sports medicine

ACL Reconstruction and Graft Selection

intermediate

6 min

28 marks

6 questions

Clinical Scenario

A 24-year-old male semi-professional soccer player presents with right knee instability 8 weeks after a non-contact pivoting injury during a match. He describes his knee "giving way" when changing direction. MRI confirms complete ACL rupture with intact medial and lateral menisci. Clinical examination reveals grade 2 Lachman (soft endpoint), positive pivot shift, and full range of motion. There is no effusion. He wishes to continue competitive sport.

MRI images are provided showing the ACL rupture.

Open Full Size

Clinical image for ACL Reconstruction and Graft Selection

Image source: Open Access medical literature (NIH/PubMed Central) • CC-BY License

Questions

Question 1 (4 marks)

Describe the anatomy and biomechanics of the ACL. What is the function of the anteromedial and posterolateral bundles?

Question 2 (5 marks)

Describe your clinical assessment of an ACL-deficient knee. What are the key examination findings and their significance?

Question 3 (6 marks)

What graft options are available for ACL reconstruction? Compare the advantages and disadvantages of each.

Question 4 (5 marks)

Describe the key technical principles for ACL reconstruction. Where should the tunnels be positioned?

Question 5 (4 marks)

What factors affect return to sport after ACL reconstruction? What is the expected timeline?

Question 6 (4 marks)

What are the causes of ACL graft failure? How would you assess and manage a patient with recurrent instability after ACLR?

Exam Tips

→BPTB failure rate: 5-7% in athletes
→Hamstring failure rate: 7-10% in athletes
→Allograft in young: 25-30% failure (4x higher)
→RTS at 6 months: 5x increased reinjury