Anatomic double-bundle anterior cruciate ligament reconstruction

A review of the literature suggests that a significant number of patients undergoing anterior cruciate ligament (ACL) reconstruction continue to suffer residual pain and instability after surgery. Consequently, there remains considerable room for improvement in surgical ACL reconstruction. Anatomically, the ACL can be divided into 2 major functional bundles, the anteromedial and the posterolateral bundle. Biomechanical studies have shown that both bundles play important roles in providing anterior and rotational stability of the knee. In particular, it has been demonstrated that biomechanically, anatomic double-bundle ACL reconstruction results in a better restoration of the rotational stability of the knee joint. We suggest that anatomic ACL double-bundle reconstruction may result in a better restoration of the in vivo kinematics of the knee joint and can improve the clinical outcomes in ACL surgery. Currently, our preferred surgical technique uses 2 separate tibial and femoral tunnels using 2 tibialis anterior or tibialis posterior tendon allografts. Future clinical studies are necessary to evaluate the long-term functional outcomes after anatomic ACL double-bundle reconstruction.