Anatomical ACL Reconstruction

Dr Freddie Fu was a pioneer of sports medicine, making numerous scientific contributions that ultimately improved patient care. He was perhaps best known as a world expert on the anterior cruciate ligament (ACL). Herein we review the seminal studies of Dr Fu guiding the evolution and adoption of anatomical ACL reconstruction. From these studies, Dr Fu defined the ACL as a dynamic structure, rich in neurovascular supply and comprised of distinct bundles, which function synergistically to facilitate normal knee kinematics in concert with bony morphology. Characterized by individual uniqueness, the ACL is inherently subject to both anatomical and morphological variations as well as physiologic aging. Accordingly, anatomical ACL reconstruction entails the functional restoration of the ACL to its native dimensions, collagen orientation, and insertion sites according to individual anatomy. Anatomical ACL reconstruction has been consistently demonstrated to be superior to traditional (Ie, non-anatomical) ACL reconstruction in restoring knee stability, but graft failure and an inability to return to pre-injury sporting levels remain a challenge. In embracing the past discoveries and lessons afforded us by Dr Fu, we may embrace future efforts to improve outcomes for patients with an ACL injury.