Double-bundle ACL reconstruction with use of a single tibial tunnel: a technique or an anatomic concept?

Despite good outcomes reported after traditional anterior cruciate ligament (ACL) reconstruction techniques, a substantial number of patients have been found to develop osteoarthritis in mid-to-long-term follow-up studies1,2 as the dynamic function of the knee was not reestablished after surgery3. As a consequence, in the past decade, the debate regarding the importance of restoring native anatomy in ACL reconstructions has led to a school of thought that suggests the solution to avoid degenerative changes following an ACL rupture could rest on reestablishing the anatomic characteristics of the ligament. As part of this recent debate, Ahn et al. presented a well-designed, retrospective study with the purpose of reporting the clinical outcomes of double-bundle ACL reconstruction with use of a single tibial tunnel and its correlation with graft appearance in a second-look arthroscopy. The assessment parameters included outcome scores such as the Lysholm knee score, International Knee Documentation Committee (IKDC) evaluation, side-to-side anterior laxity measured with use of a KT-2000 arthrometer, rotational stability graded by the pivot-shift test, and degenerative changes graded on anteroposterior and lateral weight-bearing radiographs. The overall results showed a substantial improvement after surgery in the outcome scores, …