Abstract and Introduction
Abstract
An anterior cruciate ligament (ACL) tear is one of the most common injuries seen by orthopaedic surgeons and is the most common complete ligamentous injury in the knee. Recent reports indicate that over 250,000 ACL reconstructions are performed each year in United States. Recent studies have emphasized the importance of anatomic tunnel placement during ACL reconstruction in an effort to restore normal knee kinematics, stability, and improve outcomes. ACL reconstruction was first described as an open technique, followed shortly by the outside-in, two-incision techniques, both of which provided relatively anatomic reconstruction methods. The transtibial technique became popular with the advent of offset guides early in the 1990s. The current trend appears to be shifting back towards anatomic reconstruction of the ACL through outside-in drilling or anteromedial-portal drilling. The objective of anatomic single- or double-bundle reconstruction is to restore a maximal percentage of the native ACL footprint attachment on the femur and tibia and thereby stability of the knee. This article discusses the most up-to-date literature on the anatomic considerations in ACL reconstruction, with a primary emphasis on restoring the anatomic footprint.
Introduction
Understanding the anatomic locations of the anterior cruciate ligament (ACL) is imperative when choosing a technique. It has been established that ACL reconstruction should be anatomic (i.e. reproduce the native insertion site anatomy and tension patterns). The aim of this article is to elaborate on the anatomic considerations when undertaking an ACL reconstruction based on the most current literature.