Impact of anatomical versus IDEAL anterior cruciate ligament reconstruction on postoperative functional recovery

Anterior cruciate ligament (ACL) tears are common injuries that often require reconstruction to restore knee stability and function. Anatomical reconstruction (AR) seeks to replicate the native ACL footprint and orientation, whereas isometric, direct insertion, eccentrically located, anatomical, low tension (IDEAL) reconstruction applies principles intended to optimize graft positioning and tension behavior across knee motion. This retrospective study compared postoperative functional recovery between AR and IDEAL techniques in patients treated at our institution from January 2020 to December 2021. A total of 76 patients with confirmed ACL tears were included: 39 patients underwent individualized AR and 37 received IDEAL reconstruction. Functional outcomes were assessed using the Lysholm Knee Scoring Scale and the International Knee Documentation Committee (IKDC) subjective score at 3, 12, and 24 months postoperatively. Analyses were performed using SPSS, with statistical significance defined as P < .05. Both groups demonstrated continuous improvements in Lysholm and IKDC scores across follow-up. At each postoperative time point (3, 12, and 24 months), there were no statistically significant differences between the AR and IDEAL groups for either Lysholm or IKDC scores (all P > .05). These findings indicate similar functional recovery patterns for both reconstruction strategies within the observed period. In summary, AR and IDEAL reconstruction were associated with substantial postoperative functional gains and showed comparable patient-reported outcomes through 24 months. Given the retrospective design and limited sample size, larger prospective randomized studies are required to confirm equivalence, clarify patient selection criteria, and assess longer-term durability and safety.