Anatomic ACL reconstruction

A careful review of the literature suggests that a significant number of patients undergoing anterior cruciate ligament (ACL) reconstruction demonstrate recurrent pain and instability following surgery. Consequently, there remains room for improvement in surgical ACL reconstruction. The ACL can be divided into two major functional bundles, the anteromedial and the posterolateral bundle. Biomechanical studies have shown that each bundle plays an important role in the stability of the knee joint. Cadaveric studies have suggested that double-bundle ACL reconstruction is more effective than single-bundle ACL reconstruction in restoring the rotational stability of the knee joint. Given these findings, we hypothesize that anatomic double-bundle ACL reconstruction may result in a superior restoration of the three-dimensional in vivo kinematics of the knee joint and may improve clinical long-term outcomes. Our preferred surgical technique employs the use of two separate tibial and femoral tunnels and the use of one double-stranded tibialis anterior or tibialis posterior tendon allograft for each bundle. Future clinical studies are needed to evaluate long-term functional outcomes following anatomic double-bundle ACL reconstruction.