Graft choices and fixation types in anterior cruciate ligament reconstruction

Purpose of review To review the most recent clinical research on anterior cruciate ligament surgery, including graft choices and fixation devices, and to provide insight into recent procedures being used to reconstruct the anterior cruciate ligament. Recent findings Evaluations of autograft choices, double-bundle techniques, and four-strand versus eight-strand double bundles and graft-fixation methods will be analyzed. Regarding autograft choices bone-patellar tendon-bone, hamstring, quadriceps, and bone-hamstring tendon-bone have all been demonstrated to be viable options. Some recent studies comparing bone-patellar tendon- bone autografts to hamstring autografts preferred hamstrings because of equivalent stability and lower pain scores at intermediate-term follow-up. Regarding the double-bundle technique, a recent biomechanical study showed greater rotational stability and better restoration of the knee kinematics with the double-bundle technique. Another study comparing an eight-stranded to a four-stranded double bundle showed increased stability when eight strands were used. In regards to soft-tissue-fixation techniques, recent studies showed increased success at the femoral end using the press-fit fixation and the endobutton fixation over interference screws. For soft tissue tibial tunnel fixation it was shown that BioScrew XtraLok demonstrated superior fixation over other fixation systems. Summary Although autograft bone-patellar tendon-bone has been the standard anterior cruciate ligament graft choice for years, other autograft choices have been demonstrated to be viable and perhaps superior options. Graft fixation is as important as is graft type. Regarding the double bundle technique, more clinical research is required for full understanding and acceptance of this procedure.