AANA Middle East Arthroscopy Master Course (International)-ACL Reconstruction

ACL Reconstruction

Pdf Summary

This comprehensive presentation by Professor Pietro M. Tonino addresses ongoing challenges and debates in anterior cruciate ligament (ACL) reconstruction, emphasizing that despite advancements, consensus on optimal surgical techniques and return-to-play criteria remains elusive.<br /><br />Key findings highlight that long-term outcomes after ACL reconstruction are mixed. Studies show only 60-70% of athletes, including elite NFL players, successfully return to their sports, with many facing re-injury or additional surgeries. Notably, the contralateral ACL tear risk is approximately double that of graft re-rupture. Factors influencing variable outcomes include associated meniscal and collateral ligament injuries, surgical variability in tunnel placement, graft choice (autograft vs. allograft), and postoperative rehabilitation quality.<br /><br />Surgical debate surrounds graft types, tunnel techniques (trans-tibial, anteromedial portal, outside-in), and single vs. double-bundle reconstructions, with no definitive superiority established. Efforts to use computer navigation and sockets have not conclusively improved outcomes. Rehabilitation remains inconsistent; insufficient or poorly timed return-to-play increases risk of overuse injuries.<br /><br />A critical gap exists in objective, standardized assessment tools for determining readiness to return to sport. Many studies rely on time elapsed post-surgery rather than functional tests or athlete-reported readiness, potentially leading to premature return and reinjury.<br /><br />Emerging research explores biologic adjuncts like bioactive scaffolds for ligament repair and anti-myostatin therapies to mitigate muscle atrophy post-surgery, aiming to improve recovery.<br /><br />Concluding, Professor Tonino underscores that despite decades of progress, ACL reconstruction is imperfect—surgeons "can repair but not replicate" the native ligament function. Continuous learning, individualized treatment considering associated injuries, surgical technique refinement, and improved rehabilitation protocols are essential. Importantly, emphasis on injury prevention remains critical to reduce the incidence and burden of ACL tears.

Keywords

ACL reconstruction

anterior cruciate ligament

surgical techniques

return to play

graft choice

rehabilitation protocols

re-injury risk

biologic adjuncts

functional assessment

injury prevention