Anterior Cruciate Ligament Reconstructions in Active-Duty Military Patients

Anterior cruciate ligament (ACL) tears are common injuries typically sustained by men and women in their teens and twenties. The United States military consists of a large group of young, athletic servicemen and women who are at high risk for ACL injuries. The surgical reconstruction of a ruptured ACL is the primary treatment option for athletes who want to resume unrestricted sporting activities. The middle third bone-patellar tendon-bone autograft is the most commonly used graft for ACL reconstructions in the United States, but the hamstring autograft has gained increased utilization by military surgeons because of the unique requirements of our patient population. Each graft has its own advantages, and all may be successfully used to restore knee stability after an ACL tear. The grafts chosen and the operative techniques used for ACL reconstructions reflect the training of the individual surgeons, most of whom are relatively early in their orthopedic careers. The military medical system is comprised of smaller community-sized hospitals located throughout the United States and overseas supported by major medical centers with a full complement of residency and fellowship training. Military surgeons in the Army, Navy, and Air Force perform 2,500 to 3,000 primary ACL reconstructions each year. Nearly all patients are required to return to unrestricted military duties including, for most, demanding physical activities. Therefore, we believe the military patients are analogous to a high-level athletic population with comparable expectations for their return to preinjury function.