Eminence-Based Medicine Versus Evidence-Based Medicine: Is Anterior Cruciate Ligament Reconstruction Optimally Performed With the Double-Bundle Technique?

Abstract

The anterior cruciate ligament (ACL) comprises 2 distinct bands or bundles—the anteromedial bundle, which is tighter in flexion, and the posterolateral bundle, which is tighter in extension. Traditional ACL reconstruction uses 1 graft. A new technique, known as the double-bundle technique, uses 2 tendon grafts to more closely approximate normal anatomy. Because the medical literature does not provide a definitive answer as to which reconstruction method is better, we surveyed 500 experts in sports medicine in a previous study to determine whether they agreed with the statement “ACL reconstruction is optimally performed with the double-bundle technique.” Respondants were inclined to answer “This statement is probably false.” Our article interprets the expert responses by reviewing the basic and clinical sciences implicit in the question and reviewing the literature regarding outcomes. We found that double-bundle ACL reconstruction is theoretically appealing, but evidence proving that it improves clinical outcomes is unavailable. High-quality studies are under way on the topic, which may provide a definitive answer. However, until such data are available, the expert consensus from our survey was that the double-bundle technique is not necessarily the optimal approach.