Hey Ronin,
This is a 'hot' topic, and really worth discussing.
So, even though I know you have done your research, I am just offering below a few abstracts I found of studies published in the last two years, for the benefit of all who come here for information. I'm hoping we can discuss this with you, and that you may find that to be helpful.
And here's my two cents on your choice of doc: you have already made the decision to go with the double-bundle technique, so I won't comment on that (other than offering the abstracts below), but I will say this:
Of the surgeons who are using that technique, the one you chose has to be the most experienced--that definitely always helps!
(He is also extremely well connected: he was just elected the 2009-2011 president of ISAKOS--did you know?)
All the best to you. And please let us know how you do.
Regards,
Kyle
Partial abstracts (from PubMed):
Double-bundle reconstruction of the anterior cruciate ligament: anatomic and biomechanical rationale.
Zelle BA, Vidal AF, Brucker PU, Fu FH. J Am Acad Orthop Surg. 2007 Feb;15(2):87-96
ABSTRACT: Patients continue to suffer residual pain and instability following anterior cruciate ligament reconstruction. Although overall outcomes of anterior cruciate ligament reconstruction are favorable, improved outcomes can be achieved. Recent biomechanical studies have questioned the ability of conventional single-bundle anterior cruciate ligament constructs to adequately restore normal knee kinematics. Consequently, the use of double-bundle anterior cruciate ligament constructs has been recommended to restore knee stability more effectively. Recent biomechanical data indicate that double-bundle anterior cruciate ligament reconstruction may provide better anteroposterior and rotational knee stability than do conventional single-bundle techniques. Studies are needed to evaluate the clinical impact of double-bundle reconstruction techniques on long-term functional outcomes.
An in vitro biomechanical comparison of anterior cruciate ligament reconstruction: single bundle versus anatomical double bundle techniques.
Sasaki SU, et al. Clinics. 2008 Feb;63(1):71-6.
RESULTS: There were no differences between the two techniques for any of the measurements by ANOVA tests.
CONCLUSION: The technique of anatomical double bundle reconstruction of the anterior cruciate ligament with bone-patellar tendon-bone graft has a similar biomechanical behavior with regard to anterior tibial dislocation, rigidity, and passive internal tibial rotation.
Double-bundle anterior cruciate ligament reconstruction: a computer-assisted orthopaedic surgery study.
Ferretti A, et al. Am J Sports Med. 2008 Apr;36(4):760-6.
CONCLUSION: The hypothesis that addition of the posterolateral bundle to the anteromedial bundle is able to reduce internal rotation of the tibia at 30 degrees of knee flexion is not confirmed.
CLINICAL RELEVANCE: The effective role of the anatomical double-bundle procedure in better restoring knee kinematics should be questioned in an in vivo model.
Outcome of single-bundle versus double-bundle reconstruction of the anterior cruciate ligament: a meta-analysis.
Meredick RB, Vance KJ, Appleby D, Lubowitz JH. Am J Sports Med. 2008 Jul;36(7):1414-21.
BACKGROUND: The anterior cruciate ligament (ACL) has 2 anatomic bundles. Standard ACL reconstruction is with a single-bundle graft, but double-bundle reconstruction may better control knee rotational torque, a potential cause of failure after single-bundle reconstruction. The authors investigated outcomes of single-bundle versus double-bundle ACL reconstruction.
CONCLUSION: Double-bundle reconstruction does not result in clinically significant differences in KT-1000 arthrometer or pivot-shift testing. The pivot-shift results have particular clinical relevance because the test is designed to evaluate knee rotational instability; the results do not support the theory that double-bundle reconstruction better controls knee rotation. Improved quality of future RCTs would allow meta-analysis of a greater number of outcome measures including measures of symptoms and disabilities most important to patients.
