Clinical Outcome of Double-Bundle Anterior Cruciate Ligament Reconstruction

Clinical outcomes assessment in double-bundle anterior cruciate ligament (ACL) reconstruction surgery is an essential tool in the quest for continuous improvement in surgical care. This is a review of the literature and current thinking concerning the methods of assessing clinical outcomes.There are a number of key issues when single-bundle and double-bundle ACL outcomes are assessed and compared. Firstly, a double-bundle ACL reconstruction is not necessarily an “anatomic” reconstruction. An incorrectly placed double bundle is as nonanatomical as an incorrectly positioned single bundle. It is also crucial to specify which outcome is being assessed and its relevance. Surgery that results in early return to function does not necessarily produce normal biomechanics or long term protection from osteoarthritis.Traditional clinical tests of knee stability do not show a difference between the two techniques. There is however, new evidence that this is because traditional testing is not sufficiently accurate or sensitive. In-vivo testing and laboratory studies using new methods of assessing dynamic 3D kinematics of the knee consistently show that anatomic double-bundle ACL reconstruction more closely reproduces normal biomechanics.