Advanced Anterior Cruciate Ligament Repair and Reconstruction Techniques for Different Rupture Types

Literature concerning anterior cruciate ligament (ACL) reconstruction has increased in both scope and sophistication during the last decades. Heretofore, the principle focus has been on graft choice comparisons, the appropriate handling of co-injuries such as meniscal tears, cartilage lesions, as well as extra-articular ligament injuries. Despite the accumulated knowledge, there is still a lack of clarity concerning a therapy algorithm for different rupture types. With different consequences in therapy strategy, rupture types were differentiated as (1) subsynovial ACL tears/stretch injury and proximal avulsion tears, (2) single-bundle tear (anteromedial/posterolateral), and (3) total ACL rupture. The article presented here provides an overview of recommended operative therapy strategies for different rupture types of the ACL. Within the past decade, advances in arthroscopic technology coupled with rigorous scientific inquiry have resulted in significantly improved treatment options. With these developments in mind, ACL surgery and postoperative therapy can and should be performed in a manner befitting the patient's individual circumstances. Furthermore, intra- and postoperative suggestions including vancomycin graft-coating, as well as an accelerated "Early Active Rehabilitation" program, including early active physiotherapy without postoperative bracing, as well as additional postoperative extracorporeal shock-wave therapy are recommended.