evidence-based acl reconstruction

There is controversy in the literature regarding a number of topics related to anterior cruciate ligament (acl) reconstruction. the purpose of this article is to answer the following questions: 1) bone-patellar tendon-bone reconstruction (bptb-r) or hamstrimg reconstruction (h-r); 2) double bundle or single bundle; 3) allograft or authograft; 4) early or late reconstruction; 5) rate of return to sports after acl reconstruction; 6) rate of osteoarthritis after acl reconstruction. a cochrane library and pubmed (medline) search of systematic reviews and meta-analysis related to acl reconstruction was performed. the key words were: acl reconstruction, systematic reviews and meta-analysis. the main criteria for selection were that the articles were systematic reviews and meta-analyses focused on the aforementioned questions. sixty-nine articles were found, but only 26 were selected and reviewed because they had a high grade (i-ii) of evidence. bptb-r was associated with better postoperative knee stability but with a higher rate of morbidity. however, the results of both procedures in terms of functional outcome in the long-term were similar. the double-bundle acl reconstruction technique showed better outcomes in rotational laxity, although functional recovery was similar between single-bundle and double-bundle. autograft yielded better results than allograft. there was no difference between early and delayed reconstruction. 82% of patients were able to return to some kind of sport participation. 28% of patients presented radiological signs of osteoarthritis with a follow-up of minimum 10 years.