Anatomy and Biomechanics of the Native and Reconstructed Anterior Cruciate Ligament: Surgical Implications


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Abstract

Technical errors, such as nonanatomic tunnel placement, are among the most common causes of graft failure after anterior cruciate ligament (ACL) reconstruction.No clinical superiority has been demonstrated for double-bundle ACL reconstruction compared with single-bundle reconstruction.Single-bundle reconstruction of the anteromedial bundle has been shown to restore kinematics to the level of the intact knee, whereas reconstruction of the posterolateral bundle results in high graft forces.Regardless of surgical technique (single-bundle compared with double-bundle or anteromedial portal compared with transtibial), the surgeon should avoid placement of a vertical or low femoral tunnel, as this results in abnormal knee kinematics.ACL reconstruction is a patient-specific procedure, whereby surgeons should attempt to restore the native anatomy of the knee on a case-by-case basis and must take into account specific risk factors for ACL graft failure, such as younger age, higher activity level, and use of allograft, when counseling patients.

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