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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 2007 April;58(2):219-32
Anatomical reconstruction of the anterior cruciate ligament
Petersen W., Zantop T.
Department of Trauma Hand and Reconstructive Surgery Wilhelms University Muenster, Muenster, Germany
The anterior cruciate ligament (ACL) consists out of several bundles that are separated into two functional bundles named after their tibial insertion; anteromedial (AM) and posterolateral (PL) bundle. Biomechanical studies have implicated that the AM bundle is restraint to anterior tibial translation and the PL bundle is restraint to rotational loads. Due to the relatively large insertion areas of the ACL on the femoral origin and the tibial insertion tunnel placement seems to be critical for the restoration of the native tensioning patterns of the fibres. Recently, the interest in anatomical approach to reconstruct the ACL has reawakened. Anatomical ACL reconstructions reconstructing the AM and PL bundle of the ACL separately are reported to restore the intact knee kinematics more closely when compared to a single-bundle ACL reconstruction, but clinical follow-up data is limited. Several different double-bundle techniques have been described and the most frequently used techniques use a two femoral and two tibial tunnel approach using hamstring grafts. Until now, no consensus for the fixation of the grafts, the knee flexion angle at fixation and the surgical techniques in revision cases have been found. In case of tunnel widening, two femoral and tibial tunnels may reveal a severe problem.