Latest news in ACL reconstruction: Double-Bundle technique

What is ACL and what does it do?

•  The ACL, or Anterior Cruciate Ligament, connects the femur to the tibia in the center of the knee joint. It is made up of two functional bundles of tissue, the anteromedial (AM) and posterolateral (PL) bundles.

•  The AM bundle controls anterior (forward) movement of the tibia underneath the femur, and the PL bundle controls rotational stability of the knee, such as in pivoting, twisting, running and jumping.

•  The ACL is critical to the stability of the knee especially during vigorous daily activities and cutting movements in most sports i.e. where the person's position and direction needs to change suddenly.

Is ACL injury common and why does it happen?

•  Yes. ACL tears are very common and can occur at all ages.

•  Athletes who participate in sports that involve rapid starting, stopping, and pivoting over a planted leg, such as soccer, basketball, tennis, and skiing, are susceptible to ACL tears.

•  ACL injuries are not confined to sport activities and should be suspected in any severe knee pain with a swelling.

Is surgery absolutely necessary for every ACL tear?

•  No. Some patients may be able to function in their normal daily activities without an intact ACL, if it is an isolated ligament injury and if they have a low functional demand. However, some patients may cope with normal daily home/office work activities but cannot cope for example on holiday and but the resulting instability can make sudden and pivoting movements of the knee difficult. This puts their knee at risk of further injuries of the other structures in the knee such as the meniscus. Sometimes the ACL-deficient knee can subluxate, or “give way” h during activity, resulting in painful episodes with swelling.

•  With repeated episodes of joint subluxation, the knee is more prone to develop degenerative arthritis (damage of articular coating cartilage) and meniscal tear (damage of cartilage shock absorbers inside the knee joint).

•  For returning to the pre-injury activity level, ACL reconstruction surgery is usually the option.

Can the ruptured ACL be repaired?

•  The fibers of the ACL cannot be sewn back together again due to the severe stretch-out and irreversible damage sustained at the time of injury. Therefore, the damaged ligament must be removed and reconstructed with a new ACL graft tissue.

•  ACL single bundle surgery has been performed worldwide for many years and is an accepted form of surgical treatment with predictable results.

•  Surgical technical limitations have previously limited surgery to being able to reconstructing one bundle (AM) only.

•  Very recent advances by several world class centers around the world have pioneered d D ouble-Bundle ACL reconstruction which repairs reconstructs both the anteromedial (AM) and posterolateral (PL) bundles of the ACL. This thus reproduces the natural state of affairs.

•  but Single-Bundle ACL reconstruction only repair the AM bundle.

Why is Double-Bundle ACL reconstruction performed instead of Single-Bundle?

•  Double-Bundle technique reconstructs both the anteromedial (AM) and posterolateral (PL) bundles of the ACL, which can closely replicate the normal natural anatomy of the ligament.

•  Double-Bundle ACL reconstruction when done properly give same satisfactory early recovery, clinical and functional outcome when compare with Single-Bundle ACL reconstruction.

•  Laboratory and robotic reaserch have shown that anatomic Double-Bundle reconstruction better restores knee stability as compared to Single-Bundle reconstruction. Single-Bundle ACL reconstruction does not adequately restore normal knee stability, particularly tibial rotation.

•  The double-bundle ACL reconstruction is more suited for those who have had a previous reconstruction and for patients who are at high risk for further knee injuries, for example, active individuals or those that prefer complete reconstruction athletes . The stress and demand on the ligament can be shared between the two bundles.

How long will it take to return to sports after ACL surgery?

•  It normally takes about 9-12 months to return to competitive sports after surgery.

•  The goal of rehabilitation is to return the patient to a normal and complete level of function as soon as possible without compromising the integrity of the surgically reconstructed knee.

•  Early exercise is encouraged. Rehabilitation guidelines are generally as follows:

 

Reference Links:

  1. http://ortho.medicine.pitt.edu/content/DoubleBundle.htm
  2. http://healthjournal.upmc.com/0105/DoubleBundle.htm
  3. http://emoryhealthcare.org/departments/sports/double_bundle_acl__mini_commer.html

THIS MATERIAL DOES NOT CONSTITUTE MEDICAL ADVICE. IT IS INTENDED FOR INFORMATIONAL PURPOSES ONLY. PLEASE CONSULT A PHYSICIAN FOR SPECIFIC TREATMENT RECOMMENDATIONS.