Evolution of anterior cruciate ligament reconstruction & graft choice: a review

The surgical treatment of anterior cruciate ligament (ACL) injuries dates back over 100 years from the present day [2022]. While open repair of the torn ACL was popularized in the early 1900s, the first ACL reconstructions utilized the fascia lata as a graft and other extra-articular stabilizing techniques. The first free tendon graft reported for ACL reconstructions was the quadriceps tendon (QT) in the 1930s, followed by the hamstrings tendon (HT), and then the patellar tendon. With improved understanding of the ACL anatomy and biomechanics and the invention of the arthroscope, ACL reconstruction evolved from open procedures to arthroscopic. Similarly, with the help of many surgeon-scientists who reported patient outcomes following ACL reconstruction with various techniques, graft choice evolved with the hamstrings and patellar tendon grafts becoming the dominant and preferred choice of both surgeons and patients. In present day, we see a resurgence of one of the original grafts reported, the QT, as well as primary ACL repair. Future research will result in continued advancements of ACL surgical techniques and graft harvesting, which will allow the orthopedic community (including patients and surgeons) to benefit from such innovations and advanced technologies.