Given how common ACL injuries have become, it not surprising that both research and industry have attempted to simplify orthopaedic procedures like ACL reconstruction by creating “one-size-fits-all” approaches for surgical devices and graft sizes. While such treatments may work well for most patients, human variation often creates a bell curve of anatomy, size, injury patterns, and athletic goals, and applying a standardized approach will poorly serve patients whose injuries, anatomies, and ambitions are in the tails of the bell-shaped curve. Indeed, using the same size graft and positioning tunnels in the same location simply does not make sense given the wide variation in bony morphology; the same may be true for the operation itself (“ACL reconstruction” is not a single operation, but a family of operations that includes a wide menu of surgical options), and its aftercare. Ensuring that the surgery fits the patient’s individual anatomy, injury pattern, and athletic demands can prevent many surgical complications, including graft rupture and the revision procedures that might follow.
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