ACL Reconstruction

ACL reconstruction represents the gold standard in the treatment of symptomatic ACL insufficiency based on improved stability and reduced risk of consecutive cartilage and meniscus injury when compared to non-operative treatment. However, ACL reconstruction is currently not superior to non-operative treatment in terms of subjective outcomes, long term activity level or risk of OA development. ACL deficiency is associated with altered kinematics and structural changes of the knee including steepening of cartilage slopes. Current ACL reconstruction techniques do not restore or regenerate native ACL properties including the force-attuning multilayered anchor architecture. As a result, native biomechanics are typically not restored through ACL reconstruction. Even though a central rotatory axis is re-established, residual dynamic rotatory laxity, clinically manifested by a positive pivot-shift test, is increasingly recognised as a common finding following ACL reconstruction. Surgical ACL reconstruction techniques have constantly been refined. However, several fundamental aspects of ACL reconstruction including timing, graft choice, tunnel placement, graft fixation as well as the management of concomitant pathology and indication of concurrent procedures are still controversially discussed.