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Controversies in Soft-tissue Anterior Cruciate Ligament Reconstruction: Grafts, Bundles, Tunnels, Fixation, and Harvest

Dr. Prodromos is President of Illinois Sports Medicine, Glenview, IL, and Assistant Professor, Rush University Medical Center, Chicago, IL. Dr. Fu is Professor and Chairman, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA. Dr. Howell is Professor of Mechanical Engineering and Member, Biomedical Graduate Group, University of California at Davis, Davis, California. Dr. Johnson is Director, Sports Medicine Clinic, and Assistant Professor, Carleton University, Ottawa, Ontario, Canada. Dr. Lawhorn is Assistant Professor of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, and Partner, Advanced Orthopaedics and Sports Medicine Institute, Fairfax, VA.

Dr. Howell or a member of his immediate family serves as a consultant to or is an employee of Biomet Sports Medicine and has stock or stock options held in OtisMed. Dr. Johnson or a member of his immediate family has received royalties from and has served as a consultant to ConMed Linvatec. None of the following authors or a member of their immediate families has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Prodromos, Dr. Fu, and Dr. Lawhorn.

Reprint requests: Dr. Prodromos, Illinois Sports Medicine and Orthopaedic Center Research Department, 1720 Milwaukee Avenue, Glenview, IL 60025.

Increased stability has been reported with both autografts and allografts for anterior cruciate ligament (ACL) reconstruction. However, meta-analysis has shown significantly lower overall knee stability rates and more than double the abnormal stability rate with allografts. Some issues surrounding allograft sterilization (ie, risk of disease transmission) are unresolved, and cost is also a concern. Single-bundle ACL reconstruction can produce high stability rates when tunnels are properly placed, but there is evidence that double-bundle repair may offer greater rotatory stability. Cortical fixation has been associated with increased stability owing to the high stiffness of cortical bone. Anterior and posterior approaches are both recommended. The controversy related to single-bundle versus double-bundle ACL reconstruction remains unresolved. 

This article has been cited by other articles:

				J. L. Carey, W. R. Dunn, D. L. Dahm, S. L. Zeger, and K. P. Spindler A Systematic Review of Anterior Cruciate Ligament Reconstruction with Autograft Compared with Allograft J. Bone Joint Surg. Am., September 1, 2009; 91(9): 2242 - 2250. [Abstract] [Full Text] [PDF]