The double bundle reconstruction technique

The aim of anatomic double bundle anterior cruciate ligament (ACL) reconstruction is the functional restoration of the anteromedial (AM) and posterolateral (PL) bundle of the ACL. The femoral tunnels are drilled through two medial portals (AM and PL portal) to produce divergent tunnels. Tunnel diameter for the AM bundle varies between 6 und 8 mm (PL graft 5-6 mm). At the tibia, the AM tunnel is first drilled aligned with the anterior horn of the lateral meniscus. Afterwards, the PL tunnel is drilled PCL referenced. At the femur, extracortical fixation is performed with an extracortical button technique (flip tack). At the tibia, a hybrid fixation is performed with a biodegradable interference screw and a button. The biomechanical advantages of ACL double bundle reconstruction (better rotational and AP stability) are counteracted by some disadvantages (double risk of tunnel misplacement, higher risk of tunnel misplacement, difficult revisions).