An illustrated history of anterior cruciate ligament surgery.
ABSTRACT The past 30 years have brought remarkable change in the evolution of ACL surgery. Surgeons have recognized the important role of the ACL and developed techniques for its reconstruction. As these techniques evolved, certain themes echo throughout the historical literature. Dynamic, nonisometric operations have not worked well, nor have synthetic substitutes. Perhaps most importantly, the more anatomic the reconstruction, the better it was able to restore patient function and the more predictable the result. Technological advances allowed these techniques to be refined so that they are now routinely performed with less tissue trauma, faster recovery, and reproducibly excellent results. This article reviews the historical surgical progress that has evolved coupled with overlapping controversies and concepts, which have impacted surgical changes.
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ABSTRACT: Anterior cruciate ligament (ACL) reconstruction has evolved considerably over the past 30 years. This has largely been due to a better understanding of ACL anatomy and in particular a precise description of the femoral and tibial insertions of its two bundles. In the 1980s, the gold standard was anteromedial bundle reconstruction using the middle third of the patellar ligament. Insufficient control of rotational laxity led to the development of double bundle ACL reconstruction. This concept, combined with a growing interest in preservation of the ACL remnant, led in turn to selective reconstruction in partial tears, and more recently to biological reconstruction with ACL remnant conservation. Current ACL reconstruction techniques are not uniform, depending on precise analysis of the type of lesion and the aspect of the ACL remnant in the intercondylar notch.International Orthopaedics 01/2013; · 2.32 Impact Factor
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ABSTRACT: Between 5 and 20% of patients undergoing ACL reconstruction fail and require revision. Animal studies have demonstrated slower incorporation of allograft tissue, which may affect the mechanism of graft failure. The purpose of this study is to determine the location of traumatic graft failure following ACL reconstruction and investigate differences in failure patterns between autografts and allografts. The medical records of 34 consecutive patients at our center undergoing revision ACL reconstruction following a documented traumatic re-injury were reviewed. Graft utilized in the primary reconstruction, time from initial reconstruction to re-injury, activity at re-injury, time to revision reconstruction, and location of ACL graft tear were recorded. Median patient age at primary ACL reconstruction was 18.5 years (range, 13-39 years). The primary reconstructions included 20 autografts (13 hamstrings, 6 patellar tendons, 1 iliotibial band), 12 allografts (5 patellar tendon, 5 tibialis anterior tendons, 2 achilles tendons), and 2 unknown. The median time from primary reconstruction to re-injury was 1.2 years (range, 0.4 - 17.6 years). The median time from re-injury to revision reconstruction was 10.4 weeks (range, 1 to 241 weeks). Failure location could be determined in 30 patients. In the autograft group 14 of 19 grafts failed near their femoral attachment, while in the allograft group 2 of 11 grafts failed near their femoral attachment (p < 0.02). When ACL autografts fail traumatically, they frequently fail near their femoral origin, while allograft reconstructions that fail are more likely to fail in other locations or stretch. Level III - Retrospective cohort study.Sports Medicine Arthroscopy Rehabilitation Therapy & Technology 06/2012; 4(1):22.