Reconstruction of the anterior cruciate ligament: historical overview

The first reported surgical repair of anterior cruciate ligament-deficient knees was done by Mayo Robson in 1895. The earliest anterior cruciate ligament reconstructions were done by Hey Groves in 1917 and by Alwyn Smith in 1918. Both used an intra-articular strip of iliotibial band. At this same time, the first attempt to make an artificial anterior cruciate ligament was done. Corner used wire, while Alwyn Smith used multiple silk sutures. Both methods failed. The first extra-articular procedures to correct instability in anterior cruciate ligament-deficient knees were reported by Bennett in 1926 and Cotton and Morrison and Bosworth and Bosworth in the mid 1930s. All of these surgeons reconstructed the medial side of the knee with free strips of fascia. In 1936, Campbell described the intra-articular use of patellar tendon and stressed the need for anterior cruciate ligament reconstruction in young, athletic individuals with unstable knees. In the 1950s, O'Donoghue also emphasized the early repair of an injuried anterior cruciate ligament and did much to improve the care of the college athlete. The procedures described by Jones, Slocum, Larson, and Nicholas dominated the 1960s and early 1970s. Various rotatory knee instabilities were defined, and the Lachman and pivot shift tests were born. Descriptions of various tendon transfers and intra-articular graft techniques have been published over the last 10 years. Most of these are variations of procedures described decades ago. In 1918, Alwyn Smith used electrical stimulation to decrease postoperative quadriceps atrophy. In 1936, Mauck advised the use of a hinged knee cast after surgery for better rehabilitation. Finally, in 1938, Palmer described a drill guide for more anatomic placement of an anterior cruciate ligament graft in the femur. Although prosthetic materials may have a greater place in the 1980s, the foundation for such research was laid long ago by innovative surgeons such as Hey Groves and Alwyn Smith, the great-grandfathers of anterior cruciate ligament reconstructions.