The AAOS Clinical Practice Guideline for Management of Anterior Cruciate Ligament Injuries was updated in August 2022, replacing the 2014 version. The guideline strongly recommends using autograft over allograft for ACL reconstruction to improve patient outcomes and decrease graft failure rates, particularly in young and active patients. For skeletally mature patients undergoing autograft reconstruction, surgeons may favor bone-patellar tendon-bone (BTB) to reduce graft failure risk or hamstring to reduce anterior knee pain. ACL reconstruction is favoured over repair. Evidence supports reconstruction in athletic patients over 50 when based on physiological age rather than chronological age alone. A moderate recommendation suggests anterolateral ligament or lateral extra-articular tenodesis could be considered with hamstring autograft in select patients to reduce graft failure. The guideline accounts for skeletal maturity and activity level, noting that skeletal maturity and age are related but not identical. Full details at orthoguidelines.org.
ACL injuries (AAOS CPG)
