Contemporary Anterior Cruciate Ligament Outcomes: Does Technique Really Matter?

Significant advances have been made in anterior cruciate ligament reconstruction surgical technique. Further progress is being made to improve our ability to replicate anatomy with minimally invasive techniques. Presently, wide intersurgeon variation exists regarding several crucial aspects of the procedure, suggesting that the optimal technique continues to evolve. After reviewing the history of anterior cruciate ligament reconstruction surgical technique and the surgical anatomy, this manuscript outlines the various debated topics in the literature surrounding the method for drilling the femoral tunnel (outside-in vs transtibial vs anteromedial), graft selection and method of fixation as it applies to surgical technique, number of bundles reconstructed (single vs double), and surgical approach (incision vs all-inside). For each, the best available clinical evidence is reviewed to determine advantages and disadvantages. Patient factors that may indicate the use of a certain technique and special considerations such as reconstruction in the skeletally immature are discussed.