Driving reaction time was studied in 73 patients under anterior cruciate ligament (ACL) reconstruction using a computer-linked automobile simulator. Each patient was tested pre-operatively and 2, 4, 6 and 8 weeks after surgery. Stepping and standing tests were studied at each time point. Twenty-five normal subjects were also tested as controls. Pre-operative test results did not differ significantly between groups on any of the tests. Post-operatively it took 6 weeks for driving reaction time of the right ACL group to be equivalent to that of the controls, compared to 2 weeks in the left ACL group. There was a strong correlation between the stepping and standing tests and the driving reaction time; this made them good clinical tests to monitor patients' progress and to suggest the appropriate time to resume driving.

Only 20 years ago reconstruction of the anterior cruciate ligament (ACL) involved an open intra-articular operation in which the graft was placed in a position where it was not anatomical and which involved opening both the medial and lateral capsules. There was a long scar and considerable analgesia was required after the operation. The patient remained in hospital for ten days and in a cast for six weeks. Now, a less invasive procedure allows positioning of the graft to give a full range of movement without impingement and with restoration of stability. Which type of graft is now used? A poll of members of the Australian Knee Society in 2000 revealed that all used autograft only, with 58% employing both patellar tendon and hamstring grafts in certain circumstances; the remainder were evenly divided in their preference for 'only' patellar tendon or 'only' hamstring. 1 Members of the ACL Study Group showed a different perspective, with 73% choosing the patellar tendon, 23% the hamstrings and 4% 'others', such as allografts. This had not changed from a previous survey two years earlier. 2 Another survey of orthopaedic surgeons caring for American football teams in the major leagues showed that all but one chose autologous patellar tendon grafts. 3 This article evaluates the available choices of graft and examines their advantages and disadvantages, the clinical outcomes, morbidity at the donor site, biomechanical characteristics and healing. We consider whether certain grafts are more suitable in particular cases and speculate as to the future directions of surgery of the ACL considering tissue engineering, growth factors and gene therapy. Choices of graft Autografts Biomechanical comparison. Wilson et al 4 studied the 1990 531 631 REVIEW ARTICLE

Different methods to reconstruct damaged posterolateral structures are available, but there has been little work studying their relative performance in combined PCL plus posterolateral corner (PLC) deficiency. We hypothesized that an 'anatomic' reconstruction with three graft bundles crossing the joint line would restore knee laxity closer to normal than a modified two-bundle Larson reconstruction. In a controlled laboratory study, the kinematics of cadaveric knees were measured electromagnetically with posterior drawer, external rotation, or varus rotation loads applied, with the knee at sequential stages: intact, PCL-deficient; PCL plus PLC-deficient; modified Larson reconstruction; anatomic PLC reconstruction. The graft bundles were tensioned sequentially to restore specific degrees of freedom to intact values of laxity at specific angles of knee flexion. A significant difference was not found between the two reconstructions. Both reconstructions restored external rotation and varus laxity to normal. Both restored posterior drawer to that caused by isolated PCL deficiency, but did not restore posterior laxity to normal. It was concluded that, with appropriate graft tensioning, both PLC reconstructions could restore both external rotation and varus laxity to normal, but not posterior drawer. The three-stranded anatomical reconstruction did not perform better than the modified two-strand Larson technique. Both of these isolated PLC reconstructions in knees with combined PCL plus PLC deficiency restored the knees to the laxity condition of an isolated PCL-deficiency, they could not reduce posterior drawer to normal.

No abstract

Posterior cruciate ligament (PCL) injuries are associated commonly with posterolateral corner (PLC) injuries. 13,19,39,45 Injuries to the PLC, when associated with PCL injuries, are reported to be missed frequently. 26,29,34,40 Biomechanical studies have demonstrated that cutting the posterolateral structures increases the in situ forces on the PCL 28,37 ; recurrent laxity after PCL reconstruction is most commonly Background: Although many posterior cruciate ligament (PCL) injuries are in combination with posterolateral corner (PLC) injuries, there has been little research on combined injury reconstruction; the literature includes differing recommendations.