Current Trends in Anterior Cruciate Ligament Reconstruction

Abstract

In 2006, a survey regarding anterior cruciate ligament (ACL) reconstruction was mailed to physician members of the American Orthopaedic Society for Sports Medicine. A total of 993 responses were received from 1747 possible respondents (57%). The number of ACL reconstructions per year ranged from 1 to 275 (mean = 55). The most important factors in the timing of surgery were knee range of motion and effusion. Bone-patellar tendon-bone (BPTB) autograft was most commonly preferred (46%), followed by hamstring tendon autograft (32%) and allografts (22%). Five years earlier, BPTB grafts were more frequent and hamstring tendon and allografts were less frequent (63%, 25%, and 12%, respectively). A single-incision arthroscopic technique was used by 90%. Most allowed return to full activity at 5 to 6 months, with a trend toward earlier return for BPTB grafts; quadriceps strength was an important factor in the decision. There was limited experience (4%) with double-bundle and computer-assisted ACL reconstruction.Arthroscopic-assisted, single-incision reconstruction using a BPTB autograft fixed with metal interference screws remains the most common technique used for primary ACL reconstruction. In the past 5 years, the use of alternative graft sources and methods of fixation has increased. Consensus regarding the best graft type, fixation method, and postoperative protocol is still lacking.[J Knee Surg. 2009;22:7-12.]

Hamstring tendon anterior cruciate ligament reconstruction: does gracilis tendon harvest matter?

“…Patellar tendon ACL reconstruction has been regarded by many to be the so-called 'gold standard' [2]. However, persistent morbidity after PT graft harvest [3] has led to the increased use of a four-strand semitendinosus and gracilis graft, which has comparable laxity and graft rupture rates [4,5].…”

An international survey on anterior cruciate ligament reconstruction practices

“…This preference is contrary to tradition and history, and is not strongly supported in the literature. Surveys conducted in the USA in 1999, 2001 and 2006 found that the use of BPTB autografts has progressively declined and that the use of allografting and hamstring grafting has risen [12]. Hamstrings were also more commonly preferred among younger (less than five years of practice) surgeons [12].…”

“…Surveys conducted in the USA in 1999, 2001 and 2006 found that the use of BPTB autografts has progressively declined and that the use of allografting and hamstring grafting has risen [12]. Hamstrings were also more commonly preferred among younger (less than five years of practice) surgeons [12]. Since the harvesting procedure of hamstring and BPTB grafts takes about the same time and does not involve extra cost in either case, we hypothesize that the explanation for this result lies in the high rate of complications (i.e.…”

“…A survey conducted in the USA in 2006 found that 90 % of surgeons perform a single-incision arthroscopic ACL reconstruction and, of those, 85 % still prefer the transtibial approach, while only 15 % perform an AMP approach [12]. In contrast, our worldwide survey found that 68 % prefer the AMP over a transtibial approach, a finding that is not supported by the published data, and we speculate that this is because the AMP technique has advantages that were not described or proven in trials, but may nevertheless be apparent to clinicians.…”

Anteromedial portal versus transtibial drilling techniques in ACL reconstruction: a blinded cross-sectional study at two- to five-year follow-up

“…The autograft or allograft arthroscopic single-bundle (SB) is the "gold standard" technique for anterior cruciate ligament (ACL) reconstruction [15]. Initially, the most popular femoral drilling method was the two-incision technique, where the femoral tunnel is created outside-in [5].…”