Anatomy of the ACL: Influence on Anterior Drawer and Lachman Tests

Toy, B. J.; Morse, Dennis E.; Yeasting, Richard A.; McCann, Patricia

doi:10.1123/att.4.2.54

Cited by 27 publications

(34 citation statements)

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“…Excessive collagen remodelling predisposes the cruciate ligaments to increased laxity and neurosensory impairment. Joint inflammation and ischemia further contribute to matrix changes and to the neurovascular mechanisms that may be linked to the pathophysiology of cruciate ligament disease [13, 52, 61]. Blood supply to the cruciate ligament core is already marginal and tissue hypoxia associated with micro‐injury further weakens the ligament midsubstance decreasing the possibility of any healing bridge formation across the injury site [52, 61].…”

Section: Knee Capsuloligamentous Stability Mechanoreception and Lesio...mentioning

confidence: 99%

Permanent knee sensorimotor system changes following ACL injury and surgery

Nyland

Gamble

Franklin

et al. 2017

Knee Surg Sports Traumatol Arthrosc

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The cruciate ligaments are components of the knee capsuloligamentous system providing vital neurosensory and biomechanical function. Since most historical primary ACL repair attempts were unsuccessful, reconstruction has become the preferred surgery. However, an increased understanding of the efficacy of lesion-site scaffolding, innovative suturing methods and materials, and evolving use of biological healing mediators such as platelet-rich plasma and stem cells has prompted reconsideration of what was once believed to be impossible. A growing number of in vivo animal studies and prospective clinical studies are providing increasing support for this intervention. The significance of ACL repair rather than reconstruction is that it more likely preserves the native neurosensory system, entheses, and ACL footprints. Tissue preservation combined with restored biomechanical function increases the likelihood for premorbid neuromuscular control system and dynamic knee stability recovery. This recovery should increase the potential for more patients to safely return to sports at their desired intensity and frequency. This current concepts paper revisits cruciate ligament neurosensory and neurovascular anatomy from the perspective of knee capsuloligamentous system function. Peripheral and central nerve pathways and central cortical representation mapping are also discussed. Surgical restoration of a more physiologically sound knee joint may be essential to solving the osteoarthritis dilemma. Innovative rehabilitative strategies and outcome measurement methodologies using more holistic and clinically relevant measurements that closely link biomechanical and neurosensory characteristics of physiological ACL function are discussed. Greater consideration of task-specific patient physical function and psychobehavioral links should better delineate the true efficacy of all ACL surgical and non-surgical interventions. Level of evidence IV.

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Section: Knee Capsuloligamentous Stability Mechanoreception and Lesio...mentioning

confidence: 99%

Permanent knee sensorimotor system changes following ACL injury and surgery

Nyland

Gamble

Franklin

et al. 2017

Knee Surg Sports Traumatol Arthrosc

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show abstract

“…1-A) 8 . From a healing standpoint, both better vascularity and increased intrinsic healing capacity are present within this quarter of the ACL compared with the midsubstance 9 . A histological study has suggested that proximal tears may have an intrinsic healing response similar to that of the medial collateral ligament 10 .…”

Section: Acl Tear Locations With Different Treatment Principlesmentioning

confidence: 99%

Primary Repair of Anterior Cruciate Ligament Injuries

et al. 2021

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Recently, there has been a resurgence of interest in primary anterior cruciate ligament (ACL) repair that has the potential to preserve native tissue using a more minimally invasive approach. Multiple repair techniques for different tear types have been reported over the last decade. From a healing perspective, proximal tears can be reapproximated directly to the femoral wall because they have better intrinsic healing capacity than midsubstance tears. These procedures can be classified further as direct suture repair with or without static or dynamic augmentation. Current evidence does not support direct repair of midsubstance tears because of their limited healing capacity. In many instances, biological augmentation is needed to enhance the healing potential of the ACL. While ACL repair is certainly not an effective surgical approach for all tears or in all patients, this procedure can be an effective and less morbid alternative to ACL reconstruction in carefully selected patients. The overall current reported level of evidence of published studies has ranged from low to moderate, and thus there is a need for higher-quality, comparative studies in which outcomes of larger patient groups are compared with the current gold standard of ACL reconstruction.

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“…We consider patient and injury selection to be essential for favorable outcomes in ACL repair, since the compliance of the patient and healing potential of the torn ligament and rupture pattern have a great influence on the failure rate. One of the most important aspects to consider is the favorable vascularity in the proximal third of the acl [ 10 , 11 ]. Keeping this in mind, we believe that primary repair is a reliable option for treating a select group of patients with ACL injuries.…”

Section: Introductionmentioning

confidence: 99%

Primary Proximal ACL Repair: A Biomechanical Evaluation of Different Arthroscopic Suture Configurations

Roßlenbroich¹,

Achtnich

Brodkorb³

et al. 2023

JCM

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Purpose: Several suture techniques have been described in the past for direct ACL repair with poor healing capacity and a high re-rupture rate. Therefore, we investigated a refixation technique for acute primary proximal ACL repair. The purpose of this study is to compare the biomechanical properties of different suture configurations using a knotless anchor. Methods: In this study, 35 fresh-frozen porcine knees underwent proximal ACL refixation. First, in 10 porcine femora, the biomechanical properties of the knotless anchor, without the ligament attached, were tested. Then, three different suture configurations were evaluated to reattach the remaining ACL. Using a material testing machine, the structural properties were evaluated for cyclic loading followed by loading to failure. Results: The ultimate failure load of the knotless anchor was 198, 76 N ± 23, 4 N significantly higher than all of the tested ACL suture configurations. Comparing the different configurations, the modified Kessler–Bunnell suture showed significant superior ultimate failure load, with 81, 2 N ± 15, 6 N compared to the twofold and single sutures (50, 5 N ± 14 N and 37, 5 ± 3, 8 N). In cyclic loading, there was no significant difference noted for the different configurations in terms of stiffness and elongation. Conclusions: The results of this in vitro study show that when performing ACL suture using a knotless anchor, a modified Kessler–Bunnell suture provides superior biomechanical properties than a single and a twofold suture. Within this construct, no failure at the bone–anchor interface was seen. Clinical relevance: Since primary suture repair techniques of ACL tears have been abandoned because of inconsistent results, ACL reconstruction remains the gold standard of treating ACL tears. However, with the latest improvements in surgical techniques, instrumentation, hardware and imaging, primary ACL suture repair might be a treatment option for a select group of patients. By establishing an arthroscopic technique in which proximal ACL avulsion can be reattached, the original ACL can be preserved by using a knotless anchor and a threefold suture configuration. Nevertheless, this technique provides an inferior ultimate failure load compared to graft techniques, so a careful rehabilitation program must be followed if using this technique in vivo.

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Anatomy of the ACL: Influence on Anterior Drawer and Lachman Tests

Cited by 27 publications

References 0 publications

Permanent knee sensorimotor system changes following ACL injury and surgery

Permanent knee sensorimotor system changes following ACL injury and surgery

Primary Repair of Anterior Cruciate Ligament Injuries

Primary Proximal ACL Repair: A Biomechanical Evaluation of Different Arthroscopic Suture Configurations

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