Controversies in ACL reconstruction: bone-patellar tendon-bone anterior cruciate ligament reconstruction remains the gold standard.

Controversy exists regarding the best surgical technique and graft for anterior cruciate ligament reconstruction. No technique or graft currently recreates the complex nature of the native ligament. Reconstruction with single-bundle bone-patellar tendon-bone autograft with interference screw fixation has superior results, using the following criteria, compared with the results of other reconstructive techniques. It has the least measurable laxity and the fastest graft incorporation. It has the lowest failure rate. It has no outside procurement costs and no risk of disease transmission. It is extremely reliable. Interference screw bony fixation remains the gold standard. The authors prefer this graft and technique for all patients, especially for young adult males, for patients with hyperlaxity, and for patients without antecedent anterior knee pain. Despite excellent results, problems with rotational instability persist. A more horizontal single-bundle reconstruction may decrease this instability. The senior author's (M.D.M.) surgical technique is described in this article.