Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Apr 6:8:19.
doi: 10.21037/aoj-22-39. eCollection 2023.

Evolution of anterior cruciate ligament reconstruction & graft choice: a review

Dane R G Lind  1 , Rohan S Patil  1 , Matthew A Amunategui  1 , Nicholas N DePhillipo  1
Affiliations
Review

Evolution of anterior cruciate ligament reconstruction & graft choice: a review

Dane R G Lind et al. Ann Jt. .

Abstract

The surgical treatment of anterior cruciate ligament (ACL) injuries dates back over 100 years from the present day [2022]. While open repair of the torn ACL was popularized in the early 1900s, the first ACL reconstructions utilized the fascia lata as a graft and other extra-articular stabilizing techniques. The first free tendon graft reported for ACL reconstructions was the quadriceps tendon (QT) in the 1930s, followed by the hamstrings tendon (HT), and then the patellar tendon. With improved understanding of the ACL anatomy and biomechanics and the invention of the arthroscope, ACL reconstruction evolved from open procedures to arthroscopic. Similarly, with the help of many surgeon-scientists who reported patient outcomes following ACL reconstruction with various techniques, graft choice evolved with the hamstrings and patellar tendon grafts becoming the dominant and preferred choice of both surgeons and patients. In present day, we see a resurgence of one of the original grafts reported, the QT, as well as primary ACL repair. Future research will result in continued advancements of ACL surgical techniques and graft harvesting, which will allow the orthopedic community (including patients and surgeons) to benefit from such innovations and advanced technologies.

Keywords: Anterior cruciate ligament (ACL); autograft; hamstrings; patellar tendon; quadriceps tendon (QT).

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://aoj.amegroups.com/article/view/10.21037/aoj-22-39/coif). The series “Implications of Graft Choice in ACL Reconstruction” was commissioned by the editorial office without any funding or sponsorship. NND served as the unpaid Guest Editor for the special series. The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
Evolution of ACL surgery and introduction of different autografts. ACLR, anterior cruciate ligament reconstruction; HT, hamstrings tendon; BTB, bone-patellar tendon-bone; QT, quadriceps tendon; BEAR, bridge-enhanced anterior cruciate ligament repair; ACL, anterior cruciate ligament.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Robson AW. VI. Ruptured Crucial Ligaments and their Repair by Operation. Ann Surg 1903;37:716-8. - PMC - PubMed
    1. Battle WH. A case after open section of the knee joint for irreducible traumatic dislocation. Clin Soc London Trans 1900;33:232.
    1. Perthes G. Über die Wiederbefestigung des abgerissenen vorderen Kreuzbandes im Kniegelenk. Zentralbl Chir 1926;53:866-72.
    1. Schindler OS. Surgery for anterior cruciate ligament deficiency: a historical perspective. Knee Surg Sports Traumatol Arthrosc 2012;20:5-47. 10.1007/s00167-011-1756-x - DOI - PubMed
    1. Payr Erwin. Der heutige Stand der Gelenkchirurgie. Langenbecks Arch klin Chir 1927;148:134.