If a notchplasty is necessary, it is only performed after marking the native insertion sites and drilling the femoral tunnels.
With regard to the femoral insertion site, a medial portal view obviates the need for a notchplasty, which is rarely performed since it destroys the native soft tissue and osseous anatomy of the lateral femoral condyle, leaving no references points for tunnel placement. This gives us a superior view of both insertion sites. Using this technique, we visualize the femoral insertion site from a central medial portal and the tibial insertion site from a high lateral portal. The most critical technical pearl in performing anatomic double-bundle reconstruction is accurate portal placement using a three portal technique (Cohen et al, 2007).
In full extension, the bundles are oriented vertically but become more horizontal as the knee approaches 90 Unlike the tibial insertion sites, the orientation of the femoral insertion sites varies with knee flexion. Each bundle is named after its tibial insertion site, with the AM bundle being more anterior and medial, and the PL bundle is posterior and lateral. The ACLs double-bundle anatomy has distinct insertion sites on both the tibial and femoral side. In addition, the AM and PL bundles differ in their length, width, and insertion area (Zantop et al, 2006). Anatomical analysis of the ACL in fetal, arthroscopic and cadaveric studies demonstrates that there are the two distinct functional bundles with unique insertion sites (Figure 1), (Chhabra et al, 2006 Ferretti et al, 2007). AnatomyĪnatomic and biomechanical studies reveal that the ACL has two functional bundles, the anteromedial (AM) bundle and the posterolateral (PL) bundle. Therefore, even though ACL surgery has been thought of by many as a clinical success, there is still much room for improvement. A prospective midterm study has also shown that 90% of patients have degenerative radiographic changes (Fithian et al, 2005). 2003) and approximately 40% of the patients never make a full functional recovery after surgery (Biau et al, 2007). If you continue to have this issue please contact to Healioĭespite significant advancements in ACL surgery, meta-analysis studies have demonstrated significant problems after single-bundle reconstructions: 10% to 30% of patients complain of persistent instability (Freedman et al.