New Delhi – 6^th Oct. 2009, A Rare Arthroscopic Double Bundle Double Tunnel ACL Reconstruction Surgery was performed by Senior Orthopaedic, Sports Medicine & Arthroscopic Surgeon Dr. Prateek Gupta along with Dr. Christel Pascal from France at Sir Ganga Ram Hospital. The Surgery was successfully completed by both the Doctors over a span of two hours.

This rare procedure was done so as to reproduce the original load distribution and kinematics of the knee of the patient complaining over severe instability in the knee. The arthroscopic double-bundle double-tunnel ACL reconstruction technique using autogenous hamstring tendon with 2 split grafts. The anteromedial bundle and posterolateral bundle of the ACL were replicated with each split graft of hamstring tendon and fixed with biodegradable interference screws on the 2 tibial tunnels and endo-button on the two femoral tunnels. This restored the full stability power and function in the knee which in time will allow the patient to do all his activities including sports of any kind. This procedure has advantage over single bundle as this restores not only antero-posterior stability but also regains full rotational stability.

Advantages of using Double-Bundle over Single-Bundle ACL Reconstruction Surgery

There is a significant amount of scientific evidence supporting double bundle surgery:

• The ACL is composed of two functional bundles, the anteromedial (AM) bundle and the posterolateral (PL) bundle, not just one.

• Between 10% and 30% of patients complain of pain and residual instability following Single-Bundle ACL reconstruction.

• Arthritis has been observed on x-rays in up to 90% of patients at long-term follow-up after Single-Bundle ACL reconstruction.

• Single-Bundle ACL reconstruction does not adequately restore normal knee stability, particularly tibial rotation

• Anatomic Double-Bundle reconstruction better restores knee stability compared to Single-Bundle reconstruction.

To better understand how “Double-Bundle” ACL reconstruction has evolved from “Single-Bundle” surgery, one should consider a door hinge. A door with one hinge is like a Single-Bundle reconstruction—it will open and close, but the hinge is required to work excessively. Over time the hinge will loosen and the door will wobble. In comparison, a Double-Bundle reconstruction is like a door with two or three hinges. The work is shared between the hinges, and the door can open and close smoothly for long periods of time without falling apart. One hinge doors were used in log cabins, while in medieval times two hinges were used. Today’s doors have three hinges, representing an evolution in design.