Double-Bundle Versus Single-Bundle Anterior Cruciate Ligament Reconstruction

Surgical replacement of ACL has become a common procedure to restore knee stability. Indication for reconstruction arises from the high activity level, young age, complex ligamentous injuries, degree and morphologic type of injury or a persistent instability after physiotherapy. (Voigt et aI., 2006)Literature described various methods to reconstruct ACL: single- and double-bundle techniques. All produce predominantly good results. Single- bundle technique is the standard method. Recently, a tendency toward double-bundle technique with the goal of a nearly anatomical ACL reconstruction could be recognized because;.:. Anatomical studies show that;• ACL consists of 2 functional bundles, the AM and the PL bundles.• The changing orientation of the 2 bundles’ footprints as the knee moves .• :. Biomechanical studies show that;• The functional tensioning pattern is independent throughout knee range of motion. In extension, AMB is loose, and PLB is tight. In flexion, the AMB is tight and PLB is loose.• The AM bundle appears to be an important stabilizer against anteroposterior loads. The PL bundle seems to provide additional anteroposterior knee stability and provide stabilization against rotatory loads .• :. Histological studies show that there is a greater surface area of two thin tendon grafts than of one thick tendon graft. (Ferretti et aI., 2005 - Voigt et aI., 2006)Although single-bundle ACL reconstructions continue to be the ”gold standard” in the treatment of ACL-deficient knee, several studies have revealed that it provides sufficient anteroposterior knee stability but is unable to restore the rotational stability of the knee joint. (Tashman et aI., 2004 - Ristanis et aI., 2005).