(iii) Anterior cruciate ligament reconstruction – evolution and current concepts

Since the early 20th century, the considerable evolution of anterior cruciate ligament reconstruction has been an essential impetus for our understanding of knee anatomy and biomechanics, and their relation to function, injury and rehabilitation. Traditional use of non-anatomic intra- and extra-articular reconstructions has moved to an emphasis on restoring anatomy and native knee kinematics whilst preserving biology. With new evidence and technology, old concepts such as ACL repair and lateral procedures are being revisited with a fresh perspective in an attempt to restore normal knee function. Every aspect of the technique is a source of constant innovation with new concepts and controversy. This review describes the key milestones of this evolution then provides an appraisal overview of current concepts and the rationale for variations in technique.