Anatomic reconstruction of anterior cruciate ligament: concept, indication and its efficacy

The anterior cruciate ligament (ACL) is a dynamic structure, rich in neurovascular supply and comprised of distinct bundles, which function synergistically to facilitate normal knee kinematics in concert with bony morphology. Characterized by individual uniqueness, the ACL is inherently subject to both anatomic and morphological variations as well as physiologic aging. With an expanding knowledge of ACL structure and function, reconstructive techniques increasingly seek to restore the ACL to its native dimensions, collagen orientation, and insertion sites. Furthermore, growing appreciation for morphological variation among individual patients warrants a personalized approach, including the selection of appropriate graft type and size. This article highlights our current understanding of the anatomy and function as well as our approach to individualized, anatomic ACL reconstruction. Future directions for improved treatment of ACL injuries are also considered.