Anterior Cruciate Ligament

- Discussion:
    - anatomy of ACL
    - biomechanics of ACL
    - epidemiology_of_ACL_injuries
    - mechanism: ACL Tear
    - natural history of the ACL-deficient knee
    - partial ACL injury
    - pediatric ACL injuries

- Evaluation of ACL Injuries:
    - examination

- Surgical Management: 
    - timing:
            - early surgery may be associated with arthrofibrosis
            - references:
                   - Acute anterior cruciate ligament repair.
                   - Acute anterior cruciate ligament reconstruction. Analysis of complications
                   - Arthroscopy in acute hemarthrosis of knee. Incidence of anterior cruciate tears and other injuries

    - graft placement theory:
            - femoral tunnel
            - tibial tunnel
    - surgical techniques:
            - bone patellar bone reconstruction
                      - main disadvtange of BPB reconstruction is that it does not allow for anteromedial (AM)
                                femoral tunnel positioning and does not allow for differential graft tensioning (posterior
                                graft in 10 deg flexion and anterior graft in 45 deg flexion)
            - hamstring reconstruction
                      - double bundle reconstruction
                      - allograft reconstruction
                      - extra-articular reconstruction (historical discussion)

    - graft fixation techniques
    - post operative care and complications:
            - arthrofibrosis:

- Adjunctive Techniques:
    - management of concomitant meniscal tears
    - chondral injuries 
    - anteromedial instabilility
           - Acute MCL and ACL injuries: first results of minimal-invasive MCL ligament bracing with combined ACL single-bundle reconstruction.
    - anterolateral instability:
           - lateral collateral ligament 
    - posterolateral instability
           - references:
                  - The influence of the integrity of posterolateral structures on tibiofemoral orientation when an anterior cruciate ligament graft is tensioned. 
                  - Anterolateral rotational knee instability: role of posterolateral structures. Winner of the AGA-DonJoy Award 2006. 
                  - The influence of PL instability on ACLR: comparison between isolated ACLR and AC + PL reconstruction.
    - posterior cruciate ligament
    - high tibial osteotmy
          - indicated w/ concomitant varus alignment;
          - varus classification:
                 - primary varus:
                         - varus alignment due to the underlying tibiofemoral alignment;
                         - there is no associated posterolateral ligament deficiency or abnormal lateral joint opening;
                 - double varus:
                         - there is an associated deficiency of the lateral collateral ligament;
                         - varus alignment is increased as a result of both tibiofemoral osseous alignment and abnormal lateral joint opening;
                 - triple varus:
                         - there is deficiency of all of the posterolateral structures;
                         - varus alignment increases on standing, and a varus recurvatum position is present;
          - generally HTO is performed months prior to performing ACL reconstruction;
          - in the report by Noyes FR et al (2000), the authors followed 41 young patients who had ACL deficiency, genu varus angulation,
                 and varying amounts of posterolateral ligament deficiency;
                 - all patients were treated with HTO and, in the majority (N = 34), ACL reconstruction a mean of 8 months later;
                 - posterolateral reconstructions were also required in 18 knees;
                 - patient rating of the knee condition was normal or very good in 37% (15 knees) and good in 34% (14 knees);
          - references:
                 - High Tibial Osteotomy and Ligament Reconstruction for Varus Angulated Anterior Cruciate Ligament-Deficient Knees.
                 - High tibial osteotomy and ligament reconstruction in varus angulated, anterior cruciate ligament-deficient knees. A two- 
                 - Is Correctional Osteotomy Crucial in Primary Varus Knees Undergoing Anterior Cruciate Ligament Reconstruction?
                 - Clinical outcome of simultaneous HTO and anterior cruciate ligament reconstruction for medial OA  with ACL knees:

- Misc. Articles:
  Suture of the torn anterior cruciate ligament. 5-year follow-up of 60 cases using an instrumental stability test
  Ganglion cysts of the anterior cruciate ligament: a series of 15 cases
  Ganglion cysts of the anterior cruciate ligament: a case report and review of the literature

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Clifford R. Wheeless, III, MD on Sunday, September 10, 2017 2:27 pm