INTRODUCTION: Double-bundle (DB) anterior cruciate ligament (ACL) reconstruction is becoming increasingly common. However, no definitive data on the superiority of DB reconstruction have been shown when compared with single-bundle (SB) ACL reconstruction. SOURCES OF DATA: We performed a comprehensive search of PubMed, Medline, Cochrane, CINAHL and Embase databases using various combinations of keywords such as 'ACL', 'reconstruction', 'DB' and 'SB'. Only articles published in peer-reviewed journals were included in this systematic review. AREAS OF AGREEMENT: Several new techniques are available for ACL reconstruction. DB ACL reconstruction could provide better outcome for patients in terms of closer restoration of normal knee biomechanics and improving the rotatory laxity of the knee. AREAS OF CONTROVERSY: Data are lacking to allow definitive conclusions on the use of DB reconstruction techniques for routine management of patients with ACL tear. GROWING POINTS: Given the limitations of the current studies, it is not possible to recommend systematic use of DB ACL reconstruction. Even though biomechanical results are encouraging, subjective patient evaluation is similar for SB and DB reconstruction. AREAS TIMELY FOR DEVELOPING RESEARCH: Studies of higher levels of evidence, for instances large adequately powered randomized trials, should be conducted to bring new insight in this field. With the current evidence available, a simple SB ACL reconstruction is a suitable technique, and it should be not abandoned until stronger scientific evidence in favour of DB ACL reconstruction will be produced.
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