Jan 29, 2015
Pre-Show Primer: ACL Bundle Reconstruction

Surgery to repair a torn ACL is nothing new in the sports world, but the way it’s performed is changing. On Wednesday, June 23, Timothy Heckmann, ATC, PT, of the Cincinnati Sportsmedicine & Orthopaedic Center, will present a mini-course entitled “ACL Repair: One Bundle vs. Two Bundle Technique.” T&C covered double-bundle ACL repair in 2008 when the procedure was first becoming available in the U.S., and here’s what we learned:

For almost as long as anterior cruciate ligament (ACL) reconstructions have been performed in the U.S., the single-bundle technique–reconstruction of only one of the ligament’s two bundles of fibers–has been the only available option. But complaints of weak knees and the early onset of arthritis have become common after the procedure, prompting surgeons to explore new and better ways to reconstruct the ACL.

Enter the double-bundle technique: reconstruction of both the anteromedial and posterolateral bundles, a procedure that originated in Asia almost a decade ago and is now being performed by a handful of doctors in the U.S. “The double-bundle procedure more closely duplicates the normal anatomy of the knee,” says John Samani, MD, of the Michigan Knee and Shoulder Institute in Auburn Hills, where he and partner Thomas Perkins, DO, started performing the technique earlier this year. “Not only does it prevent abnormal motion front-to-back, but it also prevents rotational movement that many athletes still experience after a single-bundle procedure.”

Perkins says long-term studies have yet to be completed, but initial feedback from patients who have undergone the double-bundle surgery has been overwhelmingly positive. “In the short term, patients have said their knee feels more normal, especially if they had the single-bundle procedure on one knee and the double-bundle procedure on the other,” Perkins says. “We hope that by controlling both the front-and-back and rotational motion, we may be able to halt degenerative arthritis, and the indications so far are very encouraging.”

The procedure typically doubles a patient’s time in the operating room, but rehab time is similar to that for the single-bundle technique and a rapidly growing number of doctors are interested in learning and refining the procedure. Samani and Perkins believe that if the research backs up the anecdotal evidence available thus far, this surgery will soon become the standard in ACL reconstruction. “It really is exciting to be able to tell a patient, ‘With this procedure, instead of 10 years of good function, we may be able to give you 30 years of great function,'” Samani says.

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