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When I was in rehab for a repaired ACL injury, I heard the various athletes comparing the type of ACL repair they had. The biggest topic was whether or not to have a single-bundle versus a double-bundle reconstruction. I don't even know what I had. Does it really make a difference?

Among competitive athletes, even the type of surgery they had can become a competition! Anterior cruciate ligament (ACL) reconstruction usually involves harvesting a piece of tendon from some other area to use as a graft. The two most common places the donated tissue comes from are the quadriceps tendon (bone-patellar tendon-bone) and the hamstrings tendon. Until recently, the bone-patellar tendon-bone graft was the preferred choice by many. But new fixation methods have made the hamstrings tendon more appealing as a graft choice. The bundles refers to number of strands of tendon that are harvested and/or doubled over to form the graft. Using bundles of tendon grafts allow the surgeon to shape and form the tendon for optimal function. The bundle may be placed vertical (straight up and down) or oblique (on a diagonal). The purpose is to restore joint rotational stability. Single-bundle grafts may not provide stable knee rotation. But double-bundles require extra tunnels in the bone to hold it in place. This can create problems much later if the knee requires revision surgery.

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