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AAOS Now

Published 1/1/2007
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Mary Ann Porucznik

Why bother with double-bundle?

Richard Hawkins, MD, has another viewpoint on the topic

Not all surgeons are as enthusiastic as Freddie Fu, MD, about the double-bundle technique for ACL reconstruction. Richard Hawkins, MD, believes Dr. Fu should be applauded for his initiative in trying to improve patient outcomes, but recommends that both surgeons and patients wait until more evidence on the efficacy of the technique has been amassed.

“With present day single-bundle, bone-tendon-bone and hamstring procedures, we have relatively reproducible techniques with fairly predictable outcomes,” he says. “The double-bundle procedure has much more bone work in the knee with extensive drilling. Is this more trauma to an already traumatized knee? Could it lead to a higher complication rate or something unforeseen down the road, such as degenerative osteoarthritis? Will this new technique compound the issue, particularly for the less experienced surgeon?”

Drs. Fu and Hawkins both agree that the single-bundle technique has excellent outcomes for most patients. “It’s hard to beat excellent,” says Dr. Hawkins, although he doesn’t want to discourage Dr. Fu and others from trying to improve patient outcomes. Instead, he encourages Dr. Fu to continue to investigate and report on this technique.

“Perhaps down the road it will become the standard, but until evidence from both basic and randomized trials suggests it is safer and superior, most of us should stick with what has been effective and reproducible for us. In 2007, for most of us, single-bundle technique is the way to go.”