Recently the “double bundle” ACL reconstruction has surfaced as the new way or, more “anatomic” method of recreating ones torn ACL. We have done them here at the Alaska Orthopedic Specialists, previously Rhyneer Caylor Clinic, and I have a few things to say about them. First of all in the laboratory, they do seem to show better rotation stability. However, the biologic body is not a dead cadaver part on an engineering bench and the human studies really don’t appear to show any difference as presented at the most recent American Academy of Orthopedic Surgeons. No one has yet shown that the outcome years later is better than the single bundle technique. We also have to drive 4 holes in the bone instead of two and this may compromise or even fracture the tibia in doing this. Four hole sites have to have perfect fixation instead of two. The graft fixation is also soft tissue to bone and at times has to be “backed up” by other staples and screws. I really don’t like surgical procedures that “need backing up” The last issue is that most surgeons I speak with including the originators of the procedure use mostly donated tissue for their graft material. I personally am not a great fan of this. Tissue donation for ACL grafts are mostly irradiated today to kill off HIV. It does denature and change the collagen in the graft and when ones graft stretches out or “fails” one always wonders if the graft was of poor quality.
By all means there are different opinions in the world regarding ACL reconstruction, the tissues used for the tendon, and the methods. I believe if you polled the world orthopedic community and had a vote, the majority would still say the bone-patellar tendon-bone autograft is the gold standard. No wonder this is what most Olympians use when they need one. Need I say more? This is my preferential method of reconstruction.
