Anatomic Anterior Cruciate Ligament Reconstruction Utilizing the Double-Bundle Technique

Abstract

Synopsis The goal of every orthopaedic surgeon should be to restore anatomy as close as possible to normal. Intense research on reconstruction of the anterior cruciate ligament (ACL) and an advancing knowledge of the anatomy and function of the 2 primary bundles of the ACL have led to techniques of ACL reconstruction that more closely restore normal anatomy. Restoring the ACL footprint is one of the most important goals of the surgery, and the choice between anatomic single-bundle and double-bundle ACL reconstruction is determined by the anatomical features of each patient. After reconstruction, the graft undergoes a complex, lengthy process of remodeling; therefore, inappropriate (early), aggressive rehabilitation can lead to graft failure and compromise the patient's outcome. The purpose of this article is to provide an overview of the anatomy and function of the ACL, the methods for anatomic single-bundle and double-bundle ACL reconstruction, and our recommendations for postoperative rehabilitation. J Orthop Sports Phys Ther 2012;42(3):184–195. doi:10.2519/jospt.2012.3783

A comparison of pain scores and medication use in patients undergoing single-bundle or double-bundle anterior cruciate ligament reconstruction

“…The DB procedure requires the drilling of an additional tunnel on both the femur and tibia. 7,9 The tibial tunnel for the posterolateral bundle is farther posterior and requires more dissection of the anteromedial tibia. This tunnel also goes through thicker cortical bone, which may cause more thermal damage due to drilling and may be a source of greater pain.…”

“…The DB autograft ACLR was performed, as described by Hensler and colleagues, 7 with semitendinosus and gracilis tendons using a 2-tunnel technique. All surgeries were conducted under spinal or general anesthesia after consultation among the surgeon, patient and anesthesiologist.…”

Managing Knee Injuries: Keeping Up With Changes

“…11,17 We have to ask ourselves, what are we doing wrong, or what is it we are not doing to improve on these disappointing results? Consequently, surgical refinements continue to be sought, with current attention, as discussed in this special issue, on double-bundle ACL, 8 anatomic placement of the graft, 8,21 and how best to surgically manage concomitant lesions. 10 Concurrently, in rehabilitation, we are more concerned than ever with restoring symmetrical motion, protecting articular cartilage and menisci, and perhaps adopting a more controlled, less aggressive rehabilitation program.…”

“…6,22 What is the best graft and surgical approach for reconstruction? 8,14,21 What is the optimal selection and timing of exercises postsurgery? 22 What is the optimal timing and criteria for return to sport (much more on this topic in JOSPT next month)?…”

“…10 Concurrently, in rehabilitation, we are more concerned than ever with restoring symmetrical motion, protecting articular cartilage and menisci, and perhaps adopting a more controlled, less aggressive rehabilitation program. 8,21,22 While the ACL is the rock star of knee ligaments, the ligament that is most often injured is the medial collateral ligament (MCL). Despite the fact that MCL injuries tend to heal relatively well, there has been growing interest in the past few years in better understanding the function of the various sections of the MCL and how to better manage more serious, recalcitrant, or chronic injuries to that structure.…”