Anatomic anterior cruciate ligament double-bundle reconstruction using 2 tibial and 2 femoral tunnels

Over the last decade, anterior cruciate ligament (ACL) reconstruction has been continuously improved. Although the current outcomes of the single-bundle ACL reconstruction are good, there remains significant room for improvement. A high percentage of patients do not return to their previous level of activity, and progressive cartilage degeneration continues to be a common problem after ACL injury. The evaluation of the 3-dimensional in vivo kinematics of the knee joint after single-bundle ACL reconstruction has demonstrated good restoration of the anteroposterior stability, whereas the rotational stability cannot be restored. Similarly, biomechanical studies in cadavers reveal that anatomic double-bundle ACL reconstruction restores the rotational knee stability more closely to normal than single-bundle ACL reconstruction. Based on these considerations, we suggest an anatomic double-bundle ACL reconstruction technique using 2 tibial and 2 femoral tunnels. This technique restores both the anteromedial and the posterolateral bundle of the ACL.