Anatomic double-bundle anterior cruciate ligament reconstruction: where are we today?

The anatomic approach to anterior cruciate ligament (ACL) reconstruction has been a growing trend in orthopaedics. Progress made over the last 7 years has led to a greater understanding of the ACL anatomy and its 2 bundles. Surgeons are now more equipped to restore the native anatomy and knee kinematics than ever before. The University of Pittsburgh experience and technique have been described and have evolved to include several key principles. These include the restoration of native ACL anatomy, insertion sites, and double-bundle tension patterns with the utilization of an accessory medial portal to provide an individualized approach to ACL reconstruction. The purpose of this technical note is to provide surgeons with a technical update regarding the anatomic approach to ACL surgery. Most of this article will be focused on anatomic double-bundle ACL reconstruction, but it must be emphasized that this is a concept rather than just a technique and should be applied to all ACL reconstructions to provide a more anatomic and individualized result.