Anatomic single- and double-bundle anterior cruciate ligament reconstruction flowchart

Arthroscopy. 2010 Feb;26(2):258-68. doi: 10.1016/j.arthro.2009.07.027.


Anatomy is the foundation of orthopaedic surgery, and the advancing knowledge of the anterior cruciate ligament (ACL) anatomy has led to the development of improved modern reconstruction techniques that approach the anatomy of the native ACL. Current literature on the anatomy of the ACL and its reconstruction techniques, as well as our surgical experience, was used to develop a flowchart that can aid the surgeon in performing anatomic ACL reconstruction. We define anatomic ACL reconstruction as the functional restoration of the ACL to its native dimensions, collagen orientation, and insertion sites. A guideline was written to accompany this flowchart with more detailed information on anatomic ACL reconstruction and its pitfalls, all accompanied by relevant literature and helpful figures. Although there is still much to learn about anatomic ACL reconstruction methods, we believe this is a helpful document for surgeons. We continue to modify the flowchart as more information about the anatomy of the ACL, and how to more closely reproduce it, becomes available.

MeSH terms

  • Anterior Cruciate Ligament / anatomy & histology*
  • Anterior Cruciate Ligament / surgery*
  • Arthroscopy / methods*
  • Biomechanical Phenomena
  • Cadaver
  • Humans
  • Joint Instability / surgery*
  • Knee Joint / pathology
  • Knee Joint / surgery
  • Outcome Assessment, Health Care
  • Posterior Cruciate Ligament / anatomy & histology
  • Practice Guidelines as Topic
  • Reconstructive Surgical Procedures / methods*
  • Rupture, Spontaneous / pathology