Advertisement

Anatomic anterior cruciate ligament reconstruction: a changing paradigm

  • Freddie H. Fu
  • Carola F. van Eck
  • Scott Tashman
  • James J. Irrgang
  • Morey S. Moreland
Knee

Abstract

Injury to the anterior cruciate ligament (ACL) of the knee is potentially devastating for the patient and can result in both acute and long-term clinical problems. Consequently, the ACL has always been and continues to be of great interest to orthopaedic scientists and clinicians worldwide. Major advancements in ACL surgery have been made in the past few years. ACL reconstruction has shifted from an open to arthroscopic procedure, in which a two- and later one-incision technique was applied. Studies have found that traditional, transtibial arthroscopic single-bundle reconstruction does not fully restore rotational stability of the knee joint, and as such, a more anatomic approach to ACL reconstruction has emerged. The goal of anatomic ACL reconstruction is to replicate the knee’s normal anatomy and restore its normal kinematics, all while protecting long-term knee health. This manuscript describes the research that has changed the paradigm of ACL reconstruction from traditional techniques to present day anatomic and individualized concepts.

Keywords

Anatomic ACL Anterior cruciate ligament Paradigm 

Notes

Acknowledgments

The department of Orthopaedic Surgery from the University of Pittsburgh receives funding from Smith and Nephew to support research related to reconstruction of the ACL.

References

  1. 1.
    Araujo PH, van Eck CF, Macalena JA, Fu FH (2011) Advances in the three-portal technique for anatomical single- or double-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 19:1239–1242CrossRefPubMedCentralPubMedGoogle Scholar
  2. 2.
    Arnoczky SP (1996) Biology of ACL reconstructions: what happens to the graft? Instr Course Lect 45:229–233PubMedGoogle Scholar
  3. 3.
    Casagranda BU, Maxwell NJ, Kavanagh EC, Towers JD, Shen W, Fu FH (2009) Normal appearance and complications of double-bundle and selective-bundle anterior cruciate ligament reconstructions using optimal MRI techniques. AJR Am J Roentgenol 192:1407–1415CrossRefPubMedGoogle Scholar
  4. 4.
    Chu CR, Williams AA, West RV, Qian Y, Fu FH, Do BH, Bruno S (2014) Quantitative Magnetic Resonance Imaging UTE-T2* Mapping of Cartilage and Meniscus Healing After Anatomic Anterior Cruciate Ligament Reconstruction Am J Sports Med doi: 10.1177/0363546514532227
  5. 5.
    Desai N, Bjornsson H, Musahl V, Bhandari M, Petzold M, Fu FH, Samuelsson K (2014) Anatomic single- versus double-bundle ACL reconstruction: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 22:1009–1023CrossRefPubMedGoogle Scholar
  6. 6.
    Ferretti M, Ekdahl M, Shen W, Fu FH (2007) Osseous landmarks of the femoral attachment of the anterior cruciate ligament: an anatomic study. Arthroscopy 23:1218–1225CrossRefPubMedGoogle Scholar
  7. 7.
    Ferretti M, Levicoff EA, Macpherson TA, Moreland MS, Cohen M, Fu FH (2007) The fetal anterior cruciate ligament: an anatomic and histologic study. Arthroscopy 23:278–283CrossRefPubMedGoogle Scholar
  8. 8.
    Forsythe B, Kopf S, Wong AK, Martins CA, Anderst W, Tashman S, Fu FH (2010) The location of femoral and tibial tunnels in anatomic double-bundle anterior cruciate ligament reconstruction analyzed by three-dimensional computed tomography models. J Bone Joint Surg Am 92:1418–1426CrossRefPubMedGoogle Scholar
  9. 9.
    Fu FH, Jordan SS (2007) The lateral intercondylar ridge–a key to anatomic anterior cruciate ligament reconstruction. J Bone Joint Surg Am 89:2103–2104CrossRefPubMedGoogle Scholar
  10. 10.
    Fu FH, Karlsson J (2010) A long journey to be anatomic. Knee Surg Sports Traumatol Arthrosc 18:1151–1153CrossRefPubMedGoogle Scholar
  11. 11.
    Gianotti SM, Marshall SW, Hume PA, Bunt L (2009) Incidence of anterior cruciate ligament injury and other knee ligament injuries: a national population-based study. J Sci Med Sport 12:622–627CrossRefPubMedGoogle Scholar
  12. 12.
    Harner CD, Irrgang JJ, Paul J, Dearwater S, Fu FH (1992) Loss of motion after anterior cruciate ligament reconstruction. Am J Sports Med 20:499–506CrossRefPubMedGoogle Scholar
  13. 13.
    Harner CD, Marks PH, Fu FH, Irrgang JJ, Silby MB, Mengato R (1994) Anterior cruciate ligament reconstruction: endoscopic versus two-incision technique. Arthroscopy 10:502–512CrossRefPubMedGoogle Scholar
  14. 14.
    Hussein M, van Eck CF, Cretnik A, Dinevski D, Fu FH (2012) Individualized anterior cruciate ligament surgery: a prospective study comparing anatomic single- and double-bundle reconstruction. Am J Sports Med 40:1781–1788CrossRefPubMedGoogle Scholar
  15. 15.
    Hussein M, van Eck CF, Cretnik A, Dinevski D, Fu FH (2012) Prospective randomized clinical evaluation of conventional single-bundle, anatomic single-bundle, and anatomic double-bundle anterior cruciate ligament reconstruction: 281 cases with 3- to 5-year follow-up. Am J Sports Med 40:512–520CrossRefPubMedGoogle Scholar
  16. 16.
    Hutchinson MR, Ash SA (2003) Resident’s ridge: assessing the cortical thickness of the lateral wall and roof of the intercondylar notch. Arthroscopy 19:931–935CrossRefPubMedGoogle Scholar
  17. 17.
    Illingworth KD, Hensler D, Working ZM, Macalena JA, Tashman S, Fu FH (2011) A simple evaluation of anterior cruciate ligament femoral tunnel position: the inclination angle and femoral tunnel angle. Am J Sports Med 39:2611–2618CrossRefPubMedGoogle Scholar
  18. 18.
    Iriuchishima T, Horaguchi T, Kubomura T, Morimoto Y, Fu FH (2011) Evaluation of the intercondylar roof impingement after anatomical double-bundle anterior cruciate ligament reconstruction using 3D-CT. Knee Surg Sports Traumatol Arthrosc 19:674–679CrossRefPubMedGoogle Scholar
  19. 19.
    Iriuchishima T, Tajima G, Ingham SJ, Shen W, Horaguchi T, Saito A, Smolinski P, Fu FH (2009) Intercondylar roof impingement pressure after anterior cruciate ligament reconstruction in a porcine model. Knee Surg Sports Traumatol Arthrosc 17:590–594CrossRefPubMedGoogle Scholar
  20. 20.
    Iriuchishima T, Tajima G, Ingham SJ, Shen W, Smolinski P, Fu FH (2010) Impingement pressure in the anatomical and nonanatomical anterior cruciate ligament reconstruction: a cadaver study. Am J Sports Med 38:1611–1617CrossRefPubMedGoogle Scholar
  21. 21.
    Johnson DL, Swenson TM, Irrgang JJ, Fu FH, Harner CD (1996) Revision anterior cruciate ligament surgery: experience from Pittsburgh. Clin Orthop Relat Res 325:100–109CrossRefPubMedGoogle Scholar
  22. 22.
    Kopf S, Forsythe B, Wong AK, Tashman S, Anderst W, Irrgang JJ, Fu FH (2010) Nonanatomic tunnel position in traditional transtibial single-bundle anterior cruciate ligament reconstruction evaluated by three-dimensional computed tomography. J Bone Joint Surg Am 92:1427–1431CrossRefPubMedCentralPubMedGoogle Scholar
  23. 23.
    Kopf S, Forsythe B, Wong AK, Tashman S, Irrgang JJ, Fu FH (2012) Transtibial ACL reconstruction technique fails to position drill tunnels anatomically in vivo 3D CT study. Knee Surg Sports Traumatol Arthrosc 20:2200–2207CrossRefPubMedCentralPubMedGoogle Scholar
  24. 24.
    Kopf S, Martin DE, Tashman S, Fu FH (2010) Effect of tibial drill angles on bone tunnel aperture during anterior cruciate ligament reconstruction. J Bone Joint Surg Am 92:871–881CrossRefPubMedGoogle Scholar
  25. 25.
    Kopf S, Pombo MW, Szczodry M, Irrgang JJ, Fu FH (2011) Size variability of the human anterior cruciate ligament insertion sites. Am J Sports Med 39:108–113CrossRefPubMedGoogle Scholar
  26. 26.
    Li RT, Lorenz S, Xu Y, Harner CD, Fu FH, Irrgang JJ (2011) Predictors of radiographic knee osteoarthritis after anterior cruciate ligament reconstruction. Am J Sports Med 39:2595–2603CrossRefPubMedGoogle Scholar
  27. 27.
    Loh JC, Fukuda Y, Tsuda E, Steadman RJ, Fu FH (2002) Woo SL (2003) Knee stability and graft function following anterior cruciate ligament reconstruction: Comparison between 11 o’clock and 10 o’clock femoral tunnel placement. Richard O’Connor Award paper Arthroscopy 19:297–304Google Scholar
  28. 28.
    Lohmander LS, Ostenberg A, Englund M, Roos H (2004) High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury. Arthritis Rheum 50:3145–3152CrossRefPubMedGoogle Scholar
  29. 29.
    Matsumoto T, Ingham SM, Mifune Y, Osawa A, Logar A, Usas A, Kuroda R, Kurosaka M, Fu FH, Huard J (2012) Isolation and characterization of human anterior cruciate ligament-derived vascular stem cells. Stem Cells Dev 21:859–872CrossRefPubMedCentralPubMedGoogle Scholar
  30. 30.
    Middleton KK, Hamilton T, Irrgang JJ, Karlsson J, Harner CD, Fu FH (2014) Anatomic anterior cruciate ligament (ACL) reconstruction: a global perspective. Part 1. Knee Surg Sports Traumatol Arthrosc 22:1467–1482CrossRefPubMedGoogle Scholar
  31. 31.
    Mott HW (1983) Semitendinosus anatomic reconstruction for cruciate ligament insufficiency. Clin Orthop Relat Res 172:90–92PubMedGoogle Scholar
  32. 32.
    Muneta T, Koga H, Mochizuki T, Ju YJ, Hara K, Nimura A, Yagishita K, Sekiya I (2007) A Prospective Randomized Study of 4-Strand Semitendinosus Tendon Anterior Cruciate Ligament Reconstruction Comparing Single-Bundle and Double-Bundle Techniques. Arthroscopy 23:618–628CrossRefPubMedGoogle Scholar
  33. 33.
    Sakane M, Fox RJ, Woo SL, Livesay GA, Li G, Fu FH (1997) In situ forces in the anterior cruciate ligament and its bundles in response to anterior tibial loads. J Orthop Res 15:285–293CrossRefPubMedGoogle Scholar
  34. 34.
    Shen W, Forsythe B, Ingham SM, Honkamp NJ, Fu FH (2008) Application of the anatomic double-bundle reconstruction concept to revision and augmentation anterior cruciate ligament surgeries. J Bone Joint Surg Am 90(Suppl 4):20–34CrossRefPubMedGoogle Scholar
  35. 35.
    Steckel H, Starman JS, Baums MH, Klinger HM, Schultz W, Fu FH (2007) Anatomy of the anterior cruciate ligament double bundle structure: a macroscopic evaluation. Scand J Med Sci Sports 17:387–392PubMedGoogle Scholar
  36. 36.
    Steckel H, Vadala G, Davis D, Fu FH (2006) 2D and 3D 3-tesla magnetic resonance imaging of the double bundle structure in anterior cruciate ligament anatomy. Knee Surg Sports Traumatol Arthrosc 14:1151–1158CrossRefPubMedGoogle Scholar
  37. 37.
    Takai S, Woo SL, Livesay GA, Adams DJ, Fu FH (1993) Determination of the in situ loads on the human anterior cruciate ligament. J Orthop Res 11:686–695CrossRefPubMedGoogle Scholar
  38. 38.
    Tashman S, Collon D, Anderson K, Kolowich P, Anderst W (2004) Abnormal rotational knee motion during running after anterior cruciate ligament reconstruction. Am J Sports Med 32:975–983CrossRefPubMedGoogle Scholar
  39. 39.
    Tashman S, Kolowich P, Collon D, Anderson K, Anderst W (2007) Dynamic function of the ACL-reconstructed knee during running. Clin Orthop Relat Res 454:66–73CrossRefPubMedGoogle Scholar
  40. 40.
    van Eck CF, Gravare-Silbernagel K, Samuelsson K, Musahl V, van Dijk CN, Karlsson J, Irrgang JJ, Fu FH (2013) Evidence to support the interpretation and use of the anatomic anterior cruciate ligament reconstruction checklist. J Bone Joint Surg Am 95:e1531–e1539CrossRefGoogle Scholar
  41. 41.
    van Eck CF, Kopf S, Irrgang JJ, Blankevoort L, Bhandari M, Fu FH, Poolman RW (2012) Single-bundle versus double-bundle reconstruction for anterior cruciate ligament rupture: a meta-analysis-does anatomy matter? Arthroscopy 28:405–424CrossRefPubMedGoogle Scholar
  42. 42.
    van Eck CF, Morse KR, Lesniak BP, Kropf EJ, Tranovich MJ, van Dijk CN, Fu FH (2010) Does the lateral intercondylar ridge disappear in ACL deficient patients? Knee Surg Sports Traumatol Arthrosc 18:1184–1188CrossRefPubMedCentralPubMedGoogle Scholar
  43. 43.
    van Eck CF, Schkrohowsky JG, Working ZM, Irrgang JJ, Fu FH (2012) Prospective analysis of failure rate and predictors of failure after anatomic anterior cruciate ligament reconstruction with allograft. Am J Sports Med 40:800–807CrossRefPubMedGoogle Scholar
  44. 44.
    van Eck CF, Schreiber VM, Mejia HA, Samuelsson K, van Dijk CN, Karlsson J, Fu FH (2010) “Anatomic” anterior cruciate ligament reconstruction: a systematic review of surgical techniques and reporting of surgical data. Arthroscopy 26:S2–S12CrossRefPubMedGoogle Scholar
  45. 45.
    Weber W, Weber E (1836) Mechanik der menschlichen Gehwerkzeuge. GöttingenGoogle Scholar
  46. 46.
    Yagi M, Wong EK, Kanamori A, Debski RE, Fu FH, Woo SL (2002) Biomechanical analysis of an anatomic anterior cruciate ligament reconstruction. Am J Sports Med 30:660–666PubMedGoogle Scholar
  47. 47.
    Yasuda K, Kondo E, Ichiyama H, Kitamura N, Tanabe Y, Tohyama H, Minami A (2004) Anatomic reconstruction of the anteromedial and posterolateral bundles of the anterior cruciate ligament using hamstring tendon grafts. Arthroscopy 20:1015–1025CrossRefPubMedGoogle Scholar
  48. 48.
    Yasuda K, van Eck CF, Hoshino Y, Fu FH, Tashman S (2011) Anatomic single- and double-bundle anterior cruciate ligament reconstruction, part 1: Basic science. Am J Sports Med 39:1789–1799CrossRefPubMedGoogle Scholar
  49. 49.
    Zantop T, Petersen W, Sekiya JK, Musahl V, Fu FH (2006) Anterior cruciate ligament anatomy and function relating to anatomical reconstruction. Knee Surg Sports Traumatol Arthrosc 14:982–992CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Freddie H. Fu
    • 1
  • Carola F. van Eck
    • 1
  • Scott Tashman
    • 1
  • James J. Irrgang
    • 1
  • Morey S. Moreland
    • 1
  1. 1.Department of Orthopaedic SurgeryUniversity of PittsburghPittsburghUSA

Personalised recommendations