slope was measured on preoperative magnetic resonance imaging. Patient-reported outcomes, including the University of California Los Angeles (UCLA) Activity Score, the Lysholm Knee Score, and International Knee Documentation Committee (IKDC) Score, were collected and compared between those undergoing SB- and DB-ACLR at a mean follow-up of 14.06 ± 2.98 years. Categorical and continuous variables were analyzed using chi-square and independent-samples t-tests, respectively. A P-value less than .05 was considered statistically significant.

Results: The mean LTS was similar between the SB and DB groups (4.76 ± 1.48 vs. 4.23 ± 1.82, P = .06). The DB group had significantly better postoperative UCLA (9.32 ± 0.95 vs. 8.55 ± 1.99, P < .01), Lysholm (94.26 ± 5.61 vs. 88.23 ± 13.45, P < .01), and IKDC score (82.99 ± 4.55 vs. 77.67 ± 11.21, P < .01). Specifically, among male patients, no significant differences were found between SB and DB groups, though trends favored DB-ACLR.

Conclusion: In patients with a flat LTS, DB-ACLR was associated with higher long-term patient-reported outcome measures than SB-ACLR; however, the clinical relevance of these differences should be interpreted with caution.

Cite this article as: Yao S, Lin K, Chan Y, et al. Comparison of subjective outcomes between single-bundle and double-bundle anterior cruciate ligament reconstruction in patients with flat lateral tibial slope. Acta Orthop Traumatol Turc., 2026; 60(5), 0795, doi: 10.5152/j.aott.2026.25795.