Single-bundle, double-bundle or triple-bundle?

Excerpt

At the recent Anterior Cruciate Ligament Study Group meeting in Hawaii, 26–31 March 2006, this subject was thoroughly discussed. I have earlier discussed single or double-bundle in an Editorial in this journal. Now, Konsei Shino from Osaka, Japan, launches a triple-bundle technique also. The reason most often proposed as an argument for double-bundle (or triple-bundle) is that it could control rotation better than single-bundle reconstructions. Philippe Neyret from Lyon, France, however, pointed out that an additional lateral tenodesis ought to control rotation better than anything we do in the centre of the joint. This makes sense of course. As many remember, the late Giles Bousquet from St Etienne in France repeatedly pointed out that ACL ruptures often were combined with a lateral injury to the popliteus tendon. Neyret thus has a point in that it might perhaps be better to add something laterally than perform double- or triple-bundle ACL reconstructions. My main argument against a widespread use of double- or triple-bundle technique is that all around the world the majority of orthopaedic surgeons do not perform more than 10 ACL reconstructions per year. We already have a far too high frequency of revision ACL reconstructions (where the cause most often is poor primary surgery). What will then happen when these relatively inexperienced ACL surgeons start trying double-bundle? …