Abstract
The anterior cruciate ligament (ACL) injury is common and creates a potentially disabling knee condition for the individual. Although many patients with loss of the ACL are functionally disabled, there seems to be a small group with minimal disability. However, there seems to be no controversy in agreeing that clinically deficient ACL knee will eventually develop meniscal lesions, articular cartilage defects, and secondary stabilizing insufficiencies. This is when a full-blown picture of an ACLdeficient knee will present itself.1 Due to significant variability of ACL injuries, evaluation methods, treatment and surgical techniques, and the precise natural history of ACL remain unresolved issues. Although one cannot convincingly argue that early surgical intervention will prevent formation of degenerative arthritis, those involved in athletic activities are prime candidates for early surgical reconstruction. There has been an evolution in surgical techniques of ACL reconstruction since the early 1980s. Arthroscopically assisted and endoscopic ACL reconstruction now is the preferred technique comparing to conventional open ACL reconstruction. Clear advantages of these methods include better joint visualization, less soft tissue and joint trauma, less morbidity, faster recovery, and ability to perform the surgery on an outpatient basis,2 as well as being more economical, which is an important factor in the health care environment of today. This chapter describes my preferred technique in the reconstruction of ACL injuries, which uses the central third of the patellar tendon autograft with press fit femoral fixation.
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References
Noyes FR, Matthews DS, Mooar PA, Grood ES. The symptomatic anterior cruciate deficient knee, part II: the results of rehabilitation activity modification and counseling on functional durability. J Bone Joint Surg 1983; 65A (2): 163–174.
Malek MM, Deluca JV, Kunkle KL, Knable KR. Outpatient ACL surgery: a review of safety, practicality, and economy. Instr Course Lect 1996; 45: 281–286.
Fleming B, Beynnon BD, Johnson RJ, McCleod WD, Pope MH. Isometric versus tension measurements: a comparison for the reconstruction of the anterior cruciate ligament. Am J Sports Med 1993; 21 (1): 82–88.
Sapega AA, Moyer RA, Schenck C, Komalahiranya N. Testing for isometry during reconstruction of the anterior cruciate ligament. J Bone Joint Surg 1990;72A(2).
Shaffer B, Gow W, Tibone JE. Graft tunnel mismatch in endoscopic anterior cruciate ligament reconstruction: a new technique of intraarticular measurement and modified graft harvesting. J Arthrosc 1993; 9 (6): 633–646.
Malek MM, Kunkle KL, Knable KR. Intraoperative complications of arthroscopically assisted ACL reconstruction using patellar tendon autograft. Instr Course Lect 1996; 45: 297–302.
Shapiro JD, Cohn BT, Jackson DW, et al. The biomechanical effects of geometric configuration of bone-tendon-bone auto-grafts in anterior cruciate ligament reconstruction. Arthroscopy 1992; 8: 453.
Kurosaka M, Yoshiya S, Andrish JT. A biomechanical comparison of different surgical techniques of graft fixation in anterior cruciate ligament reconstruction. Am J Sports Med 1987; 15: 225–229.
Daniel DM, Stone ML, Riehl B. Ligament surgery: the evaluation of results. In: Daniel DM, Akeson WA, O’Connor JJ, eds. Ligaments: structure, function, injury and repair. New York: Raven Press, 1990: 521–534.
Bibliography
Aglietti P, Buzzi RD, Andria S, Zaccherotti G. Patellofemoral problems after intraarticular anterior cruciate ligament reconstruction. Clin Orthop 1993; 288: 195–204.
Agliette P, Buzzi RD, Zaccherotti G, DeBiase P. Patellar tendon versus doubled semitendinosus and gracilis for anterior cruciate ligament reconstruction. Am J Sports Med 1994; 22: 211–222.
Bach BR, Jones GT, Sweet FA, Hager CA. Arthroscopy-assisted anterior cruciate ligament reconstruction using patellar tendon substitution. Am J Sports Med 1994; 22: 758–767.
Barber FA, Small N, Click J. Anterior cruciate ligament reconstruction by semitendinosus and gracilis tendon autograft. Am J Knee Surg 1991; 4: 84–93.
Berg EE. Intrinsic healing of a patellar tendon donor site defect after anterior cruciate ligament reconstruction. Clin Orthop 1992; 278: 160–163.
Cohn BT, Draeger RI, Jackson DW. The effect of cold therapy in the postoperative management of pain in patients undergoing anterior cruciate ligament reconstruction. Am J Sports Med 1989; 17 (3): 344–349.
Daniel DM, Stone ML, Dobson BE, Fithian DC, Rossman DJ, Kaufmann KR. Fate of the ACL injured patient: a prospective outcome study. Am J Sports Med 1994; 22 (5): 632–644.
Dodds JA, Arnoczky SP. Anatomy of the anterior cruciate ligament: a blueprint for repair and reconstruction. J Arthrosc 1994; 10 (2): 132–139.
Feagin JA, Cabaud HE, Carl WW. The anterior cruciate ligament: radiographic and clinical signs of successful and unsuccessful repairs. Clin Orthop 1982; 164: 54–58.
Grana WA, Hines R. Arthroscopic-assisted semitendinosus reconstruction of the anterior cruciate ligament. Am J Knee Surg 1992; 5: 16–22.
Hamer CD, Irrgang JJ, Paul J, Dearwater S, Fu F. Loss of motion after anterior cruciate ligament reconstruction. Am J Sports Med 1992; 20 (5): 499–506.
Henning CE, Lynch MA, Glick KR. An in vivo strain gauge study of elongation of the anterior cruciate ligament. Am J Sports Med 1985; 13 (1): 2–26.
Howell SM, Clark JA. Tibial tunnel placement in anterior cruciate ligament reconstructions and graft impingement. Clin Orthop 1982; 283: 187–195.
Howell SM. Failure of reconstruction of the anterior cruciate ligament due to impingement by the intercondylar roof. J Bone Joint Surg 1993; 75A (7): 1044–1055.
Jackson DW, Jennings LD. Arthroscopically-assisted reconstruction of the anterior cruciate ligament using patellar tendon bone autograft. Clin Sports Med 1988; 7: 785–800.
Jackson DW, Schaefer RK. Cyclops syndrome: loss of extension following intra-articular anterior cruciate ligament reconstruction. J Arthrosc 1990; 6 (3): 171–178.
Jackson DW, Gassen SI. Tibial tunnel placement in ACL reconstruction. J Arthrosc 1994; 10 (2): 124–131.
Johnson RJ, Beynon BD, Nichols CE, Renstrom PAFH. Current concept review. The treatment of injuries of the anterior cruciate ligament. J Bone Joint Surg 1992; 74A (1): 104–151.
Jones KG. Result of use of the central one third of the patellar ligament to compensate for anterior cruciate ligament insufficiency. Clin Orthop 1980; 147: 38–44.
Klein W, Shah N, Gassen A. Arthroscopic management of postoperative arthrofibrosis of the knee joint: indications, technique and results. J Arthrosc 1994; 10 (6): 591–597.
Malek MM, DeLuca JV, Verch DL, Kunkle KL. Arthroscopically assisted anterior cruciate ligament reconstruction using central third patellar tendon autograft with press-fit femoral fixation. Instr Course Lect 1996; 45: 287–295.
Malek MM, Fanelli GC, DeLuca JV. Intraarticular and extraarticular anterior cruciate ligament reconstruction. In: Scott JN, ed. The knee. Chicago: Mosby-Year Book, 1992: 791–812.
Malek MM, Fanelli GC, Golden MD. Combined intraarticular and extraarticular cruciate ligament reconstruction. Diagnosis and treatment. Chicago: Mosby-Year Book, 1991: 267–284.
Mohtadi NGH, Webster-BoGaert S, Fowler PJ. Limitation of motion following anterior cruciate ligament reconstruction: a case control study. Am J Sports Med 1991; 19 (6): 620–625.
Noyes FR, Mooar PA, Matthews DS, Butler DL. The symptomatic anterior cruciate deficient knee, Part I: the long term functional disability in athletically active individuals. J Bone Joint Surg 1983; 65A (2): 154–162.
Odensten A, Gillquist J. Functional anatomy of the anterior cruciate ligament and a rationale for reconstruction. J Bone Joint Surg 1995; 67A (2): 257–262.
O’Neil DB. Arthroscopically-assisted reconstruction of the anterior cruciate ligament: a prospective randomized analysis of three techniques. J Bone Joint Surg 1996; 78A: 814.
Paschal SO, Seemann MD, Ashman RB, Allard RN, Montgomery JB. Interference fixation versus post fixation of bone patellar tendon bone grafts for anterior cruciate ligament reconstruction: a biomechanical comparative study in porcine knees. Clin Orthop 1994; 300: 281–287.
Paulos LE, Rosenberg TD, Drawbert J, Manning J, Abbott P. Infrapatellar contracture syndrome: an unrecognized cause of knee stiffness with patella entrapment and patella infera. Am J Sports Med 1987; 15 (4): 331–341.
Richmond JC, Gladstone J, MacGillivray J. Continuous passive motion after arthroscopically assisted anterior cruciate ligament reconstruction: comparison of short versus long term use. J Arthrosc 1991; 7 (1): 39–44.
Romano VM, Graft BK, Keene JS, Lange RH. The anterior cruciate ligament reconstruction: the effect of tibial tunnel placement on range of motion. Am J Sports Med 1993; 21 (3): 259–267.
Sgaglione NA, Warren RF, Wickiewicz TL, et al. Primary repair with semitendinosus augmentation of anterior cruciate ligament injuries. Am J Sports Med 1990; 18: 64–73.
Shaffer BS, Tibone JE. Patellar tendon length change after anterior cruciate ligament reconstruction using mid third patellar tendon. Am J Sports Med 1993; 21: 449–454.
Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop 1985; 198: 43–49.
Tria JR, Alicea JA, Cody RP. Patella baja in anterior cruciate ligament reconstruction of the knee. Clin Orthop 1994; 299: 229–234.
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Malek, M.M. (2001). Arthroscopic Anterior Cruciate Ligament Reconstruction: Bone-Tendon-Bone Graft Press Fit Technique. In: Chow, J.C.Y. (eds) Advanced Arthroscopy. Springer, New York, NY. https://doi.org/10.1007/978-0-387-21541-9_46
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DOI: https://doi.org/10.1007/978-0-387-21541-9_46
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