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Bundle ACL reconstruction Traditional ACL reconstruction is performed by placing a tubular graft (measuring about 8 to 10 mm in diameter) through 1 tunnel drilled in the femur (thigh bone) and 1 tunnel drilled in the tibia (leg bone). However, the natural shape of a normal ACL is not a tube at all. In fact, it is shaped more like a fan. Each side of this fan has a slightly different function in controlling normal knee stability. The video below demonstrates a normal ACL, with its fibres fanning out, and in fact, 2 separate "bundles" of fibres can be seen in this person's knee. As such, there is a recent recognition that the traditional "single-bundle" ACL reconstruction may not necessarily truly reproduce the normal ACL anatomy. "Double-bundle" or "anatomic" ACL reconstruction involves drilling 2 holes in the femur (thigh bone) and 2 holes in the tibia (leg bone) to try to better reproduce the normal ACL.   Potential advantages of this technique are suggested to be a better reproduction of knee mechanics. Some of this is in fact proven in recent research studies. However, at the present time of writing, no clinical research studies comparing traditional single-bundle ACL with double-bundle ACL reconstruction have proven conclusively that double-bundle ACL reconstructions have a higher success rate. Furthermore, double-bundle ACL reconstruction takes slightly longer to perform, may require extra graft tissue, and may not be suitable for all patients. At Minimally Invasive Orthopaedic Surgery, we offer double-bundle ACL reconstruction in certain groups of patients. Deciding on the technique of ACL reconstruction is something that requires detailed discussion with your surgeon. Back to ACL reconstruction page. Back to main patient information. |
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