injuryupdate
20-11-2004, 11:46 AM
Interesting article from Orthopaedics Today on ACL reconstruction using a two bundle rather than single bundle technique. Hard to know whether this is going to prove to be any better than the standard patellar vs. hamstring recos.
In this link, tibialis anterior allografts are used. Obvious advantage is that no graft is taken from the patient. Obvious disadvantage is that there must be risk of graft rejection and/or viral disease. Allografts are hardly used in Australia because of this. I think this would be more of a significance difference to what is the standard in Australia than the two bundle/single bundle technique.
The other factor is that despite the attraction of drilling two holes for two different bundles, and calling this more 'anatomical', it is pretty obvious that the ACL bundles in real life are continuous with each other and not separated by two different attachment points with bones in between. That is why you hardly ever see a single bundle rupture of the ACL (it is either an insubstance tear or a complete rupture).
http://www.slackinc.com/bone/ortoday/200411/anatomicACL.asp
In this link, tibialis anterior allografts are used. Obvious advantage is that no graft is taken from the patient. Obvious disadvantage is that there must be risk of graft rejection and/or viral disease. Allografts are hardly used in Australia because of this. I think this would be more of a significance difference to what is the standard in Australia than the two bundle/single bundle technique.
The other factor is that despite the attraction of drilling two holes for two different bundles, and calling this more 'anatomical', it is pretty obvious that the ACL bundles in real life are continuous with each other and not separated by two different attachment points with bones in between. That is why you hardly ever see a single bundle rupture of the ACL (it is either an insubstance tear or a complete rupture).
http://www.slackinc.com/bone/ortoday/200411/anatomicACL.asp