The Anterior Cruciate Ligament (ACL) plays a vital role in maintaining function and stability in the knee. Over the last several decades, much research has been focused on elucidating the anatomy, structural properties, biomechanics, pathology, and optimal treatments for the ACL. Through careful and objective study, the ACL can be understood to be a dynamic structure, rich in neurovascular supply. Although it is referred to as one ligament, it is comprised of two dis-tinct bundles which function synergistically to facilitate normal knee kinematics. The bony morphology of the knee defines normal knee kinematics, as well as the nature of the soft-tissue structures about the knee. Characterized by individual uniqueness, bony morphology varies from patient to patient. The ACL, which is a reflection of each patient's unique bony morphol-ogy, is inherently subject to both anatomic and morphologic variation as well. Furthermore, the ACL is subject to physiologic aging, which can affect the anatomic and structural properties of the ligament over time. A successful anatomic ACL Reconstruction, which may be considered the functional restoration of the ACL to its native dimensions, collagen orientation, and inser-tion sites according to individual anatomy, considers all these principles. It is vital to respect the nature we observe, rather than to “create” nature to fit a one-size-fits-all surgery. Double bundle ACL Reconstruction may therefore be thought of more as a concept rather than a specific technique, one that respects the individual unique anatomy of each patient to provide a truly indi-vidualized, anatomic, and value-based ACL Reconstruction.

Purpose: This study sought to examine return to sports in athletes younger than 25 following ACL reconstruction with either patellar tendon (PT) or hamstring (HS) autografts using a matched-pairs case-control experimental design.

Method: Twenty-three matched pairs were obtained based on gender (56.5% Female), age (18.3±2.5yrs PT vs.17.6±2.6 HS), and length of follow-up (4.7±2.1yrs PT vs. 4.2±1.6 HS). All patients reported participating in very strenuous (soccer, basketball etc.) or strenuous (skiing, tennis etc.) sporting activity 4–7 times/ week prior to their knee injury. Outcomes other than return to play included the IKDC, SAS, ADLS, SF-36, knee range of motion, laxity, and hop/jump testing.

Results: Most patients in both groups were able to participate in very strenuous or strenuous sporting activity at follow-up [18 (78.3%) PT vs. 19 (82.6%) HS]. However, only 13 (56.5%) of the patellar tendon subjects and 10 (43.5%) of the hamstrings patients were able to return to pre-injury activity levels in terms of frequency and type of sport (p=.63). Hamstrings patients showed higher ADLS (p< .01) and SAS (p< .01) scores and better restoration of extension (p< 0.05).

Conclusion: While autograft and allograft patellar tendon ACL reconstruction exhibit similar clinical outcomes in high-demand individuals, autogenous hamstring grafts may lead to better subjective outcomes in young patients who participate in very strenuous levels of activity. Both graft options only allowed approximately half of the injured athletes to return to their previous level of sporting activity.

Purpose: This study sought to compare clinical outcomes and return to activity in high-demand patients following ACL reconstruction with either autograft or allograft patellar tendon using a matched-pairs case-control experimental design.

Method: Nineteen matched pairs were obtained based on gender (36.8 % female), age (27.9±8.1yrs autograft versus 28.1±9.1 allograft), and length of follow-up (9.1±2.7yrs autograft versus 10.3±2.6 allograft). All patients reported participating in very strenuous (soccer, basketball etc.) or strenuous (skiing, tennis etc.) sporting activity 4–7 times/ week prior to their knee injury. Patient-reported outcomes included the IKDC Subjective Knee Form, Activities of Daily Living (ADLS) and Sports Activity Scales (SAS) of the Knee Outcome Survey and SF-36. Range of motion, laxity, and functional strength were also assessed.

Results: There were no significant differences in patient-reported or clinical outcome measures. Sixteen (84.2%) subjects undergoing autograft reconstruction and 12 (63.2%) subjects reconstructed with allograft were able to participate in strenuous or very strenuous sporting activity at follow-up (p=.34). Similar percentages of subjects were able to return to their pre-injury level of sports activity [12 (63.2%) autograft vs. 11 (57.9%) allograft; p=1.0]. Fewer subjects undergoing reconstruction with autograft reported instability with very strenuous activity [5 (26.3%) autograft vs. 12 (63.2%) allograft], but this difference was not significant (p=.07).

Conclusion: While autograft and allograft patellar tendon ACL reconstruction exhibit similar clinical outcomes in high-demand individuals, autogenous patellar tendon grafts may be indicated to allow patients to return to very strenuous levels of activity.

Purpose: While several studies have reported improved pain control with use of femoral nerve blocks (FNB) following ACL reconstruction, there are few studies that have evaluated the effect of continuous perineural infusion on quadriceps activation and recovery of range of motion after ACL reconstruction. The purpose of this prospective randomized placebo-controlled clinical trial was to determine if the use of continuous infusion of levobupivacaine for pain control following ACL reconstruction had an adverse effect on postoperative quadriceps activation and recovery of ROM.

Method: Two-hundred-seventy patients underwent ACL reconstruction and were randomly assigned to one of three FNB groups (placebo bolus and infusion, active bolus with placebo infusion, or active bolus and continuous infusion). The patients’ ability to perform a SLR was assessed daily for the first four post-operative days. Range of motion of the knee was measured with a goniometer 1, 4, 8 and 12 weeks after surgery. Range of motion complications requiring arthroscopic debridement, manipulation under anesthesia, or application of a drop-out cast were recorded.

Results: There were no significant differences between groups in their ability to perform a SLR on postoperative day 1 through 4. There were also no differences between active and passive ROM values between groups at each follow-up period. There were 7 (3.2%) early ROM complications, but no detectable differences between groups.

Conclusion: Continuous perineural infusion of levobupivacaine (0.25% at 5mL/hr for 50 hours) following ACL reconstruction does not appear to negatively influence quadriceps activation as evidenced by the inability to perform a SLR or adversely affect recovery of range of motion in the early postoperative period after ACL reconstruction. Continuous perineural infusion can provide effective pain relief without adversely affecting post-operative recovery following ACL reconstruction.