Reconstruction of the anterior cruciate ligament: a historical view

Abstract

Management of anterior cruciate ligament (ACL) tears has continuously evolved since its first description in approximately 170 A.D. by Claudius Galenus of Pergamum and Rome. The initial immobilization using casts was replaced by a variety of surgical and conservative approaches over the past centuries. The first successful case of ACL repair was conducted by Mayo Robson in 1885, suturing cruciate at the femoral site. In the nineteenth century, surgical techniques were focused on restoring knee kinematics and published the first ACL repair. The use of grafts for ACL reconstruction was introduced in 1917 but gained popularity in the late 1900s. The introduction of arthroscopy in the 1980s represented the greatest milestones in the development of ACL surgery, along with the refinements of indications, development of modern strategies, and improvement in rehabilitation methods. Despite the rapid development and multitude of new treatment approaches for ACL injuries in the last 20 years, autografting has remained the treatment of choice. Compared to the initial methods, arthroscopic procedures are mainly performed, and more resistant and safer fixation devices are available. This results in significantly less trauma from the surgery and more satisfactory long-term results. The most commonly used procedures are still patellar tendon or hamstring autograft. Additionally, popular, but less common, is the use of quadriceps tendon (QT) grafts and allografts. In parallel with surgical developments, biological reconstruction focusing on the preservation of ACL remnants through the use of cell culture techniques, partial reconstruction, tissue engineering, and gene therapy has gained popularity. In 2013, Claes reported the discovery of a new ligament [anterolateral ligament (ALL)] in the knee that could completely change the treatment of knee injuries. The intent of these modifications is to significantly improve the primary restriction of rotational laxity of the knee after ACL injury. Kinematic studies have demonstrated that anatomic ACL reconstruction and anterolateral reconstruction are synergistic in controlling pivot displacement. Recently, there has been an increased focus on the application of artificial intelligence and machine learning to improve predictive capability within numerous sectors of medicine, including orthopedic surgery.

Advancements in Anterior Cruciate Ligament Repair—Current State of the Art

“…The literature agrees that specific rehabilitation protocols after ACL repair are lacking and are usually extrapolated by ACL-R [1][2][3][4][5][6]. However, as reported by Duong et al [14] and by Robertson et al [1], without graft harvest comorbidity, a faster and less painful recovery is expected, with quicker patient confidence in mobility.…”

“…Anterior cruciate ligament (ACL) treatment is one of the hottest topics in the orthopedic field and is continuously evolving [1,2]. Recent epidemiological studies have highlighted ACL tears as among the most prevalent knee injuries, with an estimated annual incidence ranging from 100,000 to 200,000 cases in the United States alone [3][4][5]. Moreover, ACL tears disproportionately affect athletes participating in high-risk sports such as soccer, basketball, and football, contributing significantly to morbidity and imposing a substantial economic burden [4,6].…”

A slight degree of osteoarthritis appears to be present after anterior cruciate ligament reconstruction compared with contralateral healthy knees at a minimum of 20 years: A systematic review of the literature

“…It is important to note that these techniques may slightly differ from the current standard of practice. Concerning tunnel preparation, the positioning of the ACL femoral tunnel has changed since the time these procedures were conducted [ 11 ].…”

“…Although adverse biomechanical alterations have been well acknowledged, there is on‐going debate regarding their management. Various surgical and conservative therapies have been suggested thus far [ 1 , 11 , 14 , 17 , 18 , 19 , 33 , 39 ].…”

The healing effect of the all inside technique is superior to the traditional technique in the reconstruction of the anterior cruciate ligament

“…AIST is distinct for its internal graft placement within the knee joint, differing from traditional methods with external tunnels. 25 It secures the graft internally using techniques like sutures, implants, or specialized devices.…”