Editorial Commentary: What Is an Anatomic Anterior Cruciate Ligament Reconstruction, and Does It Matter? There Are Many Ways to Skin a Cat!

Abstract

The concept of an "anatomic" anterior cruciate ligament (ACL) reconstruction remains a major focus of active research in the literature, but the true definition remains elusive. Although most authors have defined this by a tunnel position contained within the native ligament footprint, it is clear that such a description is grossly inadequate to recapitulate the form and function of the native ACL: Aperture surface area, geometry, graft bundles, collagen fiber tension, and isometry, as well as incorporation and maturation, are all critical factors that affect the final outcome. It is clear that no single- or double-bundle ACL reconstruction in 2019 is in fact anatomic; rather, it is guided by the native anatomic landmarks to more appropriately place the new graft.