Clinical Results in ACL Surgery

After the quite disappointing results obtained in the treatment of ACL-deficient knee with extra-articular reconstructions used in isolation, since the early 1980s intraarticular reconstructions become our standard treatment. Although several changes occurred in the technique and in devices used for femoral and tibial fixation of the graft, we have been always linked to three basic principles which included: semitendinosus and gracilis as graft of choice, anatomic placement of the intraarticular graft through an out-in technique of femoral drilling, and use of extra-articular reconstruction as an adjunct whenever needed. Since the November 1979, when the original Puddu’s technique was first introduced, as a result of a series of important adjustments, the results continuously improved to date. Nowadays, on the basis of our experience and medium- and long-term follow-up studies, we can reasonably state that: hamstrings represent a reliable graft as ACL substitute; anatomic intraarticular placement of the graft results in an excellent control of knee instability; ACL surgery can be effectively and safely performed in the acute tears; use of extra-articular reconstruction in case of severe instability and risky patients improves knee stability and reduces rate of failure with no risk of limiting range of motion or increasing risk of postoperative osteoarthrosis. With appropriate surgical technique and selection of patients, the overall rate of success of this surgical approach to ACL-deficient knee would raise to more than 95% of cases.