Anatomical double-bundle anterior cruciate ligament reconstruction

A careful review of the literature suggests that a significant number of patients undergoing anterior cruciate ligament (ACL) reconstruction have less than optimal results. Although overall outcomes of ACL reconstruction are favourable, there remains considerable room for improvement. Anatomically, the ACL consists of two major functional bundles, the anteromedial and the posterolateral bundle. Biomechanically, both bundles contribute significantly to the anterior and the rotational stability of the knee. Therefore, anatomical double-bundle ACL reconstruction techniques may further improve the outcomes in ACL surgery. Our preferred technique for arthroscopic double-bundle ACL reconstruction includes the use of two femoral and two tibial tunnels to restore both the anteromedial and the posterolateral bundle of the ACL and their anatomical footprints at their tibial and femoral insertion site. We use two tibialis anterior tendon allografts for the restoration of the two ACL bundles. Clinical long-term outcome studies may focus on the evaluation of functional outcomes, restoration of anterior and rotational knee stability, and the risk of degenerative osteoarthritis of the knee joint following anatomical double-bundle ACL reconstruction versus single-bundle ACL reconstruction.