Anterior cruciate ligament reconstruction: Recent evolution and technical improvement

Abstract

Purpose

Anterior cruciate ligament (ACL) injury is one of the most common knee injuries in young and active patients. ACL reconstruction has been usually recommended to restore anterior-posterior as well as rotatory knee stability. However, there are still some issues to be addressed in ACL reconstruction. Therefore, the purpose of this review was to summarize the current literature regarding recent evolution and technical improvement of ACL reconstruction.

Methods

We performed a comprehensive review of the literature regarding graft selection in ACL reconstruction, surgical technique (especially double-bundle ACL reconstruction), and additional procedures.

Results

There is still no gold standard for graft selection, while it should be individualized for each patient. Hamstrings tendon autograft and bone-patellar tendon-bone autograft are often chosen, although quadriceps tendon autograft has increased in popularity. Double-bundle ACL reconstruction was introduced to restore normal knee kinematics by closely mimicking the native anatomy. Although clinical advantages of double-bundle ACL reconstruction such as improved clinical outcome and better anteroposterior and rotatory stability have been reported, current global trend of ACL reconstruction technique is unfavourable due to technical difficulty and surgical complications. Further evolution and technical improvement are required to achieve “true” double-bundle ACL reconstruction. An additional procedure such as lateral extra-articular tenodesis, anterolateral ligament reconstruction, and anterior closing wedge osteotomy, may be considered for ACL reconstruction, especially for revision ACL reconstruction, to prevent a graft re-rupture.

Conclusion

ACL reconstruction has evolved over time in terms of technique, graft selection, and additional procedures. However, there is still room for improvement.