Double-bundle versus single-bundle ACL reconstruction.

Surgical repair of the anterior cruciate ligament is a fairly common necessity in knee injuries, usually with good to excellent outcomes. However a successful repair and return to activities for a subpopulation of patients, 10% to 30%, remain elusive. Additionally, some athletes have arthritic changes, even with ligament repair. These issues are likely multi-factorial in nature but the debate continues even over which primary operative technique will produce the most favorable outcome. This review examines and discusses the anatomic and historical rationale of double-bundle ACL reconstruction techniques, the published kinematics of double-bundle reconstructions, and the clinical literature comparing double-bundle outcomes to those of the more traditional single-bundle constructs. Conclusions regarding surgical care include a need for more standardization of measuring parameters and the future application of advanced technologies that would inform more correct models of knee kinematics for comparison to various ACL construction approaches, potentially allowing improvement in the techniques of ACL reconstruction.