Anatomical Double-Bundle Anterior Cruciate Ligament Reconstruction

Abstract

ABSTRACT The rapid development of anatomical double-bundle anterior cruciate ligament (ACL) reconstruction techniques is unprecedented, especially given the 80% to 90% success rate that has been reported for conventional single-bundle ACL reconstruction. However, in vitro and in vivo biomechanical evidence of poor transverse plane rotatory knee control and 10% to 30% complication rates associated with conventional single-bundle ACL reconstruction techniques suggest that a better method of restoring ACL function and improving patient outcomes is needed. Selection of which technique to use and its associated learning curve may decrease its desirability for the average knee surgeon who performs fewer than 10 ACL reconstruction procedures a year. This article describes an anatomical double-bundle ACL reconstruction technique that provides reciprocating double-bundle ACL function and that can be performed using a modified conventional single-bundle ACL reconstruction approach. The double-bundle function provided by this ACL reconstruction technique simulates the native ACL more closely than conventional single-bundle ACL reconstruction techniques. In addition to the aforementioned surgical innovations, there is a dire shortage of well-designed patient outcome studies regarding any of these anatomical double-bundle ACL reconstruction techniques. When considering use of a particular anatomical double-bundle ACL reconstruction technique, the knee surgeon must consider its complexity, how the procedure would influence revision surgery should it be needed, appropriate selection of patients who would benefit the most, additional patient education and behavioral change needs, rehabilitation and conditioning program modifications, and how this procedure may better protect the menisci and mitigate the onset and progression of knee osteoarthritis better than conventional single-bundle ACL reconstruction.