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Related Experiment Video

Updated: Apr 17, 2026

Author Spotlight: Implementing the Enhanced Recovery After Surgery Concept in Rehabilitation Following Anterior Cruciate Ligament Reconstruction
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Evidence-Based ACL Reconstruction.

E Carlos Rodriguez-Merchan1

  • 1E. Carlos Rodriguez-Merchan MD, PhD, Department of Orthopaedic Surgery, La Paz University Hospital, Madrid, Spain.

The Archives of Bone and Joint Surgery
|February 19, 2015
PubMed
Summary
This summary is machine-generated.

Anterior cruciate ligament (ACL) reconstruction outcomes vary by technique. Bone-patellar tendon-bone grafts offer stability but higher morbidity, while autografts generally outperform allografts. Most patients return to sports, though osteoarthritis is common long-term.

Keywords:
ACLBPTBHamstringReconstruction

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Area of Science:

  • Orthopedic Surgery
  • Sports Medicine
  • Biomedical Engineering

Background:

  • Anterior cruciate ligament (ACL) reconstruction literature presents significant controversy regarding optimal surgical techniques and outcomes.
  • Key areas of debate include graft choice, bundle technique, timing of surgery, return to sport rates, and long-term osteoarthritis development.

Purpose of the Study:

  • To systematically review and synthesize evidence addressing critical controversies in anterior cruciate ligament (ACL) reconstruction.
  • To compare bone-patellar tendon-bone reconstruction (BPTB-R) versus hamstring reconstruction (H-R).
  • To evaluate double-bundle versus single-bundle techniques, allograft versus autograft, and early versus delayed reconstruction timing.
  • To determine the rates of return to sports and the incidence of osteoarthritis post-ACL reconstruction.

Main Methods:

  • A comprehensive literature search was conducted in the Cochrane Library and PubMed (MEDLINE).
  • Systematic reviews and meta-analyses focusing on the specified ACL reconstruction controversies were selected.
  • Articles were chosen based on high-grade evidence (Grade I-II).
  • Sixty-nine articles were identified, with 26 ultimately included in the review.

Main Results:

  • Bone-patellar tendon-bone reconstruction (BPTB-R) demonstrated superior postoperative knee stability compared to hamstring reconstruction (H-R), albeit with increased morbidity.
  • Long-term functional outcomes were comparable between BPTB-R and H-R.
  • Double-bundle ACL reconstruction showed advantages in rotational laxity control, while functional recovery was similar to single-bundle techniques.
  • Autografts yielded superior results compared to allografts.
  • No significant difference was observed between early and delayed ACL reconstruction.
  • Approximately 82% of patients successfully returned to some form of sport.
  • A significant proportion (28%) of patients exhibited radiological signs of osteoarthritis at a minimum 10-year follow-up.

Conclusions:

  • While BPTB-R offers enhanced stability, functional outcomes are similar to H-R in the long term.
  • Autografts are preferred over allografts for ACL reconstruction.
  • Double-bundle techniques may improve rotational control, but functional recovery is comparable to single-bundle.
  • Early versus delayed reconstruction timing does not appear to impact outcomes.
  • High rates of return to sport are achievable, but the long-term risk of osteoarthritis following ACL reconstruction remains a significant concern.