ACL repairs have been around for a long time. I had one when I was a college athlete. Now my daughter who is a collegiate basketball player is having one. Has anything much changed over the years?

Anterior cruciate ligament (ACL) repairs have indeed been around for 30 years or more. Surgeons keep finding ways to improve it. In a recent review of ACL repairs, Dr. Ben Graf from the University of Wisconsin (Madison) gave a good summary of the last 30 years.

He said the first 10 years was spent proving ACL repairs were needed. The second 10 years worked on repairing it from the inside out. And the last decade has been looking at types of grafts (hamstring versus patellar tendon grafts).

The newest change is the use of a double-bundle repair to (maybe) replace the single-bundle method. No matter what kind of graft type used, there’s still a problem with early arthritis in the grafted knee. By studying normal anatomy, scientists think this may have to do with motion that is restricted by the ACL repair.

It seems that the standard single-bundle repair doesn’t allow the normal rotation of the tibia (lower leg bone). This type of motion is needed when an athlete pivots and shifts his or her weight to move in a different direction. The double-bundle repair attaches the tendon graft in two places instead of one. The idea is to mimic the anterior and posterior (front and back) attachments of the normal ACL.

But like many new things on the horizon, this one hasn’t been fully tested and approved. The next decade may bring many innovative changes. Improved technology and new surgical instruments will bring about these changes.