{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T19:02:13Z","timestamp":1789844533274,"version":"4.0.1"},"reference-count":126,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T00:00:00Z","timestamp":1779408000000},"content-version":"vor","delay-in-days":51,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["esskajournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J. exp. orthop."],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To synthesize recent developments in anterior cruciate ligament reconstruction (ACLR), highlighting emerging evidence, evolving surgical strategies, and persistent controversies in risk stratification, graft selection, surgical planning and rehabilitation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A narrative review of the recent literature (2023\u20132026) was conducted, incorporating randomized controlled trials, systematic reviews, large registry analyses and emerging studies. The review focused on evolving concepts in graft selection, imaging\u2010guided surgical planning, biomechanical risk factors, neuromuscular recovery and long\u2010term outcomes following ACL reconstruction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Quadriceps tendon autografts have gained prominence for their robust dimensions and low donor\u2010site morbidity, with bone\u2010block variants potentially enhancing rotational stability. Imaging innovations\u20143D mapping, navigation and individualized morphometrics\u2014improve tunnel precision. New studies reinforce posterior tibial slope, notch shape and hyperextension as critical anatomical risk factors. Neuromuscular training techniques such as VR\u2010based rehabilitation, blood flow restriction, and individualized strength timelines improve functional symmetry and readiness. Registry data show rising ACLR rates, especially among young females, and link failure to younger age, high activity, delayed surgery and septic arthritis. PROMs correlate poorly with objective performance, underscoring the need for integrated assessment. Long\u2010term outcomes remain favourable across graft types, with no consistent differences in osteoarthritis progression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>ACLR is transitioning toward a precision\u2010based, individualized model. This paradigm shift integrates anatomical risk profiling, tailored graft selection, and multimodal rehabilitation to optimize both biological and functional outcomes. Yet, unresolved questions, around pediatric predictors, repair techniques, and real\u2010world adherence, highlight the need for ongoing refinement. The field is evolving from reconstruction toward comprehensive restoration, grounded in anatomy, technology and behavioural science.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>Level V, narrative review.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jeo2.70766","type":"journal-article","created":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T11:36:52Z","timestamp":1779449812000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Advances in anterior cruciate ligament reconstruction: Risk stratification, graft choices, and functional recovery in 2026"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9545-7454","authenticated-orcid":false,"given":"M. Enes","family":"Kayaalp","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Traumatology University of Health Sciences, Istanbul Fatih Sultan Mehmet Training and Research Hospital  Istanbul T\u00fcrkiye"},{"name":"Department of Orthopaedics and Traumatology University Hospital Brandenburg\/Havel, Brandenburg Medical School Theodor Fontane  Brandenburg Havel Germany"},{"name":"Faculty of Health Sciences Brandenburg Brandenburg Medical School Theodor Fontane  Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Efstathios","family":"Konstantinou","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Musculoskeletal Trauma University Hospital of Larisa, School of Health Sciences, University of Thessaly Larisa Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gian A.","family":"Lucidi","sequence":"additional","affiliation":[{"name":"II Clinica, IRCCS Istituto Ortopedico Rizzoli Bologna Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"O\u011fuzhan","family":"Ak","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Orthopaedics and Traumatology Gazi University Ankara T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Mengis","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery and Traumatology Kantonsspital Baselland Bruderholz Switzerland"},{"name":"Department of Clinical Research, Research Group Michael T. Hirschmann, Regenerative Medicine &amp; Biomechanics University of Basel Basel Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koji","family":"Nukuto","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Kobe University Graduate School of Medicine Kobe Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamit C.","family":"Kahraman","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology University of Health Sciences, Istanbul Fatih Sultan Mehmet Training and Research Hospital  Istanbul T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erdem A.","family":"Sezgin","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Department of Orthopaedics and Traumatology Gazi University Ankara 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