Recent advances in understanding of the complex function and anatomy of the ACL has reaffirmed the importance of performing ACL reconstruction in a fashion which most accurately restores not only the function but, to the degree possible, the actual anatomy of the injured ligament.

The normal ACL is made up of two major bundles. These are the anterior medial (AM) and posterior lateral (PL). The AM bundle contributes primarily to control translation of the knee in flexion. The PL bundle, on the other hand, contributes more to controlling rotational stability as the knee approaches full extension.

Traditional ACL reconstruction techniques applied to high demand athletes (such as foot ball players, soccer players and other anthletes which involve high torque exposure) has been done employing a large single bundle graft centered as nearly possible at the anatomic sites of attachment on the tibia and femur. Graft choices primarily include Patellar Tendon Autograft (BTB), Hamstring Autograft (HS) and a variety of Allograft (Cadaver) choices. The selected graft is fixated to the femur and tibia by implanting the ends of the graft in bone tunnels created at or near the anatomic site of attachment of the normal (uninjured) ligament on the femur and the tibia.

There are a myriad of factors to consider when selecting type of graft to be used as well as the method of fixation of the graft to the bone. As with most choices in life, each has it's advantages and disadvantages. Issues related to graft selection are discussed elsewhere.

Recent improved understanding of the unique anatomy of the ACL has led surgeons around the world to develop methods of reconstructing the ACL in a more anatomic fashion than has been traditionally employed. This "anatomic" method is also referred to as the "double bundle" method as it employs two smaller bundles (or grafts) rather than one large "single bundle" (graft).

The "anatomic" method has not been in use for very long and thus we have limited experience with the results of this method especially on high demand athletes however early results are certainly promising and the rationale behind the method certainly makes sense.