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ACL surgical innovation cycles: what goes around, comes around
  1. Robin Martin1,
  2. John Nyland2,
  3. Roland Peter Jakob3
  1. 1 Department of Orthopedic Surgery and Traumatology, Lausanne University Hospital, Lausanne, Switzerland
  2. 2 Athletic Training Program, Kosair Charities College of Health and Natural Sciences, Spalding University, Louisville, Kentucky, USA
  3. 3 University of Bern, Bern, Switzerland
  1. Correspondence to Dr Robin Martin, Orthopedics, Lausanne University Hospital, Lausanne 1011, Switzerland; robin.martin{at}


Over the past 45 years, the ‘gold standards’ for ACL surgery have evolved considerably. Many discoveries in the field of ACL surgery seem to come and go, in cycles. The aim of this paper was to confirm these cyclic phenomena by methodically researching the ACL literature. It proposes a bibliometric research of the literature over the last 45 years to assess temporal changes in publications on 3 topics of high interest in ACL surgery for which we hypothesised a cycle phenomenon: surgery to address anterolateral knee instability, ACL repair and prosthetic ACL reconstruction grafts. We searched PubMed from 1975 to 2019 with different equations and different Boolean operators. Review results are presented as graphs depicting the evolution of the annual publication number over the total number of PubMed results that year. Graph analysis confirmed cycles of interest in these 3 fields. When this analysis was put into perspective with the major historical articles in each field, cycles seem to have 5 typical phases: hope, inflation, disillusion, eclipse and rebirth. The initial hope-inflation and rebirth phase trend peak interval was approximately 35 years. Rebirth trend peak slope trajectories for each topic seemed to display more rapid and stronger rise times than the initial trend peak slope trajectories. These cyclic phenomena that were observed suggest that knee surgeons need to better balance early enthusiasm and hope for innovative surgical practice efficacy with the guidance of both scientific rigour derived evidence and history.

  • knee
  • anterior cruciate ligament
  • reconstructive surgical procedures

Statistics from


  • Contributors RPJ conceived the idea and supervised the manuscript. RM designed the bibliometric analysis, undertook the literature search, collected data and prepared the manuscript. JN was highly involved in writing and editing this manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Data availability statement Data are available upon request;

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