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1Introduction13to mid-term results.25 The patient in question had reported his leg to be ‘perfectly strong’ with a follow-up of eight years. However, by 1916 Feagin and Curl had concluded that ‘it was our hope that anatomic repositioning of the residual ligament would result in healing. Unfortunately, long-term followup evaluations do not justify the hope.’7 ACL repair was by then considered a non-viable option and the focus turned towards ACL reconstruction.In 1917 Hey Groves published a technique using a strip of the fascia lata which was detached from its insertion and directed through a tunnel that was drilled in the tibia. This technique still forms the basis for current intra-articular reconstructions of the ACL. Almost 20 years later, in 1934, Galleazi was the first to report on the use of a hamstring tendon graft to reconstruct the ACL.4 At around the same time Campbell used the patellar tendon as a graft, a technique popularised a few years later by McIntosh. In 1963 the patellar tendon technique was revolutionarily altered by Jones.16 His technique included harvesting the middle third of the patellar tendon along with a patellar bone block, while leaving the graft attached to the tibial tuberosity. Because of inadequate length of the graft, the femoral tunnel had to be located anteriorly on the medial wall of the lateral condyle of the femur. In 1969 Franke was the first to describe use of a free bone-patellar tendon-bone (BPTB) graft. By 1990 this technique was considered the gold standard and became known as the Jones procedure, honouring the pioneering work performed by Jones in the early 1960s.4 Around the turn of the 21st century, a shift was made towards use of a hamstring graft.10 This evolved from a single-strand semitendinosus graft to a quadrupled combined gracilis/semitendinosus graft. The hamstring and BPTB grafts are still considered the primary choices for ACL reconstruction, followed by quadriceps tendon graft and allografts. Nowadays the choice of graft should be patient-specific, based on clinical demands, patient characteristics and patient expectations.21With the rise of arthroscopic treatments in the 1960s and 1970s, the number of ACL reconstructions have risen enormously. First only the tibial tunnel was drilled arthroscopically-assisted, but with the development of arthroscopic surgical guides for the femoral tunnel it became possible to create both tunnels from outside-in under arthroscopic control.3 The Mark Zee.indd 13 03-01-2024 08:55