Anterior cruciate ligament injuries and surgery: Current evidence and modern development

Anterior cruciate ligament injuries are among the most common orthopedic injuries affecting young and active patients. Several variations in surgical techniques exist to treat these injuries. Autografts have shown comparable results to nonirradiated allografts with respect to clinical stability, functional outcomes, and failure rates. Several randomized trials have been published comparing the double-bundle and single-bundle techniques. Pooled analysis of such studies shows the two techniques produce comparable functional outcomes, but suggest the double-bundle technique leads to superior clinical stability. There are several options for graft fixation, including interference screw, cross-pin, and cortical fixation. Despite a proliferation in fixation devices, there remains a lack of evidence to endorse any one technique exclusively. Postoperative protocols also remain varied, and current evidence has not supported the use of bracing or outpatient physiotherapy compared to home physiotherapy. The findings of future high-quality randomized trials have the potential to strengthen current reviews and inform clinical practice guidelines, to ensure that the practice of ACL reconstruction surgery remains “evidence based and on par with emerging knowledge.