Current concepts in anatomic single- and double-bundle anterior cruciate ligament reconstruction

An anterior cruciate ligament (ACL) tear is one of the most common orthopedic sport injuries. The ACL consists of 2 functional bundles-the anteromedial and posterolateral-which are named for the position of their insertion sites on the tibia. Anatomic ACL reconstruction can be defined as the restoration of the ACL to its native dimensions, collagen orientation, and insertion sites. Some biomechanical studies have demonstrated that anatomic ACL reconstruction can restore knee motion significantly similar to that of the normal knee, as compared with traditional, nonanatomic single-bundle procedures. In vivo kinematic studies have also shown that nonanatomic single-bundle reconstruction fails to restore normal dynamic knee stability in all cases. Accurate restoration of knee kinematics with anatomic ACL reconstruction is critical to protect against the possibility that nonatomic surgical technique could result in early osteoarthritis, which is common in patients who sustain ACL tears. Surgical techniques for ACL reconstruction vary, and if different aspects of the surgery are compared for superiority (eg, single- vs double-bundle techniques), it is necessary that both procedures meet criteria to be designated as "anatomic." By emphasizing the importance of restoring the native anatomy of the knee, surgeons can give their patients the best chance at restoration of joint function and preservation of long-term knee health.