Residual rotatory laxity after anterior cruciate ligament reconstruction: How do we diagnose it and prevent it?

Despite the continuous advances in anterior cruciate ligament surgery, residual rotatory laxity still represents a concrete issue that could be responsible for unsatisfactory results in over 10% of patients. Rotational laxity has been correlated with poor outcomes, degenerative changes, meniscal lesions, and premature graft failure. Residual rotatory laxity is quite difficult to diagnose, and new noninvasive devices have been developed to improve clinical diagnosis and permit an individualized approach based on constant evaluation of the specific condition. Anterior cruciate ligament reconstruction with a lateral plasty has been proposed for better rotational control and is gaining acceptance in the last few years. The menisci are secondary restraints to tibial anteroposterior translation and when lacking require attention to improve clinical results. This article is focused on the importance of the residual rotatory laxity after anterior cruciate ligament surgery, how to improve it, how to diagnose it using new available tools, and finally how this information influences the surgical approach in order to decrease the failure rate.