Anterior Cruciate Ligament Reconstruction With Double-Bundle Internal Bracing: A Technique Guide

There has been a recent increase in interest for double-bundle (db) anterior cruciate ligament reconstructions (ACLRs). Although this surgical technique has shown to improve rotational and translational stability, the literature has been inconsistent, finding its graft failure rates to be superior to that of the single-bundle (sb) ACLR. So far, no studies have reported the sb ACLR to be superior to db ACLR. It is possible that the db ACLR provides the most benefit in greatest-risk patients such as young athletes, female athletes, patients with generalized ligamentous laxity, and those undergoing revision ACLRs. The senior author's db ACLR technique incorporates a FiberTape internal brace, which is applied to both bundles. Despite inconsistencies in the literature, we suspect that autologous db ACLR with internal bracing could reduce graft failure rates and provide earlier return to preinjury activity level in high-risk patients compared with sb ACLR.