[The recent history of substitution procedures for the anterior cruciate ligament]

The evolution of operations to repair or substitute the anterior cruciate ligament is summarized for the period 1903 to the present. The increase in the understanding of the function of the ligament is described and in the light of this experience a programme for the management of these lesions is suggested. In acute lesions in a young sportsman the loss of the stability provided by the central pivot prevents competition at high level and operation to repair, substitute, or reinforce the ligament is recommended. In the older athlete non-intervention may be acceptable in view of the knowledge that the adverse mechanical consequences of a rupture of the ACL may be lessened by appropriate rehabilitation. Such measures may be successful for a couple of years, but usually, within five years, functional symptoms will appear. In patients who are middle aged, or those with no competitive need, rehabilitation only is usually adequate, and surgical reconstruction is rarely necessary. In chronic lesions operation should probably only be undertaken when instability is a notable problem. Reconstruction may be accomplished by an autograft using a bone patella bone, semi-membranosis or semi-tendonosis transfer, allograft substitution or a prosthesis.