Editorial Commentary: Graft Orientation in Anterior Cruciate Ligament Reconstruction-Does It Really Matter?

The search for an isometric, anatomic, biomechanically optimal anterior cruciate ligament (ACL) reconstruction remains elusive. To better approximate the native ACL, surgeons have used a host of different graft options and repair techniques. Surgical techniques involving single-tunnel and double-tunnel (or even triple-tunnel!) fixation sites have been used in an attempt to re-create the "2 (or more) bundles" of the ACL. Transtibial and independent femoral drilling techniques are used in an effort to create a more "anatomic" femoral tunnel placement. Once the anatomic femoral attachment site is identified, there is then a debate on how best to "fill" the attachment site with the surgical graft. These are all important discussions and debates, but one question remains . . . Does any of it really matter?