Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 22, Issue 7, pp 1467–1482 | Cite as

Anatomic anterior cruciate ligament (ACL) reconstruction: a global perspective. Part 1

  • K. K. Middleton
  • T. Hamilton
  • J. J. Irrgang
  • J. Karlsson
  • C. D. Harner
  • F. H. FuEmail author



In August 2011, orthopaedic surgeons from more than 20 countries attended a summit on anatomic anterior cruciate ligament (ACL) reconstruction. The summit offered a unique opportunity to discuss current concepts, approaches, and techniques in the field of ACL reconstruction among leading surgeons in the field.


Five panels (with 36 panellists) were conducted on key issues in ACL surgery: anatomic ACL reconstruction, rehabilitation and return to activity following anatomic ACL reconstruction, failure after ACL reconstruction, revision anatomic ACL reconstruction, and partial ACL injuries and ACL augmentation. Panellists’ responses were secondarily collected using an online survey.


Thirty-six panellists (35 surgeons and 1 physical therapist) sat on at least one panel. Of the 35 surgeons surveyed, 22 reported performing “anatomic” ACL reconstructions. The preferred graft choice was hamstring tendon autograft (53.1 %) followed by bone-patellar tendon-bone autograft (22.8 %), allograft (13.5 %), and quadriceps tendon autograft (10.6 %). Patients generally returned to play after an average of 6 months, with return to full competition after an average of 8 months. ACL reconstruction “failure” was defined by 12 surgeons as instability and pathological laxity on examination, a need for revision, and/or evidence of tear on magnetic resonance imaging. The average percentage of patients meeting the criteria for “failure” was 8.2 %.


These data summarize the results of five panels on anatomic ACL reconstruction. The most popular graft choice among surgeons for primary ACL reconstructions is hamstring tendon autograft, with allograft being used most frequently employed in revision cases. Nearly half of the surgeons surveyed performed both single- and double-bundle ACL reconstructions depending on certain criteria. Regardless of the technique regularly employed, there was unanimous support among surgeons for the use of “anatomic” reconstructions using bony and soft tissue remnant landmarks.

Level of evidence



Anatomic ACL reconstruction Global perspectives Summit 



We gratefully acknowledge each and every panellist for their participation in this endeavour, including their participation at the Panther Global Summit and their verification of the data presented in this article. We would also like to acknowledge the efforts of all University of Pittsburgh Sports Medicine research fellows who assisted in data collection and Sara Herold for her assistance with statistics. Finally, we would like to thank Dr. Pau Golanó for the femoral and tibial ACL insertion site dissections.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • K. K. Middleton
    • 1
  • T. Hamilton
    • 1
  • J. J. Irrgang
    • 1
  • J. Karlsson
    • 2
  • C. D. Harner
    • 1
  • F. H. Fu
    • 1
    Email author
  1. 1.Department of Orthopaedic SurgeryUniversity of Pittsburgh School of MedicinePittsburghUSA
  2. 2.Department of OrthopaedicsGötenborg UniversityGöteborgSweden

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