Recent concepts in anterior cruciate ligament reconstruction

Abstract

Purpose of review: The purpose of this current review on anterior cruciate ligament (ACL) reconstructions is to review the most recent clinical research on ACL surgery, and to provide insight into new developmental procedures being used to reconstruct the ACL. With the increasing number of ACL injuries, combined with advancements in science, it is critical that new techniques are explored, and that our current techniques are critically analyzed. Recent findings: Recent evaluations of allograft versus autograft, allograft and autograft choices, graft fixation methods, and the double bundle technique will be explored throughout this review. A study comparing allograft versus autograft showed that autograft has a slightly lower failure rate and a slightly higher incidence of retro- patellar pain. Regarding autograft choices, patellar tendon, hamstrings, and quadriceps tendons have all been demonstrated to be viable options. Recent autograft clinical studies show that bone-patellar tendon-bone (BPTB) appears to be slightly superior on Lachman KT-1000 and pivot-shift testing when compared with hamstrings tendon, although with new fixation techniques the hamstring graft is displaying comparable results. A current allograft study found Achilles grafts to provide superior stability results compared with allograft BPTB. Regarding the double bundle technique, theoretical improvements in rotational stability are intriguing. However, the limited clinical literature does not show the double bundle technique to produce statistically significant improved results. The clinical success rates remain very high for single bundle ACL reconstructions. Summary: Although autograft bone-patellar tendon-bone has been the standard ACL graft choice for years, other autograft choices and allograft have been demonstrated to be viable options. Graft fixation is as important as is graft type. Regarding the double bundle technique, more research is required for full understanding and acceptance of this procedure. The future of ACL reconstruction is promising due to advancements in biologic technology and techniques that will hopefully allow for faster recovery.