Single-bundle vs. double-bundle isolated posterior cruciate ligament reconstruction: a retrospective cohort study on time to work and functional outcomes

Purpose: The optimal surgical technique for posterior cruciate ligament (PCL) reconstruction remains debated, especially among patients under workers’ compensation. Biomechanical studies suggest double-bundle (DB) reconstruction provides superior stability compared to single-bundle (SB), but clinical evidence is inconclusive. The aim of this study is to compare return-to-work time, functional outcomes, and complication rates between SB and DB PCL reconstruction (PCL-R) in patients with work-related knee injuries. Methods: We conducted a retrospective, non-concurrent cohort study of patients with isolated PCL injuries covered by workers’ compensation who underwent SB or DB PCL-R between 2019 and 2022. Time to return to work, functional outcomes (KOOS, Lysholm), and postoperative complications were analysed and compared between groups. Results: A total of 22 patients were included (14 in SB, 8 in DB). The median return-to-work time was 176.5 days, with no significant difference between the groups (p = 0.516). No statistically significant differences were found in complication rates or functional scores (KOOS and Lysholm) between the 2 techniques. The small sample size (n = 22) reflects the low incidence of isolated PCL injuries. Conclusion: In workers with isolated PCL injuries, SB and DB PCL-R yielded comparable return-to-work times and functional outcomes. Although DB reconstruction may offer biomechanical advantages, these did not translate into statistically significant clinical differences in this cohort. These findings support the use of either technique in occupational settings, where timely functional recovery is crucial. Level of evidence: Retrospective study of non-concurrent cohorts (Level III).