The evolution of ACL reconstruction over the last fifty years

Chambat, Pierre; Guier, Christian; Sonnery‐Cottet, Bertrand; Fayard, Jean-Marie; Thaunat, Mathieu

doi:10.1007/s00264-012-1759-3

Cited by 209 publications

(180 citation statements)

References 44 publications

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“…Despite this, a combined procedure is still considered a useful option for revision ACL cases and in 91 patients with high-grade rotational instability [5,26]. We consider combined ACL and ALL …”

Section: Discussion 74mentioning

confidence: 99%

Combined anterolateral ligament and anatomic anterior cruciate ligament reconstruction of the knee

Smith

Yasen

Lord

et al. 2015

Knee Surg Sports Traumatol Arthrosc

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Although anatomic anterior cruciate ligament (ACL) reconstruction is established for the surgical treatment of anterolateral knee instability, there remains a significant cohort of patients who continue to experience post-operative instability. Recent advances in our understanding of the anatomical, biomechanical and radiological characteristics of the native anterolateral ligament (ALL) of the knee have led to a resurgent interest in reconstruction of this structure as part of the management of knee instability. This technical note describes our readily reproducible combined minimally-invasive technique to reconstruct both the ACL and ALL anatomically using autologous semitendinosus and gracilis grafts. This simple method of ALL reconstruction can be easily integrated with all-inside ACL reconstruction, requiring minimal additional operative time, equipment and expertise. Level of evidence: VThe final publication is available at Springer via http://dx.doi. org/10.1007/s00167-015-3783-5 Copyright © 2015, Springer Verlag. Introduction 1Although the existence of the anterolateral ligament (ALL) was first described in anatomical studies 2 over a century ago, a full appreciation of its functional importance in normal and sporting activities is 3 still being established [3,14,19,20,29,32,35,36]. Recent progress has been made in reconstructing 4 the unstable knee, but this has mainly concentrated on restoring the mechanical constraints of the 5 cruciate and collateral ligaments, with little consideration for the potential of the ALL itself as a key 6 supportive structure [5,26]. Cruciate ligament reconstruction alone can provide excellent clinical 7 outcomes, however, a significant proportion of patients continue to suffer from rotational instability 8 post-operatively, with many patients unable to return to their pre-injury level of sporting activity [2]. 9Furthermore, even when the cruciate ligaments are reconstructed anatomically, the procedure does 10 not prevent the progression to early secondary osteoarthritis [21]. Although its function remains 11 controversial, a new appreciation for the existence of the ALL as a distinct anatomical structure with 12 the potential to confer rotational stability to the knee, has led several groups to advocate 13 refinements to previous extra-articular ligament reconstruction techniques to more precisely restore 14 the kinematics of the native knee [8,15]. It is proposed that these procedures, when used in 15 conjunction with arthroscopic anatomic anterior cruciate ligament (ACL) reconstruction, will be 16 particularly beneficial to those patients who present with both anterolateral and rotatory knee 17 instability, or who remain unstable despite standard ligament reconstruction. 18Following collaboration with other research groups and preliminary cadaveric studies, the senior 19 author developed a minimally invasive anatomic technique with which to reconstruct the 20 anterolateral corner of the knee using gracilis tendon autograft, in conjunction with 'All-inside' 21 ...

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Section: Discussion 74mentioning

confidence: 99%

Combined anterolateral ligament and anatomic anterior cruciate ligament reconstruction of the knee

Smith

Yasen

Lord

et al. 2015

Knee Surg Sports Traumatol Arthrosc

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“…Although there is still some debate about the optimal treatment for acute ACL tears, surgical management in the young and active patient is recommended [7][8][9][10]. Operative procedures include extra-articular techniques, primary repair and reconstruction using autografts, allografts, xenografts, and artificial ligaments [10][11][12][13][14][15][16][17][18]. Currently, reconstruction using autograft or allograft tendon material seems to be the gold standard of surgical treatment.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical evaluation of augmented and nonaugmented primary repair of the anterior cruciate ligament: an in vivo animal study

Seitz

Pichl

Matzi

et al. 2013

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to evaluate in a sheep model the biomechanical performance of augmented and nonaugmented primary repair of the anterior cruciate ligament (ACL) following transection at the femoral end during a 12-month postoperative observation. Methods Forty sheep were randomly assigned to nonaugmented or augmented primary ACL repair using a polyethylene terephthalate (PET) band. At two, six, 16, 26 and 52 weeks postoperatively four sheep in each group were sacrificed and biomechanical testing performed. Results Compared with nonaugmented primary ACL repair, the PET-augmented repair demonstrated superior biomechanical results from 16 weeks postoperatively onwards in terms of anterioposterior (AP) laxity, tensile strength and ligament stiffness. The augmentation device works as a stress shield during the ligament healing process. The nonaugmented ACL repair also resulted in ligament healing, but the biomechanical properties were at a significantly lower level. Conclusion These results support the previously reported histological findings following augmented primary ACL repair. This animal study on the healing capacity of the ACL may provide some important contributions to how primary healing in certain types of ruptures can be achieved.

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“…4 Surgical reconstruction of the ACL can be compared on the basis of many criteria including biomechanical properties, biology, and technical difficulty of the procedure. As technology continues to improve, surgeon comfort and ease of procedure become critical to ensure consistent anatomic reconstruction and improved clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Technique for Arthroscopic-Assisted Primary Anterior Cruciate Ligament Reconstruction Using Doubled Tibialis Anterior Tendon

Rose

Crawford

2017

Arthroscopy Techniques

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Advances in surgical technique and our knowledge of anterior cruciate ligament (ACL) anatomy have resulted in a marked increase in options for ACL reconstruction. Currently, patient age and activity level, surgeon preference and experience, and cost are factors influencing the type of reconstruction recommended to address knee instability. We present a simplified transtibial method of ACL reconstruction using a single-bundle, doubled tibialis anterior allograft. This method uses fixation with a suspensory device on the femur and a bio-composite interference screw on the tibia. We recommend this simplified technique for primary ACL reconstruction because it minimizes total steps, thus limiting variance, maximizing efficiency, and reducing potential technical error.A nterior cruciate ligament (ACL) reconstruction is one of the most common procedures performed by orthopaedic surgeons with the goal of restoring functional stability.1 Advances in surgical technique have resulted in a marked improvement in outcomes, and current options for surgical reconstruction are numerous.2,3 The choice of reconstruction technique is dependent on surgeon experience and numerous patient factors, in balance with considerations of cost, efficacy, and long-term outcomes. We propose a single-bundle transtibial method using a doubled tibialis anterior allograft fixed with a suspensory device on the femoral cortex and a bio-composite interference screw in the tibia. We believe this technique simplifies ACL reconstruction by limiting the number of steps with an aim at reducing potential errors while providing an anatomic reconstruction. Surgical TechniqueACL reconstruction (Video 1) is performed by combining general anesthesia and a continuous-infusion femoral nerve catheter (0.2% ropivacaine) left in place for 72 hours to maximize pain control and minimize need for systemic narcotics. The patient is placed supine on a standard operating table, and full examination of the knee is performed including grading of the Lachman, anterior drawer, and pivot-shift tests. A lateral post is placed high on the thigh, and the leg is prepared and draped in sterile fashion. The leg is allowed to hang laterally over the side of the table and flexed to a minimum of 90. A lateral parapatellar portal is then made with a No. 11 blade even with the distal pole of the patella, creating an incision larger at the skin than the joint (one-way valve). A complete diagnostic evaluation is performed using lactated Ringer solution with epinephrine (1 mL of 1:1,000 per 5 L) and gravity flow. Concomitant meniscal or chondral pathology is noted and addressed. A medial working portal is then created with a No. 11 blade after localization with a spinal needle. The portal is placed just proximal and medial to the anterior horn of the medial meniscus. A 4.5-mm vacuum shaver is introduced through a medial working portal, and the torn fibers of the ACL are debrided minimally, focusing on those subluxated anteriorly and the midsubstance elements that are displaced. Ca...

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The evolution of ACL reconstruction over the last fifty years

Cited by 209 publications

References 44 publications

Combined anterolateral ligament and anatomic anterior cruciate ligament reconstruction of the knee

Combined anterolateral ligament and anatomic anterior cruciate ligament reconstruction of the knee

Biomechanical evaluation of augmented and nonaugmented primary repair of the anterior cruciate ligament: an in vivo animal study

Technique for Arthroscopic-Assisted Primary Anterior Cruciate Ligament Reconstruction Using Doubled Tibialis Anterior Tendon

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