Anterior cruciate ligament arthroplasty

Abstract

A unique augmentation arthroplasty has evolved from a retrospective review of 150 anterior cruciate ligament (ACL) repairs, extracapsular substitutions, and pes anserine transfers. This coincided with a proposed pathologic relationship seen in surgical exposures of the femoral intercondylar notch. From 1976 to 1983, 544 cases with known ACL insufficiency were selected for study. In 397 subsequent anterior cruciate stabilizations arthroplasties were performed. Patients with less than a 2 year followup were not included in this retrospective study. One hundred nine arthroplasties are reported: 80 isolated ACL tears and 29 multiple ligament injuries.Statistically significant relationships between elapsed time from ACL tear to surgery and meniscal tears, and elapsed time and degenerative changes in the articular surfaces were seen.Surgical techinque was arthroplasty, graft harvest, graft placement, graft set, and postoperative care. Functional score followup has occurred for an average of 3 years (range 2 to 5 years). No patient has failed to return to his or her original sport or occupational demands. Pivot shift, disengagement, or spontaneous rupture of the arthroplasty has not occurred postoperatively. Full participation has occurred with bilateral ACL arthroplasties and arthroplasty performed for previous intraarticular augmentation failure.The operative success in the preliminary follow-up period was based on: ligamentous substitution, anatomical placement, femoral intercondylar notch compliance in full range of motion, revascularization of the ligament substitute, and histologic support of the procedure.Many treatment regimens exist for managing ACL deficiency. This paper presents observations on the pathologic anatomy associated with tears of the ACL and the results of a new surgical procedure evolved to correct anatomical shortcomings and restore anterior cruciate function.The ACL is a primary restraint against excessive anterior translation of the tibia on the femur. This ligament also prevents hyperextension of the knee and excessive internal

Association of Noncontact Anterior Cruciate Ligament Injury With Presence and Thickness of a Bony Ridge on the Anteromedial Aspect of the Femoral Intercondylar Notch

“…The femoral notch is commonly widened at the lateral notch wall during native ACL reconstruction surgeries, and the ideal shape and degree of bone removal of the femoral notch is under investigation. 3,4,14,16,18,19 The anteromedial notch ridge appears to be located in a region that could also be removed during notchplasty. The bulk of the ridge, particularly the thickest portion, appears to be anterior and superior to the femoral attachment of the PCL, allowing the PCL attachment to be spared during removal of the majority of the ridge.…”

A Simple Radiographic Sign of Vertical Anterior Cruciate Ligament Tunnel Placement

“…[1][2][3] Small deviations in placement of the ACL femoral tunnel can have tremendous impact on knee biomechanics and graft tension. 6,8,9,[11][12][13] Traditionally, attempts at reconstruction of the AM bundle of the ACL utilizing a transtibial, endoscopic technique often resulted in vertical placement of the ACL femoral tunnel. [14][15][16][17] This "high" position in the intercondylar notch at the 11 and 1 o'clock position in right and left knees, respectively, has been shown to be less effective at restoring rotational stability of the knee.…”

Anterior cruciate ligament reconstruction with alternative tibial tunnel: early results after accelerated weight-bearing

“…Both patients had been immobilized for over 3 months. Kieffer et al reported such a case 4 months after the operation [6]. Christen and Jakob reviewed retrospectively 490 patellar ligament reconstructions for cruciate ligament injuries and found 6 cases of patellar splitting and 3 displaced patellar fractures in donor knees [3].…”