Timing of surgery in anterior cruciate ligament-injured knees
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Despite recent advances in the surgical techniques of anterior cruciate ligament (ACL) reconstruction in the past two decades, there is no consensus of opinion as to the ideal timing for ACL surgery. Based on the evolution of management of patients with ACL injuries over the period 1982–1994, we have found that various factors need to be considered in order to provide the best possible long-term result to the patient with minimal or no complications. In this review, we discuss the perioperative factors that one must consider to determine optimum timing for ACL surgery. Factors such as mental preparation of the patient; school, work, family, and social schedules; preoperative condition of the knee [i.e., minimal or no swelling, good strength, good leg control, and full range of motion (ROM) including full hyperextension]; and associated ligamentous and/or meniscal injuries must be considered before undertaking ACL surgery. With careful consideration of the above-mentioned factors and with our preoperative and postoperative rehabilitation program, we have been able to obtain predictable, successufl, long-term results following ACL reconstruction in our athletic population. We emphasize that every patient should be treated on his or her own merit, and treatment decisions must be individualized.
Key wordsAnterior cruciate ligament Prevention of complications Timing of surgery
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- 5.Johnson GE, Shelbourne KD (1993) Patient selection for anterior cruciate ligament reconstruction. Oper Tech Sports Med 1: 16–21Google Scholar
- 8.Rubinstein RA, Jr, Shelbourne KD (1993) Management of combined instabilities: anterior cruciate ligament/medial collateral ligament and anterior cruciate ligament/lateral side. Oper Tech Sports Med 1:66–71Google Scholar
- 9.Rubinstein RA Jr, Shelbourne KD (1993) Prevention of complications and minimizing morbidity after autogenous bonepatellar tendon-bone anterior cruciate ligament reconstruction. Oper Tech Sports Med 1:72–78Google Scholar
- 12.Shelbourne KD, Foulk DA (1995) Effect of timing of surgery in acute anterior cruciate ligament tears on the return of quadriceps strength following reconstruction using an autogenous patellar tendon graft. Am J Sports Med (in press)Google Scholar
- 18.Shelbourne KD, Rubinstein RA Jr, McCarroll JR, Weaver J (1994) Postoperative cryotherapy for the knee in ACL reconstructive surgery. Orthop Int Ec 2:165–170Google Scholar
- 19.Shelbourne KD, Klootwyk TE, Wilckens JH (1995) Ligament stability 2 to 6 years after anterior cruciate ligament reconstruction with autogenous patellar tendon graft and participation in accelerated rehabilitation program. Am J Sports Med (in press)Google Scholar
- 22.Woo SL-Y, Young EP, Ohland KJ, Marcin JP, Horibe S, Lin H-C (1990) The effects of transection of the anterior cruciate ligament on healing of the medial collateral ligament: a biomechanical study of the knee in dogs. J Bone Joint Surg [Am] 72: 382–392Google Scholar