Anterior cruciate ligament reconstruction. Current trends

Anterior cruciate ligament reconstruction is a common procedure.However, results remain often incomplete with an IKDC A scorearound 25%.How can those results be enhanced ? By improving our technique?(grafts choice, lateral tenodesis, double bundle reconstruction, …).By improving the initial assessment of the laxity ?Bone tendon bone or Hamstrings ? Results are globally similar.BTB reconstruction leads to a better control of the laxity but hamstringsreconstruction allows faster recovery and less residual pain.In fact, success doesn’t depend on the choice of the graft but on theright positioning and the strong fixation of the graft, on the controlof the whole laxity, and the spare of the menisci.Associated Lateral tenodesis is controversial. Its goal is to reducethe antero lateral subluxation of the tibia. It has significant morbidity.It should be used in cases of global laxity.Double bundle reconstruction is of great interest. Its goal is to reproducethe normal anatomy of the ACL, and thus to improve controlthe laxity, not only in the anterior posterior plane, but also inthe rotatory plane. It is performed using hamstrings tendons. Biomechanicalstudies are promising, but preliminary clinical reportsdid not demonstrate significant improvement in comparison withsingle bundle reconstruction.In conclusion, our results are still incomplete, but the main principlesare now accepted :- young active patients should be operated on in order to stabilizethe knee and avoid secondary meniscal lesions- the whole laxity has to be controlled; it means that standard intraarticular AL reconstruction is not a universal answer. Associatedprocedures can be required.- the graft must be well positioned, and strongly fixed in the bonytunnels. Computer assisted surgery might facilitate the positioningin the near future.Respect of these principles should reduce the frequency of failuresand iterative reconstructions.