The evolution of primary double-bundle ACL reconstruction and recovery of early post-operative range of motion

Knee Surg Sports Traumatol Arthrosc. 2017 May;25(5):1475-1481. doi: 10.1007/s00167-016-4347-z. Epub 2016 Oct 14.


Purpose: The aim of this study was to analyse early post-operative range of motion (ROM) as our anatomic double-bundle (DB) anterior cruciate (ACL) reconstruction technique with respect to tunnel placement evolved. It is the hypothesis of this study that more anatomic placement of the femoral insertion site of the anteromedial (AM) bundle of the ACL results in better restoration of early post-operative knee range of motion.

Methods: Two methods of DB ACL reconstruction regarding more accurate placement of the femoral AM tunnel in relation to its anatomic origin were compared. Patients presenting for 1- and 3-month post-operative clinical visits were examined for passive extension and active flexion by members of the clinical staff. Only patients undergoing primary DB reconstruction with allograft were included in the analyses. To determine the effects of the modified AM bundle placement on recovery of post-operative ROM, patients undergoing surgery in the 6 months before July 2006 (Group A, n = 50) were compared to patients undergoing surgery in the 6 months after July 2006 (Group B, n = 49).

Results: A total of 99 patients met the inclusion criteria. More accurate placement of the AM bundle of the ACL was associated with a smaller side-to-side difference in flexion at 1 month (n.s.) and at 3 months (3° reduction, p < 0.03) after surgery. There was no effect on extension (n.s.) CONCLUSION: More anatomic placement of the femoral insertion of the AM bundle was associated with improved knee flexion. The study translates the findings of previous anatomic basic science research to demonstrate improved restoration of normal joint motion. This ideally leads to improved long-term clinical outcomes and maintenance of joint and cartilage health.

Level of evidence: III.

Keywords: Anatomic; Anterior cruciate ligament; Double bundle; Femoral tunnel placement; Range of motion.

MeSH terms

  • Adolescent
  • Adult
  • Anterior Cruciate Ligament Injuries / rehabilitation
  • Anterior Cruciate Ligament Injuries / surgery*
  • Anterior Cruciate Ligament Reconstruction / methods*
  • Anterior Cruciate Ligament Reconstruction / rehabilitation*
  • Female
  • Humans
  • Knee Joint / surgery
  • Male
  • Postoperative Period
  • Range of Motion, Articular
  • Young Adult