Anterior cruciate ligament tear: Rationale and indications for anatomic ACL reconstruction

Abstract

Reconstruction of the anterior cruciate ligament (ACL) is one of the most frequently performed operations in orthopaedic sports medicine [17]. Traditionally, treatment for complete ACL tears has long been a conventional single-bundle (SB) reconstruction [13, 19]. Short-term results for SB reconstructions have been relatively good, with improvement in subjective knee instability and the ability to return to sports [25]. However, in a subset of patients, subjective knee instability persists, and they remain unable to return to prior activity. With SB reconstruction, good to excellent results are only achieved in 60 % of patients and less than 50 % returns to playing sport at their preinjury level [5, 7]. Moreover, long-term results suggest that the rate in which osteoarthritic (OA) changes occur is not reduced by SB reconstruction as compared to nonoperated knees [10, 15, 26]. Multiple studies have shown that the native biomechanical properties of the knee cannot be fully restored by nonanatomic SB reconstruction [8, 40] and that this may be a cause of cartilage thinning [3, 37].