Anatomic anterior cruciate ligament reconstruction: Freddie Fu's paradigm

Fox, Michael A.; Engler, Ian D.; Zsidai, Bálint; Hughes, Jonathan D.; Musahl, Volker

doi:10.1016/j.jisako.2022.08.003

Cited by 11 publications

(6 citation statements)

References 91 publications

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“…More precisely, several surgical approaches for femoral tunnel positioning during remnant‐preserving ACLR have been proposed: some articles used intraoperative fluoroscopy [33]; some used the lateral intercondylar ridge (LIR) as a landmark [37]; and some used the remnant itself to locate the femoral tunnel [12]. Although all of the above methods could effectively create the femoral tunnel while preserving remnants [11], several studies still showed that the remnant could affect the accuracy of femoral tunnel positioning [1, 18]. First, some landmarks have anatomic variation among individuals [28], which might bring objective deviation for femoral tunnel positioning.…”

Section: Discussionmentioning

confidence: 99%

The apex of the deep cartilage is a stable landmark to position the femoral tunnel during remnant‐preserving anterior cruciate ligament reconstruction

Zhang,

Meng,

Zhang

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose The aim of this retrospective cohort study was to investigate whether the apex of the deep cartilage (ADC) could help surgeons position the femoral tunnel accurately in remnant-preserving anterior cruciate ligament (ACL) reconstruction (ACLR). Methods In the current retrospective cohort study, a total of 134 patients who underwent ACLR between 2016 and 2020 were included. The femoral tunnel position was located using ADC as the landmark. The patients were divided into two groups: the remnant-preserving group (RP group, n = 68) underwent remnant-preserving ACLR, and the nonremnant group (NRP group, n = 66) underwent traditional ACLR with remnant removal. Postoperatively, the femoral tunnel position was evaluated on 3D-CT. The length from the ADC to the shallow cartilage margin (L) and to the centre of the femoral tunnel (l) and the length from the centre of the femoral tunnel to a low cartilage ratio in the direction from high to low (H) were measured. ResultsThe l/L values of the RP and NRP groups were both 0.4 ± 0.1 after rounding (n.s.), and the H values were 9.3 ± 1.6 mm and 9.3 ± 1.7 mm, respectively (n.s.). There was no significant difference in l/L or H between the two groups. The estimation plot also showed high consistency of H and l/L of the two groups. The inter-and intraobserver reliability of I, L, l/L, and H were almost perfect. Conclusions The apex of the deep cartilage is a good landmark for positioning the femoral tunnel in remnant-preserving ACL reconstruction. Level of evidence Level III.

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Section: Discussionmentioning

confidence: 99%

The apex of the deep cartilage is a stable landmark to position the femoral tunnel during remnant‐preserving anterior cruciate ligament reconstruction

Zhang,

Meng,

Zhang

et al. 2023

Knee surg. sports traumatol. arthrosc.

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“…Also, biomechanical studies have shown that the PL bundle contributes the most to rotatory stability to the knee in lower degrees of flexion, and the anteromedial bundle provides more sagittal stability in higher degrees of flexion [2,10]. In terms of dimensions, the ACL varies in length, ranging between 27 and 38 mm [12,13]. There is also variability among individuals, in the femoral and tibial footprints of the ACL, with cross-sectional areas of 60-130 and 100-160 mm 2 , respectively [12,14,15].…”

Section: Anatomy and Function Of The Anterior Cruciate Ligamentmentioning

confidence: 99%

“…In terms of dimensions, the ACL varies in length, ranging between 27 and 38 mm [12,13]. There is also variability among individuals, in the femoral and tibial footprints of the ACL, with cross-sectional areas of 60-130 and 100-160 mm 2 , respectively [12,14,15]. On average, the mid-substance of the ACL is 10 to 11 mm wide (range 7-17 mm) with an average thickness of 3.9 mm and a cross-sectional area of 40.9 ± 3 mm [2,16].…”

Section: Anatomy and Function Of The Anterior Cruciate Ligamentmentioning

confidence: 99%

Graft Choice in Anterior Cruciate Ligament Reconstruction

Todor

2024

Arthroscopic Surgery - New Perspectives

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Anterior cruciate ligament (ACL) reconstruction is one of the most frequent surgical procedures performed by the sports medicine orthopedic surgeon. Many factors can influence the final outcome of the procedure, and the graft used is one of them. Over the years, the surgical technique has evolved and has been refined, including tunnel placement, graft fixation, and graft choice. For the latter, the main options available to the surgeon are autografts, which include patellar tendon, hamstring tendons, and quadriceps tendon autografts, allografts, and synthetic grafts. The ideal option for graft material, if there is one, is still to be determined. All graft options have advantages and disadvantages. Usually, the operating surgeon’s preference or recommendation will determine the graft to be used, as such it is very important to have a complete knowledge of the advantages, disadvantages, and individual needs of each patient before making a decision. This chapter will focus on graft options for ACL reconstruction, evaluating the existing literature in order to provide an up-to-date review on the subject and, hopefully, contribute to an evidence-based decision for graft choice in ACL reconstruction.

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“…Dr. Freddie Fu exemplified this principle. He inspired both with his speech and his actions when he visited the University of Virginia (UVA) to give grand rounds while performing trailblazing research into the refinement of anatomic ACL reconstruction [36][37][38] . His drive for scientific inquiry led him to discover that the UVA anatomy department had one of the largest collections of preserved fetuses in the country.…”

Section: Orthopaedic Surgeon Researchmentioning

confidence: 99%

How Research Improves Clinical Care: The Case for Orthopaedic Surgeon Research Leadership and Collaboration

Chu,

Murray,

Maloney

et al. 2023

Journal of Bone and Joint Surgery

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Improving the performance and impact of orthopaedic research is a critical leadership challenge. Musculoskeletal (MSK) conditions are a leading cause of disability worldwide, for which research investment and performance lags far behind the burden of disease. In the United States, MSK disorders account for the highest health care costs, have increased in incidence at the fastest rate, and exceed the combined costs of cardiovascular diseases and neoplasms. Despite the cost to society, the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), with primary responsibility for MSK research, receives <1.4% of the funds allocated to the National Institutes of Health (NIH). Although orthopaedic surgeons are leading providers of MSK clinical care, the dearth of orthopaedic clinician-scientists also greatly reduces representation of MSK scientific and clinical expertise among academic and scientific leaders. The goals of this symposium were to highlight the critical need for greater prioritization and investment in orthopaedic research and to engage orthopaedic leaders in addressing these needs. Compelling stories of research success from 3 orthopaedic chairs were featured to highlight how orthopaedic surgeon leadership in bench-to-bedside research substantially advances MSK clinical care. Seminar participants also emphasized the need to improve evidence-based clinical practice for which multicenter prospective cohort and registry studies represent opportunities for broader involvement. Prioritization of orthopaedic clinician-scientist development and formation of multidisciplinary partnerships with basic and translational scientists were emphasized as critical needs to advance MSK health. It is critical for orthopaedic chairs to “be invested in” and to “invest in” the success of orthopaedic research. This investment includes developing a professional climate that values research achievement and collaboration as well as implementing strategies to support and sustain research success. Finally, orthopaedic leaders need to advocate for federal research funding to be proportional to the economic burden of disease for which MSK conditions carry the highest current and projected costs. With health-care costs accounting for nearly one-fifth of the U.S. economy, increasing the investment in orthopaedic research to reduce the prevalence, disability, and morbidity from MSK disease needs to be a top orthopaedic and national leadership priority.

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Anatomic anterior cruciate ligament reconstruction: Freddie Fu's paradigm

Cited by 11 publications

References 91 publications

The apex of the deep cartilage is a stable landmark to position the femoral tunnel during remnant‐preserving anterior cruciate ligament reconstruction

The apex of the deep cartilage is a stable landmark to position the femoral tunnel during remnant‐preserving anterior cruciate ligament reconstruction

Graft Choice in Anterior Cruciate Ligament Reconstruction

How Research Improves Clinical Care: The Case for Orthopaedic Surgeon Research Leadership and Collaboration

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