Anatomy and Biomechanics of the Native and Reconstructed Anterior Cruciate Ligament: Surgical Implications.

Abstract

➤ Technical errors, such as nonanatomic tunnel placement, are among the most common causes of graft failure after anterior cruciate ligament (ACL) reconstruction.➤ No clinical superiority has been demonstrated for double-bundle ACL reconstruction compared with single-bundle reconstruction.➤ Single-bundle reconstruction of the anteromedial bundle has been shown to restore kinematics to the level of the intact knee, whereas reconstruction of the posterolateral bundle results in high graft forces.➤ Regardless of surgical technique (single-bundle compared with double-bundle or anteromedial portal compared with transtibial), the surgeon should avoid placement of a vertical or low femoral tunnel, as this results in abnormal knee kinematics.➤ ACL reconstruction is a patient-specific procedure, whereby surgeons should attempt to restore the native anatomy of the knee on a case-by-case basis and must take into account specific risk factors for ACL graft failure, such as younger age, higher activity level, and use of allograft, when counseling patients.