Double Bundle Anterior Cruciate Ligament Reconstruction

This study is currently recruiting participants. (see Contacts and Locations)
Verified June 2014 by Oslo University Hospital
Information provided by (Responsible Party):
Lars Engebretsen, Oslo University Hospital Identifier:
First received: December 15, 2009
Last updated: June 2, 2014
Last verified: June 2014

There has been an increased awareness in ACL injuries for Norwegian teams, particularly in handball and soccer. The overall number of ACL tears in the United States has been reported to be between 95,000 to 200,000 annually. In accordance with these numbers, the reported number of reconstructions in Norway ranges from 1500 to 2000 per year, and in the United States from 50,000 to 100,000 per year, making ACL reconstruction one of the most common orthopaedic procedures performed, especially among young, active and healthy individuals. However, reports state that there is a subset of patients (10-40%) who remain subjectively and objectively unstable and/or are unable to regain prior function. Additionally, it has been reported that degenerative joint disease is associated with traditional single-bundle ACL reconstructions in up to 50% in some studies.

It is well known that the ACL is composed of 2 functional bundles named after their tibial attachments, the anteromedial (AM) and posterolateral (PL) bundles.

It is believed that the current single-graft, single-bundle technique for reconstructing the anterior cruciate ligament does not anatomically reconstruct either one of these bundles.

In the last two years, the double bundle technique has been introduced and a few clinical studies are available, however only a few RCTs.

Further study is very important to determine if double-bundle ACL reconstructions should be performed, if single-bundle reconstructions can be adjusted to better adapt to their biomechanical insufficiency in restoring internal rotation torques and valgus moments, and also in trying to identify which patients might better benefit from single-bundle versus double-bundle ACL reconstructions.

Condition Intervention
Knee Stability
Procedure: Single Bundle
Procedure: double bundle

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Single Blind (Investigator)
Primary Purpose: Treatment
Official Title: Single Bundle or Double Bundle Anterior Cruciate Ligament Reconstruction. A Randomized, Controlled Trial.

Resource links provided by NLM:

Further study details as provided by Oslo University Hospital:

Primary Outcome Measures:
  • KOOS score(QOL) [ Time Frame: 1-5 years ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Standing radiographs (Kellgren Lawrence methode) [ Time Frame: 3-5 years ] [ Designated as safety issue: No ]

Estimated Enrollment: 112
Study Start Date: January 2010
Estimated Study Completion Date: December 2016
Estimated Primary Completion Date: December 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Single-bundle technique
Anatomic single-bundle technique
Procedure: Single Bundle


Transarthroscopic technique with medial portal placement of the femoral tunnel. Harvest of the Semitendinosus/gracilis (ST/G) tendons through a 3-5 cm incision at the pes anserinus. The femoral tunnel is positioned at the anatomic foot print determined by the anatomic landmarks. The graft will be fixed with an Endobutton on the femur and with an Biosure PK screw in the tibia with approximately 4 kegs of graft pretension and with the knee close to extension. Prior to the final fixation, the knee will be taken through flexion and extension movements.The surgery will be carried out by an experienced knee surgeon.

Other Name: Endo-button
Active Comparator: Double-bundle technique
Anatomic double bundle technique
Procedure: double bundle


Transarthroscopic technique. Harvest of the Semitendinosus/gracilis (ST/G) tendons through a 3-5 cm incision at the pes anserinus.Through a medial portal 2 tunnels will be anatomically placed in the foot print on the femur and the two tibial tunnels will be placed using the Smith and Nephew drill guide. The graft will be fixed with 2 Endobuttons on the femur and with 2 Biosure PK screws in the tibia with approximately 4 kgs of graft pretension. Prior to the final fixation, the knee will be taken through 20 flexion and extension movements. The PL bundle will be fixed with the knee close to ful extension and the AM bundle with the knee in approximately 45 degrees of flexion. The surgery will be carried out by an experienced knee surgeon.

Other Name: Endo-button

Detailed Description:

The goal of this study:

The goal is to compare the two techniques: single bundle hamstrings versus double bundle hamstrings using the KOOS score as the primary variable and clinical examinations and standing radiographs (Kellgren Lawrence method) after 1,2 and 5 years as secondary variables.


There are no differences between the two methods as judged by the KOOS score (QOL).

Questions to be answered:

Is there a difference between double-bundle and single-bundle technique in the KOOS score? Are there differences between hamstrings single bundle and double bundle technique when the Lachman test and the pivot shift test are being used? Is there a difference between hamstrings double-bundle technique and single-bundle technique in return to sports? Are there differences between double-bundle technique and single -bundle technique in functional tests (one-leg hop and tre leg side jump)? Is there a difference in the development of osteoarthritis between the two techniques?


Ages Eligible for Study:   18 Years to 40 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Clinically verified ACL rupture (history, Lachman test 2+ or more with no endpoint; pos pivot shift and arthroscopically verified) The graft used foe PL bundle has a minimum size of 5.0mm.

Exclusion Criteria:

  • PCL injury,
  • ACL injury to the contra lateral knee
  • > 1+ medial or lateral-posterolateral ligament instability at operation date
  • Previous ACL reconstruction
  • Meniscal injury leaving < 50% of the meniscus intact
  • Established OA as judged by Kellgren 3-4.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT01033188

Contact: Cathrine Aga, MD +47 40601176

Ullevaal University Hospital Recruiting
Oslo, Norway
Contact: Aga, MD   
Sub-Investigator: Lars Engebretsen, MD, Phd         
Sponsors and Collaborators
Oslo University Hospital
Study Chair: Lars Engebretsen, Phd, MD Supervisor
  More Information

No publications provided

Responsible Party: Lars Engebretsen, Professor, Oslo University Hospital Identifier: NCT01033188     History of Changes
Other Study ID Numbers: 6.2009.234
Study First Received: December 15, 2009
Last Updated: June 2, 2014
Health Authority: Norway:National Committee for Medical and Health Research Ethics

Keywords provided by Oslo University Hospital:
Double bundle
ACL reconstruction
single bundle processed this record on March 26, 2015