Techniques in Double‐Bundle Anterior Cruciate Ligament Reconstruction: As Simple as ABC, or Putting the Cart Before the Horse?

摘要

First, let's review our idioms. ABC are the first three letters of our alphabet, letters we learn as very young children … simple. In addition, the letters are arranged in a formal order, one follows the next. This is similar to surgical techniques where we follow a series of steps to achieve an outcome. Yet we have both the experience and humility to understand that advanced, minimally invasive, reconstructive surgical techniques are rarely simple. Thus, when we introduce the idiom, “as simple as ABC,” which means that something is as easy as following the undemanding steps, we must add a question mark and raise the question: are things really as simple as they appear?In addition, we have a second theme that motivates us to introduce the letters ABC in the context of double-bundle anterior cruciate ligament (ACL) reconstruction. “A” may represent anatomy, “B” may represent biomechanics, and “C” may represent clinical. We believe that when introducing new surgical techniques and comparing them with a previously established gold standard, we must seek support in the anatomic, biomechanical, and clinical realms to justify application of these techniques to our patients—especially when the techniques may not be as simple as they appear.Next, the old expression “putting the cart before the horse” represents the idea of doing things backward or out of order. Just as B and C follow A, the cart must follow the horse. The horse does the pulling, and if we put the cart first, we will go nowhere. In a similar manner, it would seem backward to perform new surgical techniques on patients without being certain that the clinical outcome will be superior. Yet in surgery, we face a paradox: how can we demonstrate clinical superiority of new techniques unless we perform such techniques? Of course, we can't. Yet in our desire to improve outcomes, new techniques must be introduced. Are we putting the cart before the horse? We think not; rather, in arthroscopic and related surgery, we believe that we are able to address the paradox in a manner as simple as ABC. First, we study anatomy; next, we investigate biomechanics. Thus, our A and B provide a logical and ethical series of steps on which to base our C: clinical investigation.Thus, in this issue, we feature a Technical Note Symposium on the topic of double-bundle ACL reconstruction.1Christel P. Sahasrabudhe A. Basdekis G. Anatomic double-bundle anterior cruciate ligament reconstruction with anatomic aimers.Arthroscopy. 2008; 24: 1146-1151Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar, 2Colombet P.D. Robinson J.R. Computer-assisted, anatomic, double-bundle anterior cruciate ligament reconstruction.Arthroscopy. 2008; 24: 1152-1160Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar, 3Nakagawa T. Takeda H. Nakajima K. et al.Intraoperative three-dimensional imaging-based navigation-assisted anatomic double-bundle anterior cruciate ligament reconstruction.Arthroscopy. 2008; 24: 1161-1167Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar, 4Pombo M.W. Shen W. Fu F.H. Anatomic double-bundle anterior cruciate ligament reconstruction: Where are we today?.Arthroscopy. 2008; 24: 1168-1177Abstract Full Text Full Text PDF PubMed Scopus (81) Google Scholar, 5Shino K. Nakata K. Nakamura N. et al.Rectangular tunnel anterior cruciate ligament reconstruction with bone–patellar tendon–bone graft to mimic natural fiber arrangement.Arthroscopy. 2008; 24: 1178-1183Abstract Full Text Full Text PDF PubMed Scopus (123) Google Scholar, 6Smith P.S. Schwartzberg R.S. Lubowitz J.H. No tunnel 2-socket technique: All-inside anterior cruciate ligament double-bundle retroconstruction.Arthroscopy. 2008; 24: 1184-1189Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar, 7Volpi P. Denti M. Double-bundle reconstruction of the anterior cruciate ligament using the transtibial technique.Arthroscopy. 2008; 24: 1190-1194Abstract Full Text Full Text PDF PubMed Scopus (9) Go