Implant-free ACL reconstruction: a review

Implant-free anterior cruciate ligament (ACL) reconstruction is the fixation of ACL grafts without the need for artificial implants. Our aim was to study the evolution of this technique, review the biomechanical evidence and summarise the results. Implant-free graft fixation for bone patella tendon ACL reconstruction was first described in 1987. This concept of implant-free graft fixation was adapted for hamstring and quadriceps tendons as alternative graft sources. Various biomechanical studies have reported that by adhering to certain technical details, this technique provides comparable fixation strength as conventional ACL fixation. The outcome studies of implant-free ACL reconstruction also report clinical results similar to ACL reconstruction with conventional implants.