title: Controversies in soft-tissue anterior cruciate ligament reconstruction: grafts, bundles, tunnels, fixation, and harvest.
abstract: Increased stability has been reported with both autografts and allografts for anterior cruciate ligament (ACL) reconstruction. However, meta-analysis has shown significantly lower overall knee stability rates and more than double the abnormal stability rate with allografts. Some issues surrounding allograft sterilization (ie, risk of disease transmission) are unresolved, and cost is also a concern. Single-bundle ACL reconstruction can produce high stability rates when tunnels are properly placed, but there is evidence that double-bundle repair may offer greater rotatory stability. Cortical fixation has been associated with increased stability owing to the high stiffness of cortical bone. Anterior and posterior approaches are both recommended. The controversy related to single-bundle versus double-bundle ACL reconstruction remains unresolved.
authors.affiliation: Orthopaedic Center Research Department, Illinois Sports Medicine, 1720 Milwaukee Avenue, Glenview, IL 60025, USA.
authors.forename: Chadwick C
authors.initials: CC
authors.lastname: Prodromos
authors.forename: Freddie H
authors.initials: FH
authors.lastname: Fu
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Howell
authors.forename: Donald H
authors.initials: DH
authors.lastname: Johnson
authors.forename: Keith
authors.initials: K
authors.lastname: Lawhorn
mesh_terms: D016118:Anterior Cruciate Ligament / Q000601:surgery* / Q000637:transplantation*; D001424:Bacterial Infections / Q000517:prevention & control; D001863:Bone Screws; D006801:Humans; D016268:Internal Fixators; D019637:Orthopedic Procedures / Q000295:instrumentation / Q000379:methods*; D014182:Transplantation, Autologous / Q000379:methods; D014184:Transplantation, Homologous / Q000379:methods