Anatomic Anterior Cruciate Ligament Reconstruction: The French Experience

Anatomical observation and biomechanical studies have shown that the anterior cruciate ligament (ACL) mainly consists of 2 distinct bundles, the anteromedial bundle (AMB) and posterolateral bundle (PLB). These 2 bundles have different roles in the control of knee stability. The AMB essentially controls the anterior tibial translation, whereas the PLB mainly controls the rotatory stability of the knee by limiting the internal rotation of the lateral tibial plateau. Current techniques for reconstruction do not completely reproduce the anatomy and function of the ACL. They address only the anteromedial bundle, which does not fully restore ACL function throughout the arc of motion. Current grafts control the anterior tibial subluxation near extension but are less efficacious in providing rotatory stability. Recently several authors have suggested reconstructing not only the anteromedial bundle, but also the posterolateral bundle. After discussing the relevant anatomical and biomechanical data, this article describes a double-bundle ACL reconstruction technique using hamstring tendons routed through 2 tibial and 2 femoral independent tunnels. Short-term results of this technique are encouraging; however, long-term follow-up studies are needed to compare the outcome of a more physiologic double-bundle ACL reconstruction with single-bundle techniques.