Editorial Commentary: Proper Graft Choice and Lateral Extra-Articular Tenodesis Are Key to Successful Anterior Cruciate Ligament Reconstruction in Female Soccer Players.

Abstract

Over the last decade, techniques and outcomes of anterior cruciate ligament reconstruction have evolved dramatically. We have improved our graft choices from favoring autograft over allograft in younger patients and transitioned from transtibial to independent drilling to improve our femoral tunnel position, but our outcomes were still disappointing in high-risk populations such as those with generalized ligament laxity and female soccer (football) players with low return to sports rates, incomplete restoration of rotatory stability, and relatively high rates of osteoarthritis. With the renewed focus on extra-articular procedures, predominantly anterolateral ligament reconstruction and lateral extra-articular tenodesis, and avoiding the use of isolated soft-tissue grafts in high-risk patients, outcomes have significantly improved over the last decade. The indications for extra-articular procedures have expanded and the minimal downsides seem to validate this trend. Careful documentation and monitoring of long-term incidence of posttraumatic osteoarthritis will be the final step in implementing these additional procedures most active patients.