The Role of the Double-

bundle ACL

北京大学第三医院运动医学研究所

Institute of Sports Medicine of

Peking University 3rd Hospital

Jia-Kuo Yu 余家阔，yujiakuo@126.com

I or a member of my immediate

family DO NOT have a financial

interest or other relationship with

a commercial company or

institution.

What should be the

true appearance of

the ACL footprint?

The Role of the ACL

Anatomy

ACL Ruptures

Ways to Rrconstruct

the Ruptured ACL

1. Trans-Tibia SB-ACLR

2. AM Portal-Over the Top

Over the Top

3. Standard SB-ACLR

4. AMB Rrconstruction

Sasaki, 2012

Jia-Kuo Yu

5. ASB-ACLR

6. Rectangular Socket Tunnels -BPTB

Shino K, Nakata K, Nakamura N et al. (2005) Anatomically oriented anterior cruciate

ligament reconstruction with a bone– patellar tendon–bone graft via rectangular socket and

tunnel: a snug-fit and impingement-free grafting technique. Arthroscopy 21:1402.e1–

1402.e5

AIR: anterior intercondylar ridge

7. Oval Tunnels

Petersen W, Forkel P, Metzlaff S, Zantop T. NVITED REVIEW ARTICLE: Anatomic Single-bundle

ACL Reconstruction With Oval Tunnels: Femoral Flip Tack and Distal Hybrid Fixation. Techniques

in Orthopaedics 2013, 28(2): 149-156.

8. T

ripp

le Tu

nn

els

Konsei Shino

2015

Sasaki, 2012

9. Old DB-ACLR-Femoral Side

Old DB-ACLR-Tibia

10. New DB-ACLR-Femoral Side

10. New DB-ACLR-Tibial Side

EBM（Evidence

Based Medicine）for

DB-ACLR

The importance of the

Cochrane Database

The Systematic Review Database of the 5

Continents Worldwide.

Offer Evidences for Clinical Treatemnts

and National Health Policy-making (

Evidence -Based Medicine，EBM).

→ Cochrane Database of Systematic Review

and EBM

Other Evidence for EBM

Evidence of Level I, RCT Studies.

Good Meta Analysis.

Good Evidence of Level II.

EBM Showed the DB-

ACLR was the Best

One

经AM入路和参照HDP定位 经AM入路定位Footprint中心

1. DB-ACLR Showed

Good Footprint

Outline.

Trans-Tibia术式

DB-ACLR

2. Better AP and Rotational

Stability

Mascarenhas et al（2015）: 199

Articles, Meta Analysis on 9 Systematic

reviews.

Pivot Shift：2 no Diff，7 DB Better

than the SB.

AP Stability：8 DB Better than the SB.

，1 no Diff.

3. Clinical Scoring was Better

for the DB-ACLR

From 2005, My Team Didn’t Found the Lysholm,

Tegner and IKDC Diff between the SB and the

DB.

Karikis（2016）, Mayr（2016）, Sasaki（2016）,

Björnsson et al : Systematic review（2015），

also.

Mascarenhas（2015）, Meta Analysis on 9

Systematic reviews：Objective IKDC Scoring，

DB was Better.

Level of Evidence 2, Jia-Kuo Yu*，

AJSM IF4.439, 2013

66%

4. DB-ACLR Could Protect the

Cartilage Better

（2015-2016）

5. More Evideces Showed DB-

ACLR Better

2015

6. AAOS Guideling

AAOS:DB-ACLR vs SB-ACLR

Physicians should use bone-patellar

tendon-bone or hamstring-tendon

auto­grafts, and should use a single- or

double-bundle approach when

performing intra-articular ACL

reconstruction.

2016 7. EBM

Cochrane in CORR® + Cochrane

Database of Systematic Reviews 2012

Compared with SB-ACLR, the DB-ACLR

Showed：

Better AP Stability.

Better Rational Stability.

Could Recover to the Preinjured Sports Ability

Better.

Less Recontructed ACL Ruptures.

Less Post Operation Meniscus Tears.

DB-ACLR Had Showed Enough EBM Evidence.

The Operative Techniques Were Complicated,

Time Needed, Expensive, and Longer Learning

Curve than TKA.

SB-ACLR Was Clinically Needed for Many

Patients Who not suitable for the DB-ACLR.

No Diff between the SB and DB offen Caused by

Study Design, bad Technique, not Accurate

Evaluation, and so on.

Good DB-ACLR Should Be Done for Top Athlete

for Some Special Sports.

Conclusion

References • Kevin Kar Ming Leung, Jia-kuo Yu*, Hao Luo, Yingfang Ao, Jianquan Wang, Guoqing Cui, Yuelin Hu, Xi Gong,

Yongjian Wang, Jiying Zhang, Yulei Liu. The Position of the Posterolateral Bundle Femoral Tunnel During

Arthroscopic Double-Bundle Anterior Cruciate Ligament Reconstruction: A Cadaveric Study. Arthroscopy 2011,

27(7): 959-964. (SCI, IF: 3.317).

• Jia-Kuo Yu, Yingfang Ao, Jianquan Wang, Guoqing Cui, Yuelin Hu, Xi Gong,Hao Luo, Lianxu Chen, Yongjian

Wang, Dong Jiang, Huawei Liu, Jiying Zhang. Paper # 19: The Relationship Between the Different Femoral Tunnel

Tech niques and the Second-look Arthroscopy Results in Double-Bundle ACL Reconstructions. Arthroscopy The

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DOI:10.1016/j.arthro.2011.08.020. (SCI, IF: 3.317).

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double-bundle anterior cruciate ligament reconstructions. Chinese Medical Journal 2011, 124(21): 3551-3555.

(SCI, IF: 0.983).

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Zhang, Jia-Kuo Yu*. Double-Bundle Anterior Cruciate Ligament Reconstruction Using Bone-Patellar Tendon-Bone

Allograft : Technique and 2- to 5-Year Follow-up. Am J Sports Med 2012, 40(5): 1084-1093(SCI, IF: 3.792).

• Xi Gong, Dong Jiang, Yong-Jian Wang, Jian Wang, Ying-Fang Ao, Jia-Kuo Yu*. Second-Look Arthroscopic

Evaluation of Chondral Lesions After Isolated Anterior Cruciate Ligament Reconstruction: Single- Versus Double-

Bundle Reconstruction. Am J Sports Med 2013 41(10):2362-2367 (IF 4.439).

• Wang HJ, Ao YF, Jiang D, Gong X, Wang YJ, Wang J, Yu JK *. Relationship Between Quadriceps Strength and

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• Yu JK. Comparative study on the clinic effects of arthroscopic reconstructions of single-bundle and double-bundle

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