The Concept of Anatomic Anterior Cruciate Ligament Reconstruction

Growing interest in double-bundle anterior cruciate ligament (ACL) reconstruction has sparked tremendous research, yielding a better understanding of normal ACL anatomy, kinematics, and function. Recent studies have more accurately defined the size and orientation of the femoral and tibial insertion sites of the anteromedial and posterolateral bundles. At our institution, we have identified specific osseous landmarks to better guide tunnel placement. The goal of anatomic ACL is to use these discoveries, refine technique, and reconstruct the ACL in a manner that most closely mimics normal anatomy. Logically, we believe that anatomic ACL reconstruction will lead to more favorable kinematics and, in turn, improved patient outcomes. This article summarizes our experiences and details our systematic approach to anatomic ACL reconstruction. Finally, we highlight multiple issues with conventional ACL reconstruction to better illustrate the concept of anatomic ACL reconstruction.