Data source: the Pubmed database was used (www.pubmed.com). Search was limited to articles written in English, Portuguese and French. 65 articles were included.

 

Data synthesis: availability, safety, low cost and biological characteristics make autograft the “gold-standard” for the reconstruction of the anterior cruciate ligament (ACL). Bone-patellar tendon-bone graft is the most used, but four-strand hamstring graft has gain more popularity because of its lower morbidity. The classical single-bundle ACL reconstruction can restore anteroposterior stability although it fails to support combined rotatory forces. Double-bundle reconstruction can sometimes restore knee kinematics more accurately. Femoral drilling via the anteromedial portal results in a significantly more anatomic and more oblique tunnel in the coronal plane. Fixation methods have technical problems, although there is no significant difference in outcomes between them.

 

Conclusion: More than a century after the first surgical reconstruction of the ACL we still continue looking for the ideal graft; a graft that is biologically integrated and able to reproduce the anatomy, biomechanics and neuromuscular control, still does not exist. Graft choice is multifactorial.

 

 

Key-words: Anterior Cruciate Ligament; Reconstruction; Controversies.