Evolving Techniques in ACL Graft Fixation

Abstract

More than 1600 techniques for ACL reconstruction have been published.1 Within recent years, most of the debate was neither the choice of graft nor the fixation, but rather the usefulness of a single-bundle or double-bundle reconstruction. Meanwhile, several studies have questioned the clinical and experimental benefits of a double-bundle reconstruction when compared with a center-to-center reconstruction technique.2 In cases with hyperextension, a double-bundle reconstruction can even limit full side-to-side extension.3 No matter if reconstructions use single or double bundles, the most important surgical goal of ACL reconstruction remains control of the tunnel placement. Following this, the choice of graft fixation is an important cornerstone that determines the fate of the transplant and may compromise the final result. Implants may be beneficial for secure fixation but can hamper the integrity of the graft and cause difficulties in tunnel-to-bone healing, allergies, postoperative MRIs, and revision surgery. This issue of Techniques in Orthopedics provides an overview of the history of graft fixation, the biomechanical strengths and weaknesses of individual types of fixation, and has a special focus on implant-free graft fixation techniques. It provides well-recognized and documented techniques with more than 10 years of experience, such as evolving techniques that can be used for any type of graft in the future. We hope that the Orthopedic Community enjoys these technical novelties and are anxious to receive your feedback.