One-Bundle Anterior Cruciate Ligament Augmentation Using the Anatomic Reconstruction Concept

The anatomical double-bundle concept changed our way of assessing and treating symptomatic one-bundle tears of the anterior cruciate ligament (ACL). The diagnosis of symptomatic anteromedial or posterolateral bundle tears is a combination of patient history, clinical examination, magnetic resonance imaging, and arthroscopic evaluation. The ACL augmentation is performed similar to a “traditional” single-bundle technique while sparing the intact ACL fibers. This may support mechanical strength of the reconstruction and may protect the augmentation (“internal stress shielding”), especially in the early postoperative period, and may maintain mechanoreceptors, neural elements and blood vessels to allow better proprioception, vascularization and an accelerated rehabilitation with faster return to sports. The technique requires a precise arthroscopic anatomical knowledge and a careful augmentation while preserving intact parts of the ACL. So far, clinical results are good reconfirming the anatomical concept of the procedure. However, the results of one-bundle ACL reconstruction have to be followed up closely in the long term to investigate whether there is any disadvantage for the patient.