Current Concepts Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction Anthony M. Buoncristiani, M.D., Fotios P. Tjoumakaris, M.D., James S. Starman, B.S., Mario Ferretti, M.D., Freddie H. Fu, M.D. Abstract: Anterior cruciate ligament (ACL) reconstruction is one of the most common procedures performed by orthopaedic surgeons. The procedure has improved significantly since its inception in 1900 and continues to be intensively studied with outcomes receiving considerable attention. Traditional ACL reconstruction techniques have focused on one portion of the ACL—the antero- medial bundle. Single-bundle ACL reconstruction is the criterion standard and has provided good to excellent results, with many athletes being able to return to sports; however, recently, some authors have noted persistent instability with functional testing and degenerative radiographic changes after single-bundle ACL reconstruction. As a result, several centers have attempted to improve upon the single-bundle technique by reconstructing both the anteromedial and posterolateral bundles of the ACL. This article will present the embryologic, anatomic, and biomechanical rationale for double- bundle ACL reconstruction. In addition, the latest outcomes of double-bundle ACL reconstruction will be presented. Key Words: Anterior cruciate ligament—Double bundle—Anatomic reconstruc- tion—Rotational stability—Clinical outcome. A nterior cruciate ligament (ACL) reconstruction is one of the most common procedures performed by orthopaedic surgeons, with approximately 100,000 such procedures being performed per year in the United States alone. 1 With the current trend of partic- ipation in organized sports at a younger age, this number will continue to increase. 2 At the other end of the spectrum, with regard to the health-conscious baby boomers, a large number of sports-related injuries continue to occur well into the seventh decade of life. 3 Because of its high prevalence of injury, the ACL continues to be intensively studied, and outcomes of ACL surgery receive considerable attention. This has included research on technical factors such as tunnel position, 4 graft choices, 5,6 and fixation methods, 7 as well as postoperative rehabilitation protocols. 8 As a result, ACL reconstruction techniques have improved significantly over the last several decades. 9,10 Traditional ACL reconstruction techniques have fo- cused on reconstruction of one portion of the ACL— the anteromedial (AM) bundle. Single-bundle ACL reconstruction is the criterion standard and has pro- vided good to excellent results, with many athletes being able to return to sports. 11,12 However, recently, other authors have noted persistent instability with functional testing and degenerative radiographic changes after single-bundle ACL reconstruction. 13-18 As a result, several centers have attempted to improve upon the single-bundle technique by reconstructing both the AM and posterolateral (PL) bundles of the ACL, the so-called anatomic ACL reconstruction From the Department of Orthopaedic Surgery, University of Pittsburgh Center for Sports Medicine, Pittsburgh, Pennsylvania, U.S.A. The authors report no conflict of interest. Address correspondence and reprint requests to Freddie H. Fu, Department of Orthopaedic Surgery, University of Pittsburgh Cen- ter for Sports Medicine, 3471 5th Ave, Suite 1011, Pittsburgh, PA 15213, U.S.A. E-mail: ffu@upmc.edu © 2006 by the Arthroscopy Association of North America 0749-8063/06/2209-6155$32.00/0 doi:10.1016/j.arthro.2006.06.005 1000 Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 22, No 9 (September), 2006: pp 1000-1006