Anatomic double-bundle anterior cruciate ligament reconstruction using soft tissue interference screw fixation

An anatomic double-bundle anterior cruciate ligament (ACL) reconstruction technique has been reported to have better or at least similar results than a single-bundle technique in many randomized controlled trials. However, most of these studies have used cortical fixation for the graft fixation, which may not be as anatomic as the aperture fixation. Already 15 years ago we started to perform a double-bundle ACL reconstruction with aperture fixation using bioabsorbable interference screws, and started a prospective, randomized study comparing this technique to a single-bundle technique for ACL reconstruction. The purpose of this review is to introduce the technique and results of the anatomic double-bundle ACL reconstruction with bioabsorbable interference screw fixation comparing to the single-bundle ACL reconstruction with interference screw fixation. According to our prospective, randomized trial, the anatomic double-bundle ACL reconstruction with bioabsorbable interference screw fixation resulted in significantly better clinical results than the single-bundle ACL reconstruction during the 10-year follow-up. At the beginning, rotational stability was better with the double-bundle technique, and during the years fewer graft failures leading to ACL revision surgery was found with the double-bundle procedure. The double-bundle ACL reconstruction is stronger and more durable than the single-bundle ACL reconstruction even at the 10-year follow-up. The bioabsorbable interference screws used for the graft fixation seem to absorb totally in 2 to 5 years, and are replaced by bone after they have absorbed. No adverse effects related to these screws were found during the 10-year follow-up.