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Surgical management of the anterior cruciate ligament-deficient knee has evolved from primary repair to extracapsular augmentation to anterior cruciate ligament reconstruction using biologic tissue grafts. The technique of anterior cruciate ligament reconstruction has improved over the last few decades with the aid of knowledge gained from basic science and clinical research. The biology and biomechanics of anterior cruciate ligament reconstruction were analyzed in the previously published first part of this article. In this second part, current operative concepts of anterior cruciate ligament reconstruction as well as clinical correlations are discussed. The latest information regarding anterior cruciate ligament reconstruction is presented with a goal of demonstrating the correlation between the application of basic science knowledge and the improvement of clinical outcomes.

The aerosols generated in an operating room during surgery were simulated in the laboratory by using a variety of common surgical power tools. A Stryker bone saw, a Hall drill, and a Shea drill were used on bone, and a Bovie electrocautery was used in both the cutting and coagulation modes on tendon, all in the presence of a thin film of blood. A 10-stage, low-pressure cascade impactor was used to determine the particle size distribution of each aerosol, and Hemastix was used to assess the hemoglobin content of each particle size fraction. The same assessment was done for another series of blood aerosols that had previously shown the ability to infect human T-cell cultures. All of the tools tested produced blood-containing aerosol particles in the respirable size range (less than 5 microns). Because surgical masks offer little protection against such particles, personal sampling is indicated to define the risk of exposure to bloodborne pathogens by this route.

Surgical treatment of the knee dislocations in our series provided satisfactory subjective and objective outcomes at two to six years postoperatively. The patients who were treated acutely had higher subjective scores and better objective restoration of knee stability than did patients treated three weeks or more after the injury. Nearly all patients were able to perform daily activities with few problems. However, the ability of patients to return to high-demand sports and strenuous manual labor was less predictable.

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