Controversies in the Surgical Technic for the Reconstruction of the Anterior Cruciate Ligament of the Knee

Manuel A. C. Campos

Goal: the goal of this article is to present a review of the controversies in the surgical reconstruction of the anterior cruciate ligament of the knee in graft selection, fixation methods and single or double bundle technique.
 
Data source: the Pubmed was used (www.pubmed.com). Search was limited to articles written in English, Portuguese and French. 65 articles were included.
 
Data synthesis: availability, safety, low cost and biological characteristics make autograft the “gold-standard” for the reconstruction of the anterior cruciate ligament (ACL). Bone-patellar tendon-bone graft is the most used, but four-strand hamstring graft has gain more popularity because of its lower morbidity. The classical single-bundle ACL reconstruction can restore anteroposterior stability although it fails to support combined rotatory forces. Double-bundle reconstruction can sometimes restore knee kinematics more accurately. Femoral drilling via the anteromedial portal results in a significantly more anatomic and more oblique tunnel in the coronal plane. Fixation methods have technical problems, although there is no significant difference in outcomes between them.
 
Conclusion: More than a century after the first surgical reconstruction of the ACL we still continue looking for the ideal graft; a graft that is biologically integrated and able to reproduce the anatomy, biomechanics and neuromuscular control, still does not exist. Graft choice is multifactorial.
 
 
Key-words: Anterior Cruciate Ligament; Reconstruction; Controversies.


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