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Double-Bundle Anterior Cruciate Ligament Reconstruction

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Controversies in the Technical Aspects of ACL Reconstruction

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Abstract

Anterior cruciate ligament (ACL) rupture is a common sports injury, and surgical reconstruction is the standard treatment in most active patients. Double-bundle (DB) ACL reconstruction is one application of the anatomic reconstruction concept, which aims to restore the ACL to its native dimensions, collagen orientation, and insertion site. Biomechanical studies have shown that anatomic DB reconstruction restores knee laxity closer to normal than transtibial single-bundle (SB) reconstruction. Several prospective, comparative clinical studies with level I or II evidence have also reported superior outcomes of anatomic DB compared with SB reconstruction. Although the best evidence from the highest-quality meta-analyses suggests that DB reconstruction yields superior postoperative knee laxity restoration when compared with SB reconstruction, the effect on clinical outcomes and risk of graft failure have not been significantly different. However, heterogeneity of studies, including differences in tunnel position and relatively short-term follow-up, is the limitation of this evidence. Future biomechanical and long-term clinical cohort studies with anatomic ACL reconstruction are needed to further examine the improvement in knee laxity and clinical outcomes afforded by DB reconstruction.

Editors’ Comments on the Evidence Single- vs Double-Bundle Reconstruction

We have included two parts to this chapter, one presenting evidence in favor of double-bundle ACL reconstruction and one in favor of single bundle. As the reader will see, either technique can be supported by the existing literature. There is no clear evidence regarding which procedure has better short- or long-term outcomes, and, therefore, surgeons are recommended to choose the procedure they feel is best for their patient while understanding the pros and cons of each.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Kaufman Building Suite 1011, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA

    Sebastián Irarrázaval MD, Marcio Albers MD & Freddie H. Fu MD

  2. Department of Orthopaedic Surgery, Kobe University, Kobe, Japan

    Masahiro Kurosaka MD

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  1. Sebastián Irarrázaval MD
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  2. Marcio Albers MD
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  3. Masahiro Kurosaka MD
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  4. Freddie H. Fu MD
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Correspondence to Freddie H. Fu MD .

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Editors and Affiliations

  1. Institute for Medical Science in Sports, Osaka Health Science University, Osaka, Japan

    Norimasa Nakamura

  2. Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy

    Stefano Zaffagnini

  3. Hospital for Special Surgery, New York, New York, USA

    Robert G. Marx

  4. UPMC Center for Sports Medicine, Pittsburgh, Pennsylvania, USA

    Volker Musahl

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Irarrázaval, S., Albers, M., Kurosaka, M., Fu, F.H. (2017). Double-Bundle Anterior Cruciate Ligament Reconstruction. In: Nakamura, N., Zaffagnini, S., Marx, R., Musahl, V. (eds) Controversies in the Technical Aspects of ACL Reconstruction. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-52742-9_19

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