Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction

Over the past decade, intense research of the function of the 2 distinct bundles, the anteromedial and posterolateral, of the anterior cruciate ligament (ACL) has led to pronounced changes in the technical concepts of ACL reconstruction. Recently, the renewed focus of ACL reconstruction has been to restore the anatomy of the ACL to its native dimensions, collagen orientation, and insertion sites. The goal of ACL reconstruction is to restore normal knee kinematics, to enable patients to return to their preinjury level of activity, and to prevent further degenerative changes of the articular knee cartilage. Anatomic double-bundle ACL reconstruction has recently gained popularity as a concept that can be used to achieve these goals. This article provides an overview of the anatomy and function of the ACL. Furthermore, we highlight individual anatomic considerations as they pertain to ACL reconstruction and describe the technique for anatomical ACL reconstruction.