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Re-Revision ACL Reconstruction: A Double-Bundle Technique Video
Camden Bohn1,2, Catherine Hand1,3, Joshua Chang1,2
1Midwest Orthopaedics at RUSH, Chicago, Illinois, USA.
Video Journal of Sports Medicine
|August 14, 2025
Summary
Revision anterior cruciate ligament (ACL) reconstruction using the double-bundle technique offers anatomic benefits and enhanced stability. This method aims to replicate native ACL anatomy for improved outcomes in complex cases.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Knee Biomechanics
Background:
- Anterior cruciate ligament (ACL) tears are common knee injuries requiring surgical intervention.
- Revision ACL reconstruction often employs single-bundle techniques, but the native ACL has two bundles.
- Double-bundle ACL reconstruction aims to replicate native anatomy more accurately.
Purpose of the Study:
- To demonstrate a reproducible arthroscopic surgical technique for double-bundle ACL reconstruction.
- To highlight the benefits of double-bundle ACLR in revision settings.
Main Methods:
- Arthroscopic delineation of the ACL footprint.
- Sequential drilling of anteromedial and posterolateral femoral sockets, maintaining a bone bridge.
- Creation of two tibial tunnels under direct visualization.
- Allograft preparation (tibialis anterior and bone-patellar tendon-bone).
- Sequential graft passage and fixation using interference screws and anchors.
Main Results:
- A clinical trial showed an 85% survival rate from needing a second revision ACLR with allograft use over 10.7 years.
- Meta-analysis indicated double-bundle superior to single-bundle in International Knee Documentation Committee subjective evaluations (P < .05).
- Another meta-analysis found no significant difference in clinical outcomes between single-bundle and double-bundle ACLR.
Conclusions:
- Double-bundle ACL reconstruction provides significant anatomic and biomechanical advantages.
- It offers increased graft volume and stability, particularly beneficial in re-revision cases with concurrent lateral extra-articular tenodesis and normal posterior tibial slope.
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