Galassi L, Santoro GD, Cugliari M, Schena D. Anterior cruciate ligament reconstruction in the modern era: A patient-centered approach. World J Clin Cases 2025; 13(31): 109712 [DOI: 10.12998/wjcc.v13.i31.109712]
Corresponding Author of This Article
Luca Galassi, Lecturer, MD, Researcher, Postgraduate School of Vascular and Endovascular Surgery, University of Milan, Festa del Perdono Street, Milan 20122, Lombardy, Italy. luca.galassi@unimi.it
Research Domain of This Article
Orthopedics
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Nov 6, 2025 (publication date) through Nov 8, 2025
Times Cited of This Article
Times Cited (0)
Journal Information of This Article
Publication Name
World Journal of Clinical Cases
ISSN
2307-8960
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Galassi L, Santoro GD, Cugliari M, Schena D. Anterior cruciate ligament reconstruction in the modern era: A patient-centered approach. World J Clin Cases 2025; 13(31): 109712 [DOI: 10.12998/wjcc.v13.i31.109712]
Anterior cruciate ligament reconstruction in the modern era: A patient-centered approach
Luca Galassi, Giuseppe Diodato Santoro, Marianna Cugliari, Daniele Schena
Luca Galassi, Postgraduate School of Vascular and Endovascular Surgery, University of Milan, Milan 20122, Lombardy, Italy
Giuseppe Diodato Santoro, Marianna Cugliari, Postgraduate School of Orthopaedics and Traumatology Surgery, University of Milan, Milan 20122, Lombardy, Italy
Daniele Schena, Orthopaedics and Traumatology Unit, ASST Bergamo Est, P.O. Pesenti Fenaroli, Alzano Lombardo 24022, Lombardy, Italy
Co-first authors: Luca Galassi and Giuseppe Diodato Santoro.
Author contributions: Galassi L and Santoro GD contributed to conceptualization; methodology, validation; Galassi L, Cugliari M, and Santoro G contributed to writing—original draft preparation; Galassi L, Santoro GD, Cugliari M, and Schena D contributed to writing—review and editing; all authors have read and agreed to the published version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Luca Galassi, Lecturer, MD, Researcher, Postgraduate School of Vascular and Endovascular Surgery, University of Milan, Festa del Perdono Street, Milan 20122, Lombardy, Italy. luca.galassi@unimi.it
Received: May 19, 2025 Revised: June 9, 2025 Accepted: September 2, 2025 Published online: November 6, 2025 Processing time: 164 Days and 10.6 Hours
Abstract
Anterior cruciate ligament (ACL) injuries are among the most frequent knee pathologies, with athletes—particularly females and those in pivot-heavy sports such as soccer, basketball, volleyball, and skiing—at increased risk. The success of ACL reconstruction is multifactorial, relying on individualized graft selection, surgical precision, patient-specific characteristics, and optimized rehabilitation. Despite the availability of various graft options—hamstring tendon, bone-patellar tendon-bone, and quadriceps tendon—no single type has demonstrated clear superiority, reinforcing the need for patient-tailored approaches based on anatomical, functional, and age-related factors. Surgical techniques continue to evolve, with adaptations such as physeal-sparing methods for skeletally immature patients and minimally invasive procedures aimed at reducing morbidity and improving recovery. Rehabilitation is a critical determinant of functional outcomes. Current evidence supports immediate mobilization, early weight-bearing, and initiation of neuromuscular and strength training, while routine use of continuous passive motion and bracing is discouraged, except in multi-ligament injuries. Prehabilitation is recommended, though accelerated rehabilitation remains controversial. Implant choice and fixation strategy are also essential to long-term success. The use of materials that reduce the risk of chronic complications and support biological integration is increasingly favored. Nevertheless, rare mechanical failures emphasize the need for accurate tunnel placement, appropriate implant selection, and vigilant postoperative monitoring. Outcomes are further influenced by patient-specific variables, including bone quality, metabolic status, and physical activity levels. Optimal ACL reconstruction results from a comprehensive, patient-centered strategy that integrates surgical accuracy, individualized rehabilitation, and continuous follow-up to minimize complications and enhance recovery.
Core Tip: Optimal outcomes in anterior cruciate ligament reconstruction depend on more than technical precision, they require a personalized approach accounting for patient-specific anatomy, sport demands, comorbidities, and psychological readiness. This review offers a comprehensive synthesis of current best practices across graft choice, surgical technique, rehabilitation, and postoperative monitoring to guide individualized clinical decision-making.
