DOUBLE BUNDLE ACL RECONSTRUCTION- HOW BIG IS THE LEARNING CURVE?

Abstract

Introduction: Recent data suggests that Double Bundle ACL reconstruction is bio-mechanically and potentially clinically superior. The success of Doudle bundle ACL reconstruction is dependent on tunnel placement. Of clinical concern is the increased technical difficulty and the potential for complications. The aim of our study was to determine how big the learning curve was for a high volume ACL Surgeon.

Methods: Ten Double bundle ACL reconstruction procedures were carried out on suitable individuals. Following the procedure all patients underwent a CT scan of the relevant knee. Femoral tunnel placement was measured according to the quadrant technique described by Bernard and Hertel. The ideal tunnel locations used for analysis were those described by Zantop et al. On the tibial side, the radiographic measurements were performed according to Staubli and Rauschning. The centres of the AM and PL bundles were expressed as percentages of the maximum tibial sagittal diameter. The tibial ACL attachment at the centre of the AM bundle was taken to be 30% of the maximal tibial diameter and the centre of the PL bundle was located at 44%.

The tunnel positions were measured for each patient.

Results: Good tunnel placement was achieved in the majority of patients. There was an initial learning curve with improvement in tunnel placement as experience increased. Femoral tunnel positions had the greatest variation. There were no complications. The technical challenges are discussed.

Conclusion: We have shown that it is possible for a high volume ACL surgeon to convert from a single bundle reconstruction technique to a double bundle reconstruction with relative accuracy.