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Along with increasing knowledge of anterior cruciate ligament (ACL) anatomy and kinematics as well as clinical experience, orthopedic surgeons have engaged in and witnessed an amazing evolution regarding surgical reconstructive techniques.
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Today, many surgeons intend to replicate the native ACL as much as possible, aiming at anatomic ACL reconstruction.
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An outline of the new surgical preferences is starting to form; orthopedic surgeons have shifted their preferences in arthroscopic technique,
Trends in Surgeon Preferences on Anterior Cruciate Ligament Reconstructive Techniques
Section snippets
Key Points
Primary Repair and Augmentation
Several clinical attempts of primary repair of the ACL have been tried; but almost all of them report discouraging results, although short-term outcomes are positive.5, 6 These results led orthopedic surgeons onto the path of different augmentation techniques that would theoretically not only promote healing but also prevent elongation and rupture. However, studies on augmentation together with repair revealed high rerupture rates and unfavorable outcomes.7 The incapacity of the ruptured ACL to
Synthetic Grafts
The use of synthetics when reconstructing the ACL is theoretically very appealing, allowing surgeons to use custom made off-the-shelf grafts while also shortening operating time by avoiding time-consuming graft harvest. Accordingly, patients undergoing reconstructive surgery would be free of donor site morbidity, such as muscle weakness and pain. However, more than a century later, through several clinical attempts with silk, silver wire, Teflon (DuPont, Wilmington, Delaware), polyester, carbon
Fixation techniques
For the purpose of understanding the rapid development in graft fixation techniques, one must appreciate that the reconstructed ACL is no stronger than its weakest link, which is the graft fixation, as noted by Kurosaka and colleagues.66 The patellar tendon autograft with an interference screw fixation technique has enjoyed a status of gold standard since the latter part of the twentieth century.4 However, with the emerging world-wide popularity of the hamstring graft and lesser used graft
Summary
There has been an amazing evolution in the knowledge of ACL anatomy and the surgical techniques for ACL reconstruction from open to arthroscopic reconstruction. An outline of the new surgical preferences is starting to form, yet another shift in paradigm is identified, the anatomic reconstructive concept. Today, orthopedic knee surgeons performing ACL reconstruction have a wide array of graft choices and fixation techniques at hand, which enables them to specifically tailor each reconstruction
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Cited by (51)
Orthopaedic Innovation and the Balance With Conflicts of Interest
2022, Operative Techniques in OrthopaedicsCitation Excerpt :Management of anterior cruciate ligament (ACL) injuries has undergone significant changes over a relatively short period of time. The earliest descriptions of ACL synthetic reconstruction stem from descriptions of primary repair with silk sutures in 1895 by Sir Arthur Mayo-Robson.21 Interest in synthetic grafts for ACL replacement was spurred by the theoretical benefits of stronger graft material and decreased need for additional dissection or the morbidity of graft harvest.22
Addition of the Sartorius Tendon Improves Biomechanics of a Four-Strand Hamstring Anterior Cruciate Ligament Autograft
2022, Arthroscopy - Journal of Arthroscopic and Related SurgeryIatrogenic injury of posterolateral structures during femoral tunneling in anterior cruciate ligament reconstruction: A cadaveric study
2020, Annals of Medicine and SurgeryCitation Excerpt :Two familiar procedures are widely used in femoral tunnel drilling. They are transtibial technique and anteromedial portal (trans portal) technique [3]. Anatomic femoral tunnel position is difficult to achieved using transtibial technique.
Comparison of bone surface and trough fixation on bone–tendon healing in a rabbit patella–patellar tendon injury model
2020, Journal of Orthopaedic TranslationCitation Excerpt :Therefore, promoting the functional and biological recovery of BTI is meaningful and urgent in sports medicine. Clinically, surgical integrity is the common way for treating BTI injuries, such as reattaching the injured tendon/ligament to bone in rotator cuff repair and anterior talofibular ligament reconstruction [3,11,12]. Based on the fixation site of the tendon, the surgical protocols used to integrate the raptured tendon with the bone could be classified into two categories: direct fixation to the bone surface (bone surface fixation, BSF) and placement within a bone tunnel/trough (bone trough/tunnel fixation, BTF) [13–16].
Developing Bioreactors to Host Joint-Derived Tissues That Require Mechanical Stimulation
2019, Encyclopedia of Tissue Engineering and Regenerative Medicine: Volumes 1-3
The authors did not receive any outside funding or grants directly related to the research presented in this article. The Department of Orthopaedic Surgery from the University of Pittsburgh receives funding from Smith and Nephew to support research related to reconstruction of the ACL. The authors state that this article is an original work only submitted to this journal. All authors contributed to the preparation of this work.