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ACL injuries: the secret probably lies in optimising rehabilitation
  1. Adam G Culvenor1,2,
  2. Christian J Barton1,3
  1. 1 La Trobe Sports and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
  2. 2 Institute of Anatomy, Paracelsus Medical University Salzburg and Nuremburg, Salzburg, Austria
  3. 3 Department of Surgery, University of Melbourne, St. Vincent’s Hospital, Melbourne, Victoria, Australia
  1. Correspondence to Dr Christian J Barton, La Trobe Sports and Exercise Medicine Research Centre, School of Allied Health La Trobe University, Melbourne, Victoria 3086, Austria; c.barton{at}latrobe.edu.au

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Since the first report of surgical repair for a ruptured cruciate ligament in 1895, a great deal of research has attempted to identify the optimal surgical technique. Today, the two mainstay choices are hamstring–tendon and bone–patellar tendon–bone autografts, with preferences differing around the globe.1

Systematic reviews of randomised controlled trials have identified very few differences in outcomes more than 2 years postoperatively between these two popular graft choices.2 Similarly, variations of surgical technique, such as double-bundle reconstruction, while potentially providing greater passive stability, offer no proven superior clinical or functional outcomes.3

Clinician’s and researcher’s quest for the Holy Grail—a quick return to sport without re-injury or increased osteoarthritis risk—has led to less conventional management approaches. This includes an alarming resurgence of synthetic ligaments as described in a recent BJSM blog (http://blogs.bmj.com/bjsm/2017/07/06/synthetics-ligaments-knee-deja-vu-innovation/). Do we really need to pursue unconventional surgical interventions that have failed to stand the test of time?

Perhaps the secret for clinicians and researchers lies not in chasing the next sexy surgical trend but in ensuring completion of an outstanding rehabilitation programme. …

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