Anterior cruciate ligament reconstruction: A literature review of the anatomy, biomechanics, surgical considerations, and clinical outcomes

Anterior cruciate ligament (ACL) ruptures are some of the most common knee injuries seen by sports medicine physicians. However, given the complex anatomy and function of the ACL, reconstruction of this ligament is anything but straightforward. The last decade has seen much advancement in ACL reconstruction, with an improved knowledge of the biology and biomechanics of graft incorporation, new choices for graft material and graft fixation devices, and more accelerated rehabilitation protocols. Although there are numerous studies in the literature on ACL reconstruction, there is yet to be a consensus among surgeons on the "best" graft choice and the "optimal" fixation device. This is generally attributed to the small sample size in most studies, which prohibits a definite conclusion of superiority of one technique over another. Additionally, it is difficult to directly compare the results from one study to another because there is tremendous heterogeneity between studies. This review is intended to examine the anatomy, biomechanics, surgical considerations, and clinical outcomes after ACL reconstruction that have been highlighted in the literature during the past 10 years.