Review Article: The future of knee ligament surgery.

Abstract

A large number of anterior cruciate ligament (ACL) reconstructions are being performed each year around the world (estimated between 75,000 to 100,000 cases in the United States alone). However the question remains: ‘how perfect are current operative techniques?’ Numerous techniques have been introduced to the literature, but success rates for longterm clinical outcome can still not exceed 85–90%.4,5,19 The global perspective on ACL reconstruction shows that more then 20 different surgical techniques are available today and that more then five different grafts are currently being used with different rehabilitation protocols and different outcome assessments. At the recently held Panther Sports Medicine Symposium (Pittsburgh, PA, USA, May 4–6, 2000), 14 specialists in knee ligament reconstruction presented their graft choices and preferred techniques for ACL reconstruction on a global panel consisting of experts from five continents. Interestingly, about 50% of the experts were in favor of the hamstring tendons, 50% preferred the B-PT-B graft, and two-thirds of the surgeons used multiple grafts. There was a discussion about several possibilities for fixation of grafts that have undergone an evolutionary process in the past two decades. Especially for hamstring tendons, we still have not yet found the perfect solution. However, talking about different grafts keeps us from addressing the real dilemma: ‘the perfect graft does not yet exist!’ This perfect graft would reproduce insertion sites and biomechanics, provide biological incorporation, and resume neuromuscular control.