Surgical and Biomechanical Perspectives on Osteoarthritis and the ACL Deficient Knee: A Critical Review of the Literature

Richard Z Fu*, 1, David D Lin2
1 Department of Medicine, Imperial College London, UK
2 Department of Surgery, West Middlesex University Hospital, Imperial College Academic Health Sciences Partner, London, UK

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© Fu and Lin.; Licensee Bentham Open.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution License ( which permits unrestrictive use, distribution, and reproduction in any medium, provided the original work is properly cited.

* Address correspondence to this author at the Department of Medicine, Imperial College London, South Kensington Campus, London SW7 2AZ, UK; Tel: +44 (0)20 7589 5111; E-mail:


This review was undertaken to better understand the debate regarding the issue of osteoarthritis associated with anterior cruciate ligament (ACL) injuries, from a surgical and biomechanical standpoint. Much of the current debate focuses on contributory surgical factors and their relative roles in increasing or decreasing the risk of future osteoarthritis development, primarily highlighting the controversy over whether reconstructive surgery itself is necessarily protective. This review addresses the evolution of ACL reconstruction techniques over time, and with a view to thoroughly examine the role of surgery, outcome differences in procedural technique are reviewed, with a focus on open versus arthroscopic methods, graft choice and the use of a double versus single bundle reconstruction technique.

Moreover, other potentially important contributory factors are identified and discussed, such as intrinsic biomechanical alterations sustained at the time of initial injury, and how these may have a more significant role with regard to future osteoarthritic changes in the knee than previously attributed.

Keywords: : Anterior cruciate ligament, ACL, biomechanics, graft choice, injury, osteoarthritis, reconstruction, review..