Korean J Sports Med.  2023 Dec;41(4):185-200. 10.5763/kjsm.2023.41.4.185.

Current Trends and Future Developments in Anterior Cruciate Ligament Reconstruction: Current Concepts Review

• Lee DW
• Kim JN
• Kim SW
• Cho SI
• Kim NY
• Park BS

• KMID: 2548992
• DOI: http://doi.org/10.5763/kjsm.2023.41.4.185

Abstract

As the number of anterior cruciate ligament (ACL) reconstructions has increased significantly, surgical techniques have also made a lot of progress, and clinical outcomes are improving accordingly. However, the authors still have different opinions on ACL anatomy, femoral tunnel position, how to make a femoral tunnel, and graft selection, and many parts are controversial. Major factors contributing to the failure of ACL reconstruction, such as technical errors and biological healing failures. To reduce technical errors, a comprehensive understanding of ACL anatomy and the ability to create a well-positioned femoral tunnel are crucial. This involves recognizing the advantages and disadvantages of three surgical techniques: modified transtibial, transanteromedial portal, and outside-in. To improve biological healing, the four principles of tissue engineering (cells, growth factors, scaffolds, and mechanical stimuli) have been increasingly explored in various methods of bioaugmentation. Residual rotational instability of the knee joint remains a significant concern. Since the rediscovery of the anterolateral ligament (ALL) in the knee joint, the role of anterolateral complex, including the ALL and the deep iliotibial band, as secondary stabilizers of anterolateral rotatory instability, has gained attention. In the quest to reinforce the anterolateral complex, there are two approaches: ALL reconstruction as anatomical reconstruction concept and lateral extraarticular tenodesis as a nonanatomical reinforcement concept.

Keyword

Anterior cruciate ligament; Anterolateral ligament; Anterior cruciate ligament anatomy; Anterior cruciate ligament reconstruction; Anatomical reconstruction