The posteromedial bundle of the ACL is the smaller bundle, taut in knee extension, running from the posteromedial ACL femoral origin to the posteromedial tibial insertion, complementing the dominant anterolateral bundle.
Restrains anterior tibial translation in near-extension (0-30 degrees), contributes to rotational stability in extension, and provides the secondary restraint when the anterolateral bundle is injured.
Double-bundle ACL reconstruction addresses both the AM bundle (primary) and PM bundle (secondary) to restore the complete ACL biomechanical profile. Single-bundle reconstruction predominantly reconstructs the AL bundle. The PM bundle is assessed and preserved if intact in partial ACL tear management.
Preservation of the intact PM bundle during partial ACL reconstruction in isolated AL bundle tears maintains the residual PM constraint and may improve rotational stability outcomes.
Reconstruction of both ACL bundles using separate femoral and tibial tunnels to restore the full rotational and anterior stability profile of the native ACL.
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