History of anterior cruciate ligament surgery

Abstract

The history of the anterior cruciate ligament (ACL) surgery is a very fascinating tale subject to constant evolution, as a path marked by multiple progresses and various long-lasting intuitions and ideas. Along the centuries improved anatomical, physiological and biomechanical knowledge has led to progressively better understand ACL ruptures and evolves from the initial conservative cast immobilization treatment of the past centuries to surgical repair and reconstruction. These reparative and reconstructive techniques have undergone constant evolutions and developments. From the eighties, the advent of arthroscopy enabled minimizing surgical invasiveness, adopting new, stronger and safer fixation devices and promoting quicker, safer, and more aggressive rehabilitation. Several reasons have led to an increase in the success rate, including rapid diagnosis and early treatment, factors that prevented the occurrence of associated meniscal and cartilaginous injuries which, often can cause complications, worsening of results and development of early osteoarthritis. Actually, conventional reconstructions using autologous hamstring tendons or bone-patellar tendon-bone grafts are the procedures most popular today, along with the use of quadriceps tendon grafts and allografts. Orthopedic surgeons have in the last years shown greater interest on understanding and reproducing more precisely ACL’s femoral and tibial insertions and this has opened up new horizons leading to increased studies toward biological reconstructions with preservation of ACL remnants through partial reconstructions procedures and all biological reparative procedures, including cell culture techniques, tissue engineering, and gene therapy.