BOOK
The Anterior Cruciate Ligament: Reconstruction and Basic Science E-Book
(2017)
Additional Information
Book Details
Abstract
The Anterior Cruciate Ligament: Reconstruction and Basic Science, 2nd Edition, by Dr. Chadwick Prodromos, provides the expert guidance you need to effectively select the right procedure and equipment, prevent complications, and improve outcomes for every patient. Written and edited by world leaders in hamstring, allograft, and bone-patellar tendon-bone (BTB) ACL reconstruction, this revised reference is a must-have resource for the full range of anterior cruciate ligament reconstruction techniques, plus fixation devices, rehabilitation, revision ACLR surgery, and much more!
- Covers the latest clinical and technical information on pain control, genetics and biologics, the use of ultrasound, and much more.
- Features dozens of new chapters that offer up-to-date information on pain control after ACLR, single vs. double bundle repairs, genetics and collagen type, all-inside techniques, biologics, pediatrics, ACL ganglion cysts, prognosis for ACLR success, allografts vs. autografts, and more.
- Provides the experience and insight of a "dream team" of ACL experts, including James Andrews on sports medicine, Frank Noyes on HTO and ACLR, and Andrew Amis on the benefits of the older femoral tunnel placement technique.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| IFC | ES1 | ||
| The Anterior Cruciate Ligament: Reconstruction and Basic Science | i | ||
| The Anterior Cruciate Ligament: Reconstruction and Basic Science | iii | ||
| Copyright | iv | ||
| Dedication | v | ||
| ABOUT THIS BOOK | vii | ||
| WHY THIS BOOK IS NEEDED | vii | ||
| ABOUT THE CONTRIBUTORS | vii | ||
| TECHNIQUE CHAPTER “TROUBLESHOOTING” | vii | ||
| STAYING CURRENT: THE ACL DATABASE | vii | ||
| Acknowledgments | viii | ||
| List of Contributors | ix | ||
| Contents | xvii | ||
| Video Contents | xxiii | ||
| The Anterior Cruciate Ligament: Reconstruction and Basic Science | xxv | ||
| I - Anatomy and Genetics of Anterior Cruciate Ligament Injury | 1 | ||
| 1 - Anatomy and Biomechanics of the Anterior Cruciate Ligament | 1 | ||
| INTRODUCTION | 1 | ||
| ANTERIOR CRUCIATE LIGAMENT ANATOMY | 1 | ||
| Historical Descriptions | 1 | ||
| ANTERIOR CRUCIATE LIGAMENT DEVELOPMENT | 2 | ||
| Histology of the Anterior Cruciate Ligament | 2 | ||
| Anatomy of the Anterior Cruciate Ligament | 2 | ||
| Anatomy of Anteromedial and Posterolateral Bundles | 3 | ||
| Crossing Pattern | 4 | ||
| Tensioning Pattern | 4 | ||
| Anatomic Considerations in Anterior Cruciate Ligament Surgery | 4 | ||
| ANTERIOR CRUCIATE LIGAMENT BIOMECHANICS | 4 | ||
| Historical Studies | 4 | ||
| Anterior-Posterior Translation Control | 5 | ||
| Rotational Stability | 5 | ||
| Biomechanical Strength | 7 | ||
| Biomechanics Considerations in Anterior Cruciate Ligament Surgery | 7 | ||
| CONCLUSION | 7 | ||
| SELECTED READINGS | 7 | ||
| 2 - Genetic Influences on Anterior Cruciate Ligament Injury | 8 | ||
| INTRODUCTION | 8 | ||
| MOLECULAR GENETICS: SOME BASIC CONCEPTS | 8 | ||
| GENETIC RISK FACTORS FOR ANTERIOR CRUCIATE LIGAMENT INJURY | 9 | ||
| FUTURE WORK | 11 | ||
| CLINICAL RELEVANCE | 11 | ||
| CONCLUSION | 12 | ||
| SELECTED READINGS | 12 | ||
| 3 - Association Between Anterior Cruciate Ligament Tear and Femoroacetabular Impingement | 12 | ||
| INTRODUCTION | 12 | ||
| FEMOROACETABULAR IMPINGEMENT | 12 | ||
| ANTERIOR CRUCIATE LIGAMENT INJURIES | 14 | ||
| FEMOROACETABULAR IMPINGEMENT: ANTERIOR CRUCIATE LIGAMENT INJURY | 14 | ||
| CONCLUSION | 15 | ||
| SELECTED READINGS | 15 | ||
| REFERENCES | 15.e1 | ||
| II - Mechanism, Incidence, and Epidemiology of Anterior Cruciate Ligament Injury | 16 | ||
| 4 - Mechanisms of Noncontact Anterior Cruciate Ligament Injuries | 17 | ||
| INTRODUCTION | 16 | ||
| ANTERIOR TIBIAL TRANSLATION | 16 | ||
| HAMSTRING CO-CONTRACTION | 16 | ||
| KNEE FLEXION ANGLE | 17 | ||
| HIP FLEXION ANGLE | 17 | ||
| KNEE VALGUS/VARUS ORIENTATION | 17 | ||
| INTERNAL/EXTERNAL TIBIAL TORQUE | 18 | ||
| POSTERIOR GROUND REACTION FORCE | 18 | ||
| OTHER MECHANISMS | 18 | ||
| CONCLUSION | 18 | ||
| 5 - Risk and Gender Factors for Noncontact Anterior Cruciate Ligament Injury | 19 | ||
| INTRODUCTION | 19 | ||
| ENVIRONMENTAL RISK FACTORS | 19 | ||
| Bracing Pros and Cons | 20 | ||
| SEX, AGE, AND LEVEL OF COMPETITION AS RISK FACTORS | 20 | ||
| ANATOMICAL RISK FACTORS | 20 | ||
| Association Between Q Angle and Injury Risk | 20 | ||
| Notch Width and Anterior Cruciate Ligament Size as Risk Factors | 20 | ||
| Posterior Lateral Tibial Slope and Medial Tibial Plateau Depth as Risk Factors | 21 | ||
| Body Mass Index and Risk for Anterior Cruciate Ligament Injury | 21 | ||
| HORMONAL RISK FACTORS | 23 | ||
| Monthly Distribution of Anterior Cruciate Ligament Injuries | 23 | ||
| Sex Hormones and Laxity | 23 | ||
| Sex Hormones and Ligament Biology | 24 | ||
| Sex Hormones and Other Concerns | 24 | ||
| NEUROMUSCULAR RISK FACTORS | 24 | ||
| Cognitive Function | 25 | ||
| FAMILIAL TENDENCY TO NONCONTACT ANTERIOR CRUCIATE LIGAMENT INJURY | 25 | ||
| SUMMARY | 26 | ||
| 6 - Risk of Anterior Cruciate Ligament Injury as a Function of Type of Playing Surface | 27 | ||
| INTRODUCTION | 27 | ||
| BIOMECHANICS/SURFACE CHARACTERISTICS | 27 | ||
| CLINICAL | 28 | ||
| CONCLUSION | 28 | ||
| 7 - Incidence of Anterior Cruciate Ligament Injury as a Function of Gender, Sport, and Injury-Reduction Programs | 29 | ||
| INTRODUCTION | 29 | ||
| PURPOSE | 29 | ||
| METHODS | 29 | ||
| EXPOSURES | 29 | ||
| DATA CONVERSIONS | 29 | ||
| INDIVIDUAL SPORTS | 29 | ||
| Alpine Skiing | 29 | ||
| Soccer | 38 | ||
| Indoor Soccer | 38 | ||
| Basketball | 38 | ||
| Volleyball | 38 | ||
| American, Gaelic, and Australian Football | 38 | ||
| Rugby | 39 | ||
| Lacrosse | 39 | ||
| Field Hockey | 39 | ||
| Handball | 39 | ||
| Wrestling | 39 | ||
| Ballet and Modern Dance | 39 | ||
| Other Sports | 39 | ||
| THE OVERALL RISK OF ANTERIOR CRUCIATE LIGAMENT TEAR | 39 | ||
| FEMALE–MALE INJURY RISK RATIO | 40 | ||
| ANTERIOR CRUCIATE LIGAMENT TEAR-PREVENTION PROGRAMS | 40 | ||
| IMPLICATIONS FOR FUTURE ANTERIOR CRUCIATE LIGAMENT INJURY-REDUCTION RESEARCH | 40 | ||
| CONCLUSIONS | 40 | ||
| 8 - Analysis of Anterior Cruciate Ligament Injury Prevention Programs for the Athlete | 41 | ||
| INTRODUCTION | 41 | ||
| RISK FACTORS | 41 | ||
| A REVIEW OF PREVENTION PROGRAMS | 42 | ||
| THE BIOMECHANICS OF ANTERIOR CRUCIATE LIGAMENT INJURY: GENDER INFLUENCES | 42 | ||
| VIDEO-BASED ANALYSIS | 43 | ||
| Methodology | 43 | ||
| THE FIFA 11+ INJURY-PREVENTION PROGRAM | 44 | ||
| PHYSIOLOGICAL EFFECTS OF THE FIFA 11 | 44 | ||
| THE FIFA 11+: A FOCUS ON NEUROMUSCULAR CONTROL | 44 | ||
| IMPLEMENTATION AND ADHERENCE TO INJURY-PREVENTION METHODS | 45 | ||
| CONCLUSIONS | 45 | ||
| III - Diagnosis and Nonoperative Treatment of Anterior Cruciate Ligament Tears | 46 | ||
| 9 - Diagnosis of Anterior Cruciate Ligament Tear | 46 | ||
| INTRODUCTION | 46 | ||
| DIAGNOSIS IN THE ACUTE VERSUS THE CHRONIC SETTING | 46 | ||
| PARTIAL TEARS | 46 | ||
| HISTORY | 46 | ||
| Acute | 46 | ||
| Chronic | 46 | ||
| PHYSICAL EXAM | 47 | ||
| Pivot Shift | 47 | ||
| Lachman Test | 47 | ||
| Anterior Cruciate Ligament Versus Posterior Cruciate Ligament Tear | 47 | ||
| Valgus Laxity | 47 | ||
| Locking | 47 | ||
| Hemarthrosis | 47 | ||
| Patellofemoral Injury | 47 | ||
| KT-1000 or Other Instrumented Lachman Test | 47 | ||
| Examination Under Anesthesia | 48 | ||
| Radiographs | 48 | ||
| Magnetic Resonance Imaging | 48 | ||
| CONCLUSIONS | 50 | ||
| 10 - Magnetic Resonance Imaging for the Diagnosis and Treatment of Anterior Cruciate Ligament Tears | 51 | ||
| INTRODUCTION | 51 | ||
| MAGNETIC RESONANCE IMAGING HARDWARE AND PROTOCOL | 51 | ||
| MAGNETIC RESONANCE IMAGING OF NORMAL ANTERIOR CRUCIATE LIGAMENT | 51 | ||
| MAGNETIC RESONANCE IMAGING APPEARANCES OF ANTERIOR CRUCIATE LIGAMENT INJURY | 51 | ||
| Primary Signs | 51 | ||
| Secondary Signs | 54 | ||
| Anterior Tibial Translation | 54 | ||
| Uncovered Posterior Horn of Lateral Meniscus | 54 | ||
| Osseous Contusion | 54 | ||
| PARTIAL TEARS OF THE ANTERIOR CRUCIATE LIGAMENT | 57 | ||
| ASSOCIATED INJURIES | 60 | ||
| CONCLUSION | 60 | ||
| 11 - Nonoperative Management of Anterior Cruciate Ligament Deficient Patients | 60 | ||
| INTRODUCTION | 60 | ||
| NONOPERATIVE OR OPERATIVE MANAGEMENT OF ANTERIOR CRUCIATE LIGAMENT DEFICIENT PATIENTS | 60 | ||
| POTENTIAL COPERS AND NONCOPERS AFTER ANTERIOR CRUCIATE LIGAMENT INJURY | 61 | ||
| THE ROLE OF THE QUADRICEPS AND HAMSTRINGS IN ANTERIOR CRUCIATE LIGAMENT DEFICIENT KNEES | 61 | ||
| BRACING IN ANTERIOR CRUCIATE LIGAMENT DEFICIENT PATIENTS: IS IT EFFECTIVE? | 61 | ||
| REHABILITATION | 62 | ||
| IMPORTANCE OF THE HAMSTRINGS | 63 | ||
| CONCLUSION | 64 | ||
| IV - Economics of Anterior Cruciate Ligament Reconstruction | 66 | ||
| 12 - Economics of Anterior Cruciate Ligament Tear and Reconstruction | 66 | ||
| INTRODUCTION | 66 | ||
| Purpose | 66 | ||
| Background | 66 | ||
| Macroeconomic Cost-Effectiveness of Anterior Cruciate Ligament Reconstruction | 66 | ||
| Sources of Cost Information | 66 | ||
| Third-Party Payer Payments | 66 | ||
| Hospital and Surgicenter Costs | 67 | ||
| Cost-Effectiveness of Anterior Cruciate Ligament Prevention Programs | 67 | ||
| Prehabilitation. Physical therapy has been advocated by some before ACLR. This has been shown to be cost-effective for stiff kne... | 67 | ||
| Intraoperative Costs | 67 | ||
| Allograft Versus Autograft | 67 | ||
| BTB Versus Hamstring | 67 | ||
| Fixation Implant Costs | 67 | ||
| Anterior Cruciate Ligament Instrumentation Tray Rental | 68 | ||
| Disposables | 68 | ||
| Single-Bundle Versus Double-Bundle Anterior Cruciate Ligament Reconstruction | 68 | ||
| Navigation | 68 | ||
| Platelet Rich Plasma or Other Tissue Engineering Strategies | 68 | ||
| Total Intraoperative Cost | 68 | ||
| Postoperative Costs | 68 | ||
| Nerve Blocks | 68 | ||
| Cold Machines | 69 | ||
| Continuous Passive Motion | 69 | ||
| Postoperative Knee Braces | 69 | ||
| Functional Knee Braces | 69 | ||
| Physical Therapy | 69 | ||
| AUTHOR’S PREFERRED ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION METHOD | 69 | ||
| ECONOMIES OF ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION FOR DEVELOPING COUNTRIES | 69 | ||
| CONCLUSIONS | 69 | ||
| V - Graft Mechanical Properties | 71 | ||
| 13 - Relative Strengths of Anterior Cruciate Ligament Autografts and Allografts | 71 | ||
| INTRODUCTION | 71 | ||
| METHODS | 71 | ||
| COMPARISON OF GRAFT STRENGTHS | 71 | ||
| EFFECT OF LIGAMENTIZATION | 71 | ||
| ALLOGRAFT STRENGTHS | 71 | ||
| QUADRICEPS TENDON GRAFT STRENGTH | 71 | ||
| RELATIVE STRENGTH OF HAMSTRING AND BONE–PATELLAR TENDON–BONE GRAFTS | 71 | ||
| OVERALL RELATIVE GRAFT STRENGTHS | 72 | ||
| CONCLUSIONS | 72 | ||
| 14 - Comparative and Morphological Analysis of Commonly Used Autografts for Anterior Cruciate Ligament Reconstruction with the Native... | 73 | ||
| HISTOLOGICAL AND MORPHOLOGICAL PARAMETERS OF THE TENDON GRAFTS AND NATIVE ANTERIOR CRUCIATE LIGAMENT | 73 | ||
| TRANSMISSION ELECTRON MICROSCOPE | 73 | ||
| IMMUNOHISTOCHEMISTRY | 74 | ||
| Histochemistry | 74 | ||
| QUANTITATIVE EVALUATION | 74 | ||
| STATISTICAL EVALUATION | 74 | ||
| RESULTS | 74 | ||
| DISCUSSION | 75 | ||
| CONCLUSION | 77 | ||
| VI - Graft Choices | 78 | ||
| 15 - The Case for the Bone-Patellar Tendon-Bone Autograft with Anterior Cruciate Ligament Reconstruction | 78 | ||
| INTRODUCTION | 78 | ||
| THE IDEAL ANTERIOR CRUCIATE LIGAMENT GRAFT | 78 | ||
| BIOLOGIC COMPATIBILITY AND INCORPORATION | 78 | ||
| GRAFT STRENGTH | 78 | ||
| GRAFT FIXATION AND HEALING | 79 | ||
| REHABILITATION AND RETURN TO SPORT | 79 | ||
| GRAFT-SPECIFIC COMPLICATIONS | 79 | ||
| COMPARATIVE LITERATURE | 80 | ||
| AUTHOR’S PREFERRED METHOD | 81 | ||
| 16 - The Case for Hamstring Anterior Cruciate Ligament Reconstruction | 81 | ||
| INTRODUCTION | 81 | ||
| STABILITY RATES | 82 | ||
| VII - Graft Harvest Techniques, Preparation, and Complications | 88 | ||
| 19 - Hamstring Harvest Technique for Anterior Cruciate Ligament Reconstruction | 88 | ||
| TECHNIQUE OF HAMSTRING GRAFT HARVEST | 88 | ||
| SKIN INCISION | 88 | ||
| EXPOSURE OF THE TENDON | 88 | ||
| TENDON RELEASE | 88 | ||
| STRIPPING OF THE TENDON | 89 | ||
| PREPARATION OF THE GRAFT | 89 | ||
| Preparation of the Four-Bundle Semitendinosus Graft | 89 | ||
| Graft Sizing | 89 | ||
| TIPS FOR HARVESTING THE HAMSTRING GRAFTS TO AVOID COMPLICATIONS | 89 | ||
| 20 - Posterior Mini-Incision Hamstring Harvest Approach for Anterior Cruciate Ligament Reconstruction | 90 | ||
| INTRODUCTION | 90 | ||
| ANATOMY | 90 | ||
| SURGICAL TECHNIQUE | 91 | ||
| Patient Positioning | 91 | ||
| Making the Posterior Skin Incision | 91 | ||
| Finding the Semitendinosus | 91 | ||
| Finding the Semitendinosus Insertion | 91 | ||
| Making the Anterior Incision | 91 | ||
| Identifying the Semitendinosus in the Anterior Incision | 92 | ||
| Identifying the Gracilis | 92 | ||
| Harvesting the Semitendinosus and Sectioning the Accessory Semitendinosus | 92 | ||
| What If the Tendon Stripper Gets Caught in the Thigh? | 92 | ||
| Freeing the Tendon Distally | 92 | ||
| Graft Preparation | 92 | ||
| Time of Harvest | 92 | ||
| HARVEST PROBLEMS WITH THE TRADITIONAL APPROACH AND SOLUTIONS USING THE COMBINED POSTERIOR/ANTERIOR MINI-INCISION APPROACH | 92 | ||
| Problem 1: Premature Tendon Amputation | 92 | ||
| Solution | 92 | ||
| Problem 2: Tendon Identification | 93 | ||
| Solution | 93 | ||
| Problem 3: Hang-Up of the Tendon Stripper in the Distal Thigh at the Fanning-Out of the Semitendinosus or Semimembranosus Sling | 94 | ||
| VIII - Reconstruction Techniques Including Double-Bundle | 131 | ||
| 32 - Pearls for Anterior Cruciate Ligament Reconstruction | 131 | ||
| 33 - Anterior Cruciate Ligament Reconstruction Using Hamstrings in Press-Fit Technique without Hardware | 135 | ||
| INTRODUCTION | 135 | ||
| METHODS | 135 | ||
| Surgical Technique | 135 | ||
| Graft Preparation | 135 | ||
| Troubleshooting | 136 | ||
| Postoperative Rehabilitation | 136 | ||
| Biomechanical Studies | 136 | ||
| Tunnel Widening | 136 | ||
| Results | 136 | ||
| Biomechanical Testing | 137 | ||
| Results | 137 | ||
| Clinical Results | 138 | ||
| RESULTS | 138 | ||
| CONCLUSION | 138 | ||
| 34 - Anterior Cruciate Ligament Reconstruction with Quadriceps Tendon Autograft | 140 | ||
| INTRODUCTION | 140 | ||
| TECHNIQUE | 140 | ||
| REHABILITATION | 141 | ||
| PITFALLS AND COMPLICATIONS | 141 | ||
| AUTHOR’S EXPERIENCE | 141 | ||
| 35 - Three-Portal Technique for Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction | 142 | ||
| INTRODUCTION | 142 | ||
| THREE-PORTAL TECHNIQUE FOR ANATOMIC SINGLE-BUNDLE ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION | 142 | ||
| Three-Portal Technique for Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction | 142.e1 | ||
| INDICATIONS AND CONTRAINDICATIONS | 143 | ||
| PATIENT POSITIONING | 143 | ||
| ARTHROSCOPIC PORTALS | 143 | ||
| ANATOMIC ANTERIOR CRUCIATE LIGAMENT FEMORAL TUNNEL PLACEMENT | 144 | ||
| HOW TO FIND THE CENTER OF THE ANTERIOR CRUCIATE LIGAMENT FEMORAL ATTACHMENT SITE | 145 | ||
| DRILLING THE ANTERIOR CRUCIATE LIGAMENT FEMORAL TUNNEL | 145 | ||
| DRILLING THE TIBIAL TUNNEL | 146 | ||
| CONCLUSIONS | 146 | ||
| 36 - Anatomical Double-Bundle Anterior Cruciate Ligament Reconstruction Procedure Using the Semitendinosus Tendon | 147 | ||
| INTRODUCTION | 147 | ||
| THEORY OF THE PROCEDURE | 147 | ||
| PRACTICAL PROCEDURE | 148 | ||
| Preparation for Arthroscopic Surgery | 148 | ||
| Creation of Tibial Tunnels | 148 | ||
| Creation of Femoral Tunnels | 148 | ||
| Graft Fashioning | 149 | ||
| Graft Placement | 149 | ||
| Graft Tensioning and Fixation | 149 | ||
| WHAT TO DO IF YOU GET IN TROUBLE | 150 | ||
| CLINICAL RESULTS | 150 | ||
| CONCLUSION | 150 | ||
| 37 - Anatomical Double-Bundle Anterior Cruciate Ligament Reconstruction with a Semitendinosus Hamstring Tendon Graft | 151 | ||
| INTRODUCTION | 151 | ||
| ANATOMY OF THE ANTERIOR CRUCIATE LIGAMENT | 151 | ||
| SCIENTIFIC RATIONALE | 151 | ||
| SURGICAL TECHNIQUE | 151 | ||
| Preparation of the Double-Bundle Semitendinosus Graft | 152 | ||
| Arthroscopic Anterior Cruciate Ligament Reconstruction | 152 | ||
| PRELIMINARY RESULTS | 153 | ||
| OTHER APPLICATIONS | 153 | ||
| SPECIAL CONSIDERATIONS | 153 | ||
| TROUBLESHOOTING | 154 | ||
| 38 - Anatomic Double-Bundle Reconstruction of the Anterior Cruciate Ligament | 155 | ||
| INTRODUCTION | 155 | ||
| PREOPERATIVE CONSIDERATIONS | 155 | ||
| History and Physical | 155 | ||
| Imaging | 155 | ||
| Indications | 155 | ||
| SURGICAL TECHNIQUE | 155 | ||
| Anesthesia and Positioning | 155 | ||
| Anterior Cruciate Ligament Graft Preparation | 155 | ||
| Surgical Landmarks | 156 | ||
| Surgical Technique | 156 | ||
| POSTOPERATIVE CONSIDERATIONS | 158 | ||
| Rehabilitation | 158 | ||
| Complications | 158 | ||
| Results | 158 | ||
| CONCLUSION | 159 | ||
| TROUBLESHOOTING | 159 | ||
| 39 - Augmented Grafts: Synthetic/Allograft/Autograft | 160 | ||
| INTRODUCTION | 160 | ||
| AUTOGRAFT AUGMENTATION OF ACUTE REPAIR OF ANTERIOR CRUCIATE LIGAMENT | 160 | ||
| AUTOGRAFTS, ALLOGRAFTS, AND SYNTHETICS FOR ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION | 160 | ||
| NONDEGRADABLE BIOLOGIC GRAFT (XENOGRAFT) | 161 | ||
| DEGRADABLE SYNTHETIC DEVICES FOR ANTERIOR CRUCIATE LIGAMENT AUGMENTATION OR PROSTHESIS | 161 | ||
| POLYDIOXANONE | 161 | ||
| ARTELON (POLYURETHANE-UREA) | 161 | ||
| COMMENTS AND FUTURE DIRECTIONS | 161 | ||
| ACUTE REPAIR OF ANTERIOR CRUCIATE LIGAMENT | 161 | ||
| ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING AUTOGRAFTS AND ALLOGRAFTS | 161 | ||
| ANTERIOR CRUCIATE LIGAMENT PROSTHESES (PERMANENT DEVICES) | 162 | ||
| CONCLUSIONS | 162 | ||
| 40 - A Systematic Review of Single- Versus Double-Bundle Results | 163 | ||
| INTRODUCTION | 163 | ||
| Characteristics of Studies Comparing Single- and Double-Bundle Anterior Cruciate Ligament Reconstruction | 163 | ||
| Knee Laxity | 163 | ||
| Anteroposterior Laxity | 164 | ||
| Rotatory Laxity | 164 | ||
| Patient-Reported Outcome Measures | 165 | ||
| Graft Failure | 165 | ||
| Range of Motion and Strength | 165 | ||
| Return to Sport | 165 | ||
| Osteoarthritis | 165 | ||
| CONCLUSION | 166 | ||
| IX - Principles of Tunnel Formation | 167 | ||
| 41 - Transtibial Tunnel Drilling of the Femoral Tunnel for Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction | 167 | ||
| INTRODUCTION | 167 | ||
| Comfortable Knee Flexion Angle | 167 | ||
| Adequate Tunnel Length | 167 | ||
| Decreased Graft Abrasion at the Femoral Outlet | 167 | ||
| TRANS FEMORAL TUNNEL DISADVANTAGES | 167 | ||
| Difficult Knee Flexion Angle | 167 | ||
| Shorter Femoral Tunnel Length | 167 | ||
| Increased Graft Femoral Tunnel Abrasion | 167 | ||
| TRANSTIBIAL FEMORAL TUNNEL DRILLING TECHNIQUE | 167 | ||
| CONCLUSIONS | 168 | ||
| 42 - The Anteromedial Portal for Anterior Cruciate Ligament Reconstruction | 169 | ||
| INTRODUCTION | 169 | ||
| ADVANTAGES | 169 | ||
| TECHNIQUE | 169 | ||
| POSSIBLE COMPLICATIONS | 170 | ||
| 43 - Intraoperative Fluoroscopy for Anterior Cruciate Ligament Tunnel Placement | 173 | ||
| INTRODUCTION | 173 | ||
| OPERATING ROOM SETUP | 173 | ||
| ANTERIOR CRUCIATE LIGAMENT FEMORAL TUNNEL PLACEMENT | 173 | ||
| ANALYZING THE ANTERIOR CRUCIATE LIGAMENT FEMORAL TUNNEL POSITION | 174 | ||
| ANTERIOR CRUCIATE LIGAMENT TIBIAL TUNNEL PLACEMENT | 175 | ||
| ANALYZING ANTERIOR CRUCIATE LIGAMENT TIBIAL TUNNEL POSITION | 176 | ||
| CONCLUSION | 177 | ||
| 44 - Anterior Cruciate Ligament All-Inside Retroconstruction: Single- and Double-Bundle Techniques | 178 | ||
| TECHNIQUE | 178 | ||
| All-Inside Single-Bundle Anterior Cruciate Ligament Reconstruction | 178 | ||
| Graft Harvest | 178 | ||
| Graft Preparation | 179 | ||
| Tunnel Preparation | 179 | ||
| Graft Passage | 180 | ||
| Double-Bundle All-Inside Anterior Cruciate Ligament Reconstruction | 181 | ||
| Troubleshooting | 181 | ||
| CONCLUSION | 181 | ||
| 45 - Femoral Tunnel Creation Using the Zimmer Biomet SwitchCut Femoral Aimer | 182 | ||
| 46 - Use of the Pinpoint Guide System for Anterior Cruciate Ligament Reconstruction | 184 | ||
| INTRODUCTION | 184 | ||
| TWO-INCISION TECHNIQUE DETAILS | 184 | ||
| REVISION ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION | 185 | ||
| ALL-EPIPHYSEAL DRILLING FOR SKELETALLY IMMATURE | 185 | ||
| LONG BONE–PATELLAR TENDON–BONE GRAFT (GRAFT TUNNEL MISMATCH) | 185 | ||
| INABILITY TO HYPERFLEX LEG | 187 | ||
| 47 - Femoral Tunnel Placement to Restore Normal Knee Laxity after Anterior Cruciate Ligament Reconstruction | 188 | ||
| INTRODUCTION | 188 | ||
| FUNCTIONAL ANATOMY OF THE ANTERIOR CRUCIATE LIGAMENT RELATED TO GRAFT TUNNELS | 189 | ||
| ANTERIOR CRUCIATE LIGAMENT ISOMETRY AND RECONSTRUCTION | 189 | ||
| ANATOMICAL SINGLE-BUNDLE ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION | 191 | ||
| ANATOMICAL DOUBLE-BUNDLE ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION | 192 | ||
| DISCUSSION | 193 | ||
| 48 - Description of the Direct Femoral Attachment of the Anterior Cruciate Ligament: Implication for Femoral Tunnel Placement in Reconstruction | 193 | ||
| INTRODUCTION | 193 | ||
| MACROSCOPIC ANATOMY OF THE ANTERIOR CRUCIATE LIGAMENT | 193 | ||
| MICROSCOPIC ANATOMY OF THE ANTERIOR CRUCIATE LIGAMENT | 194 | ||
| FUNCTION OF THE DIRECT INSERTION ANDINDIRECT INSERTION | 195 | ||
| COMPARISON OF MACROSCOPIC AND MICROSCOPIC OBSERVATIONS | 195 | ||
| IMPLICATION FOR FEMORAL TUNNEL PLACEMENT IN ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION | 196 | ||
| 49 - Flexible Reamers for Anterior Cruciate Ligament Reconstruction | 197 | ||
| INTRODUCTION | 197 | ||
| TECHNIQUE | 197 | ||
| Patient Positioning | 197 | ||
| Locating the Femoral Footprint | 197 | ||
| Tunnel Creation | 198 | ||
| Tibial Tunnel and Impingement | 200 | ||
| X - Control of Pain in Anterior Cruciate Ligament Reconstruction | 202 | ||
| 50 - Risks and Benefits of Femoral Nerve Block for Anterior Cruciate Ligament Reconstruction | 202 | ||
| METHODS OF PAIN CONTROL | 202 | ||
| METHODOLOGY FOR FEMORAL NERVE BLOCK | 202 | ||
| RISKS OF FEMORAL NERVE BLOCKS: ARE THEY RARE BUT REAL? | 203 | ||
| Benefits of FNB in ACLR, are They Clinically Relevant? | 203 | ||
| Alternative Blocks | 203 | ||
| 51 - Saphenous Nerve Block for Anterior Cruciate Ligament Reconstruction | 204 | ||
| 52 - Efficacy of Cryotherapy for Pain Control After Anterior Cruciate Ligament Reconstruction | 207 | ||
| INTRODUCTION | 207 | ||
| MEASUREMENT METHODOLOGY | 207 | ||
| Temperature Measurements | 207 | ||
| Cooling Treatments | 208 | ||
| RESULTS AND DISCUSSION | 208 | ||
| 53 - Chondrolysis: Risk-Benefit Analysis of “Caine” Local Anesthetics for Anterior Cruciate Ligament Reconstruction | 210 | ||
| INTRODUCTION | 210 | ||
| BENEFITS OF LOCAL ANESTHETICS | 210 | ||
| BASIC SCIENCE STUDIES | 211 | ||
| CLINICAL STUDIES: CHONDROLYSIS | 211 | ||
| CONCLUSION | 213 | ||
| 54 - Use of Preoperative Gabapentin for Postoperative Pain Relief After Anterior Cruciate Ligament Reconstruction | 215 | ||
| INTRODUCTION | 215 | ||
| WHY NOT TO USE NERVE BLOCKS | 215 | ||
| USING GABAPENTIN | 215 | ||
| CONCLUSION | 215 | ||
| 55 - Obturator and Sciatica Nerve Block for Anterior Cruciate Ligament Reconstruction | 216 | ||
| INTRODUCTION | 216 | ||
| OBTURATOR NERVE BLOCK TECHNIQUE | 217 | ||
| SCIATIC NERVE BLOCK TECHNIQUE | 217 | ||
| CONTRAINDICATIONS AND COMPLICATIONS | 217 | ||
| CONCLUSION | 218 | ||
| XI - Additional Surgical Considerations | 219 | ||
| 56 - Notch Anatomy and Notchplasty | 219 | ||
| ANATOMY | 219 | ||
| INDICATIONS AND POTENTIAL RISKS | 220 | ||
| TECHNIQUES AND AVOIDING COMPLICATIONS | 222 | ||
| 57 - Computer-Assisted Navigation for Anterior Cruciate Ligament Reconstruction | 224 | ||
| RATIONALE | 224 | ||
| NEED FOR PRECISION IN TUNNEL PLACEMENT | 225 | ||
| CURRENT ACCURACY WITHOUT NAVIGATION | 225 | ||
| TECHNIQUES OF COMPUTER-ASSISTED NAVIGATION | 225 | ||
| RESULTS | 227 | ||
| DISCUSSION | 227 | ||
| 58 - Sparing the Anterior Cruciate Ligament Remnant: Is It Worth the Hassle? | 228 | ||
| INTRODUCTION | 228 | ||
| INDICATIONS AND CONTRAINDICATIONS | 229 | ||
| PROPRIOCEPTION AND BIOMECHANICAL FEATURES | 229 | ||
| VASCULARIZATION AND HISTOLOGY | 229 | ||
| CLINICAL RESULTS | 229 | ||
| THE AUTHOR’S PREFERRED SURGICAL TECHNIQUE | 229 | ||
| DISADVANTAGES | 229 | ||
| CONCLUSION | 230 | ||
| 59 - Graft Tensioning in Anterior Cruciate Ligament Reconstruction | 231 | ||
| INTRODUCTION | 231 | ||
| IN VITRO STUDIES ON GRAFT TENSIONING | 231 | ||
| Effect of Initial Graft Tension on Tension-Flexion Curve | 231 | ||
| Effects of Initial Graft Tension on the Anterior Cruciate Ligament–Reconstructed Knee Immediately After Surgery | 232 | ||
| Relaxation of Graft Tension After Surgery | 232 | ||
| Effects of High Initial Graft Tension on Anterior Cruciate Ligament–Reconstructed Knees with Various Fixation Devices | 234 | ||
| Biological Effects of Extremely Low or High Tension on the Graft | 234 | ||
| Effects of Initial Graft Tension on the Outcome after Anterior Cruciate Ligament Reconstruction | 234 | ||
| RANDOMIZED CLINICAL TRIALS ON THE EFFECT OF INITIAL GRAFT TENSION ON THE OUTCOME AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION... | 235 | ||
| CONCLUSION | 236 | ||
| 60 - The Use of CO2 Instead of Fluid in Arthroscopic Anterior Cruciate Ligament Reconstruction | 237 | ||
| INTRODUCTION | 237 | ||
| BODY | 237 | ||
| ?Surgical Technique (Video 60.1) | 237 | ||
| Tips and Tricks | 237 | ||
| ?Benefits of Gas Distension (Video 60.2) | 238 | ||
| Disadvantages of Gas Distension | 239 | ||
| CONCLUSION | 239 | ||
| XII - Fixation Biomechanics | 241 | ||
| 61 - Intratunnel Anterior Cruciate Ligament Graft Fixation | 241 | ||
| INTRODUCTION | 241 | ||
| Intratunnel Anterior Cruciate Ligament Graft Fixation | 241 | ||
| INTRATUNNEL FIXATION OF BONE–PATELLAR TENDON–BONE ANTERIOR CRUCIATE LIGAMENT GRAFTS | 242 | ||
| GUIDELINES FOR INTRATUNNEL FIXATION OF BONE–PATELLAR TENDON–BONE ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTIONS | 243 | ||
| Femoral Fixation: Two-Incision Technique | 243 | ||
| Femoral Fixation: Endoscopic Technique | 243 | ||
| Tibial Fixation | 243 | ||
| INTRATUNNEL FIXATION OF SOFT TISSUE ANTERIOR CRUCIATE LIGAMENT GRAFTS | 243 | ||
| GUIDELINES AND RECOMMENDATIONS FOR INTRATUNNEL FIXATION OF SOFT TISSUE GRAFT ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTIONS | 243 | ||
| 62 - Biomechanical Considerations of Suspensory Cortical Fixation Devices | 244 | ||
| INTRODUCTION | 244 | ||
| BIOMECHANICAL TESTING | 244 | ||
| Fixed-Loop Cortical Suspension Devices | 244 | ||
| Adjustable-Loop Cortical Suspension Devices | 245 | ||
| ULTIMATE STRENGTH TESTING | 245 | ||
| CLINICAL IMPORTANCE | 246 | ||
| CONCLUSIONS | 246 | ||
| XIII - Soft-Tissue Graft Cortical Fixation | 247 | ||
| 63 - Endobutton Anterior Cruciate Ligament Reconstruction Femoral Fixation | 247 | ||
| INTRODUCTION | 247 | ||
| BIOMECHANICS | 247 | ||
| CLINICAL RESULTS | 247 | ||
| SURGICAL TECHNIQUE | 247 | ||
| Principle | 247 | ||
| Materials | 247 | ||
| Femoral-Tunnel Formation | 247 | ||
| Principles of Femoral-Tunnel Drilling | 247 | ||
| Notchplasty | 247 | ||
| Basic Technique | 248 | ||
| Minimum Tunnel Length | 248 | ||
| Redrilling If the First Tunnel Is Too Short | 248 | ||
| Finishing the Femoral Tunnel | 248 | ||
| Calculating Endobutton–Continuous Loop Length | 248 | ||
| Passing the Graft | 249 | ||
| Seating the Endobutton | 249 | ||
| Removing the Passing Sutures | 249 | ||
| THE XTENDOBUTTON | 252 | ||
| CONCLUSIONS | 252 | ||
| 64 - Cortical Screw Post Femoral Fixation Using Whipstitches, Fabric Loop, or Endobutton: The Universal Salvage | 254 | ||
| BACKGROUND | 254 | ||
| Importance | 254 | ||
| History | 254 | ||
| BIOMECHANICS | 254 | ||
| Advantages | 254 | ||
| SURGICAL TECHNIQUE | 254 | ||
| Materials | 254 | ||
| Incision | 255 | ||
| Femoral Screw Insertion Technique | 255 | ||
| Attaching the Graft to the Femoral Post | 255 | ||
| Endobutton-CL Fabric Loop Passed Around the Femoral Post | 255 | ||
| Fabric Tape Tied Around the Femoral Post | 255 | ||
| Whipstitch Technique | 255 | ||
| Graft Passed Through the Endobutton-CL Loop and Sutures Used to Tie the Endobutton to the Femoral Post | 256 | ||
| Fixating Single Strands of Graft and Odd Numbers of Strands | 256 | ||
| Radiography | 257 | ||
| THE FEMORAL POST TECHNIQUE CAN SALVAGE THE FOLLOWING SITUATIONS | 257 | ||
| CONCLUSIONS | 257 | ||
| 65 - Arthrex TightRope Fixation of a Soft Tissue Graft | 258 | ||
| SURGICAL TECHNIQUE | 258 | ||
| HAMSTRING GRAFT HARVESTING | 258 | ||
| GRAFT PREPARATION | 259 | ||
| FEMORAL SOCKET CREATION | 259 | ||
| TIBIAL SOCKET CREATION | 259 | ||
| GRAFT PASSAGE AND FIXATION | 261 | ||
| 66 - RigidLoop Femoral Fixation Techniques | 263 | ||
| INTRODUCTION | 263 | ||
| BIOMECHANICS | 263 | ||
| PROCEDURE | 263 | ||
| Materials | 263 | ||
| PREPARATION AND SETUP | 263 | ||
| Notchplasty | 263 | ||
| Femoral Tunnel Drilling | 263 | ||
| Reaming the Femur | 264 | ||
| AUTHOR HINT | 264 | ||
| Outside-In Femoral Tunnel Creation | 264 | ||
| Preparing the Graft | 264 | ||
| Passing the Graft | 265 | ||
| Troubleshooting and Tips | 265 | ||
| Retrograde Reaming of the Entire Femoral Tunnel | 265 | ||
| Femoral Cortex Blowout | 265 | ||
| Additional Methods for Calculating Loop Length | 265 | ||
| Difficulty with Button Deployment | 266 | ||
| Inability to Pass the Graft | 266 | ||
| 67 - MedShape ExoShape Fixation | 267 | ||
| INTRODUCTION | 267 | ||
| SURGICAL TECHNIQUE | 267 | ||
| 68 - Biomet ToggleLoc | 269 | ||
| ANTERIOR CRUCIATE LIGAMENT SOFT TISSUE FEMORAL CORTICAL FIXATION: ZIPLOOP TECHNOLOGY | 269 | ||
| TECHNIQUE | 270 | ||
| Step 1 | 270 | ||
| Step 2 | 270 | ||
| Step 3 | 270 | ||
| Step 4 | 270 | ||
| Step 5 | 270 | ||
| Step 6 | 270 | ||
| Step 7 | 270 | ||
| Step 8 | 270 | ||
| Step 9 | 271 | ||
| Step 10 | 271 | ||
| Step 11 | 271 | ||
| Step 12 | 271 | ||
| Step 13 | 272 | ||
| Step 14 | 272 | ||
| Step 15 | 272 | ||
| 69 - EZLoc: Optimizing Femoral Fixation for Soft-Tissue Graft Anterior Cruciate Ligament Reconstruction | 273 | ||
| OPERATIVE TECHNIQUE | 273 | ||
| CONCLUSION | 276 | ||
| XIV - Soft-Tissue Graft Interference Screw Fixation | 277 | ||
| 70 - Hamstring Tendon Interference Screw Fixation | 277 | ||
| INTRODUCTION | 277 | ||
| INTERFERENCE SCREW FIXATION | 277 | ||
| TYPES OF INTERFERENCE SCREWS | 277 | ||
| TECHNIQUE CONSIDERATIONS | 278 | ||
| 71 - Compression Aperture Fixation of Soft-Tissue Anterior Cruciate Ligament Reconstructions | 280 | ||
| INTRODUCTION | 280 | ||
| TECHNIQUE | 281 | ||
| Pearls and Pitfalls | 283 | ||
| CONCLUSION | 283 | ||
| 72 - Milagro Advance (Beta-Tricalcium Phosphate, Polylactide Co-Glycolide Biocomposite) Interference Screw for Anterior Cruciate Liga... | 284 | ||
| INTRODUCTION | 284 | ||
| BIOMECHANICAL AND BIOCHEMICAL DATA | 284 | ||
| BASIC SCIENCE OF BETA-TRICALCIUM PHOSPHATE COPOLYMERS | 285 | ||
| CLINICAL INFORMATION | 285 | ||
| 73 - Anterior Cruciate Ligament Reconstruction with the Use of Femoral INTRAFIX: Rationale, Procedure, and Pearls for a Novel Anterio... | 288 | ||
| INTRODUCTION | 288 | ||
| GRAFT PREPARATION: AUTOGRAFT | 288 | ||
| GRAFT PREPARATION: ALLOGRAFT | 288 | ||
| FEMORAL TUNNEL PREPARATION | 289 | ||
| TIBIAL TUNNEL PREPARATION | 289 | ||
| GRAFT PASSAGE AND FEMORAL FIXATION | 289 | ||
| Trial Insertion | 289 | ||
| Femoral Fixation | 290 | ||
| TIBIAL FIXATION: SINGLE-TUNNEL, DOUBLE-BUNDLE TECHNIQUE | 290 | ||
| POTENTIAL PITFALLS AND PROBLEMS AND HOW TO ADDRESS THEM | 290 | ||
| Screw not Engaging the Sheath | 290 | ||
| Posterior Tunnel Wall Violation | 290 | ||
| Anterior Cruciate Ligament Revision after Using Femoral INTRAFIX | 291 | ||
| Recent Biomechanical Studies Relevant to Femoral INTRAFIX | 291 | ||
| CONCLUSIONS | 291 | ||
| 74 - Utilizing the ComposiTCP Screw for Interference Screw Fixation | 291 | ||
| TECHNIQUE | 292 | ||
| 75 - Bioabsorbable Versus Metal Interference Screws: Adverse Events and Clinical Results | 294 | ||
| ADVERSE EVENTS | 294 | ||
| Tunnel Widening | 294 | ||
| Incomplete Biodegradation and Bony Ingrowth | 294 | ||
| Cyst or Sterile Abscess Formation and Pretibial Reaction | 297 | ||
| Effusion and Synovial Reaction | 297 | ||
| Screw Breakage and Migration | 297 | ||
| Infection or Septic Arthritis | 297 | ||
| CLINICAL RESULTS | 297 | ||
| Clinical Knee Stability | 297 | ||
| KT-1000 Arthrometry | 297 | ||
| Pivot-Shift Test | 297 | ||
| Functional Results | 297 | ||
| International Knee Documentation Committee Scores | 297 | ||
| Lysholm Score | 297 | ||
| Tegner Score | 297 | ||
| CONCLUSION | 297 | ||
| 76 - Use of TunneLoc for Anterior Cruciate Ligament Reconstruction | 298 | ||
| INTRODUCTION | 298 | ||
| OUR TECHNIQUE | 299 | ||
| PEARLS AND PITFALLS | 300 | ||
| CONCLUSION | 301 | ||
| 77 - Improving Biodegradable Interference Screw Properties by Combining Polymers | 302 | ||
| INTRODUCTION | 302 | ||
| BIOMECHANICAL RESULTS | 302 | ||
| Fixation Strength | 302 | ||
| Torsional Strength | 303 | ||
| Strength Retention | 303 | ||
| CLINICAL RESULTS | 303 | ||
| Clinical Experience | 303 | ||
| Prospective Randomized Clinical Trial | 303 | ||
| Magnetic Resonance Imaging | 304 | ||
| CONCLUSIONS | 305 | ||
| XV - Soft-Tissue Graft Tibial Fixation | 307 | ||
| 78 - Whipstitch-Post Tibial Fixation for Anterior Cruciate Ligament Reconstruction | 307 | ||
| BIOMECHANICS | 307 | ||
| Elongation and Stiffness | 307 | ||
| Indirect Versus Direct Fixation | 307 | ||
| CLINICAL RESULTS | 308 | ||
| SURGICAL TECHNIQUE | 308 | ||
| Principal | 308 | ||
| Sutures | 308 | ||
| Suitable Tibial Screws | 308 | ||
| Whipstitch Implantation | 308 | ||
| Tubularization | 308 | ||
| Tensioning | 308 | ||
| Trimming Tendon Grafts | 309 | ||
| Sizing the Grafts | 309 | ||
| Tying the Whipstitches | 309 | ||
| Screw Insertion | 309 | ||
| Screw Insertion Location | 309 | ||
| Unicortical Implantation | 309 | ||
| Screw Tightening | 310 | ||
| TROUBLESHOOTING | 310 | ||
| CONCLUSIONS | 310 | ||
| 79 - WasherLoc: Optimizing Tibial Fixation of Soft-Tissue Grafts Used for Anterior Cruciate Ligament Reconstruction | 311 | ||
| INTRODUCTION | 311 | ||
| WASHERLOC FIXATION TECHNIQUE | 312 | ||
| TROUBLESHOOTING | 313 | ||
| CONCLUSION | 314 | ||
| 80 - Hamstring Anterior Cruciate Ligament Reconstruction with INTRAFIX and BioINTRAFIX Tibial Fastener Systems | 315 | ||
| INTRODUCTION | 315 | ||
| SURGICAL TECHNIQUE | 315 | ||
| Graft Preparation | 315 | ||
| Use with Allografts | 316 | ||
| Tibial Tunnel | 316 | ||
| Tunnel Sizing | 316 | ||
| Femoral Graft Fixation | 316 | ||
| Graft Passage, Graft Tensioning, and Tibial Fixation | 316 | ||
| Device Insertion | 317 | ||
| Troubleshooting | 318 | ||
| Sheath Overinsertion | 318 | ||
| Screw Breakage | 318 | ||
| Failure to Advance | 319 | ||
| Low Bone Density | 320 | ||
| Too Short a Graft | 320 | ||
| Closure and Postoperative Dressings | 320 | ||
| POSTOPERATIVE MANAGEMENT | 321 | ||
| RESULTS | 321 | ||
| CONCLUSION | 321 | ||
| XVI - Bone–Tendon–Bone Graft Fixation | 322 | ||
| 81 - Interference Screw Fixation in Bone–Patellar Tendon–Bone Anterior Cruciate Ligament Reconstruction | 322 | ||
| INTRODUCTION | 322 | ||
| GRAFT PREPARATION | 322 | ||
| SCREW SELECTION | 322 | ||
| BONE TUNNEL PREPARATION | 323 | ||
| RELATIVE POSITION OF SCREW AND GRAFT WITHIN TUNNEL | 323 | ||
| PARALLELISM AND DIVERGENCE | 324 | ||
| EXTREMES OF BONE DENSITY | 325 | ||
| INTERFERENCE SCREW FIXATION PROBLEMS | 325 | ||
| AUTHORS’ PREFERRED APPROACH | 325 | ||
| CONCLUSION | 325 | ||
| 82 - Use of the TightRope Bone–Tendon–Bone for Anterior Cruciate Ligament Reconstruction | 326 | ||
| SURGICAL TECHNIQUE | 326 | ||
| 83 - Anterior Cruciate Ligament Reconstruction Using a Mini-Arthrotomy Technique with Either an Ipsilateral or a Contralateral Autoge... | 330 | ||
| INTRODUCTION | 330 | ||
| PREOPERATIVE PLANNING | 331 | ||
| Radiographs | 331 | ||
| Rehabilitation | 331 | ||
| TECHNIQUE | 331 | ||
| Preparation | 331 | ||
| Preparation When Using a Graft From the Contralateral Knee | 331 | ||
| Arthroscopic Evaluation | 331 | ||
| Exposure | 331 | ||
| Tibial Exposure | 331 | ||
| Medial Arthrotomy | 332 | ||
| Femoral Exposure | 332 | ||
| Notchplasty | 332 | ||
| Tunnel Placement | 332 | ||
| Tibial Tunnel | 332 | ||
| Femoral Tunnel | 333 | ||
| Graft Harvest and Preparation | 333 | ||
| Ipsilateral Graft | 333 | ||
| Contralateral Graft | 335 | ||
| Passage of the Graft, Fixation, and Tensioning | 335 | ||
| Closure | 336 | ||
| Ipsilateral Graft | 336 | ||
| Contralateral Graft | 336 | ||
| Postoperative Care | 336 | ||
| COMMENTS | 336 | ||
| Special Considerations with Contralateral Graft | 336 | ||
| CONCLUSION | 336 | ||
| 84 - Anterior Cruciate Ligament Reconstruction Using the Endobutton Continuous Loop Bone–Tendon–Bone Fixation System | 337 | ||
| INTRODUCTION | 337 | ||
| ADVANTAGES | 337 | ||
| TECHNIQUE | 337 | ||
| “Anatomical”/Anterior Medial Portal Technique | 337 | ||
| XVII - Graft Healing and Ligamentization | 341 | ||
| 85 - Graft Remodeling and Ligamentization after Anterior Cruciate Ligament Reconstruction | 341 | ||
| PHASES OF REMODELING | 341 | ||
| Early Graft-Healing Phase | 341 | ||
| Proliferation Phase of Graft Healing | 341 | ||
| Ligamentization Phase of Graft Healing | 343 | ||
| REMODELING OF HUMAN AUTOGRAFTS AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION | 344 | ||
| Magnetic Resonance Imaging Studies of Human Anterior Cruciate Ligament Grafts | 344 | ||
| Biopsy Studies of Human Anterior Cruciate Ligament Grafts | 345 | ||
| Human Graft Remodeling and Rehabilitation | 347 | ||
| CONCLUSION | 347 | ||
| 86 - Graft-Tunnel Healing | 348 | ||
| INTRODUCTION | 348 | ||
| LIGAMENT-TO-BONE INSERTION SITE | 348 | ||
| TYPES OF GRAFT | 348 | ||
| Autograft | 348 | ||
| XVIII - Revision Anterior Cruciate Ligament Reconstruction | 355 | ||
| 88 - Hamstring Four- to Six-Strand Double-Bundle Graft for Revision or High-Risk Primary Anterior Cruciate Ligament Reconstruction | 355 | ||
| INTRODUCTION | 355 | ||
| GRAFT CONFIGURATIONS | 355 | ||
| TIBIAL TUNNEL | 355 | ||
| FEMORAL TUNNEL | 355 | ||
| RESULTS | 356 | ||
| CONCLUSION | 356 | ||
| SURGICAL TECHNIQUE | 356 | ||
| Patient Positioning, Sterile Prepping | 356 | ||
| Routine Arthroscopy | 356 | ||
| Evaluation of Tibial Tunnel | 356 | ||
| Evaluation of Femoral Tunnel | 356 | ||
| Hamstring Harvest | 357 | ||
| Graft Preparation | 357 | ||
| Tibial Post Insertion | 357 | ||
| Drilling the Tibial Tunnel | 357 | ||
| Drilling the Femoral Tunnel | 357 | ||
| Passing the Graft | 358 | ||
| Tibial Fixation | 358 | ||
| Dressing | 358 | ||
| 89 - Revision Anterior Cruciate Ligament Reconstruction with Bone–Patellar Tendon–Bone Autograft | 359 | ||
| INTRODUCTION | 359 | ||
| Risk Factors | 359 | ||
| Technical Errors | 359 | ||
| Graft Choice | 359 | ||
| Preoperative Planning | 360 | ||
| SURGICAL TECHNIQUE AND CONSIDERATIONS FOR REVISION | 361 | ||
| Advantages of Open Procedure | 361 | ||
| Tunnel Placement Around Hardware | 361 | ||
| Tunnel Placement Around Existing Tunnels (Bone Loss) | 361 | ||
| Button Fixation—Advantages | 361 | ||
| Reharvest of the Patellar Tendon Autograft | 361 | ||
| RESULTS OF REVISION ANTERIOR CRUCIATE LIGAMENT SURGERY | 362 | ||
| SUMMARY | 362 | ||
| 90 - Revision Anterior Cruciate Ligament Reconstruction: Management of Femoral Tunnel Malposition | 364 | ||
| INTRODUCTION | 364 | ||
| PREOPERATIVE EVALUATION AND HARDWARE MANAGEMENT | 364 | ||
| GRAFT SELECTION AND GRAFT FIXATION | 364 | ||
| FEMORAL TUNNEL MANAGEMENT | 365 | ||
| TECHNICAL PROBLEMS RELATED TO FEMORAL TUNNEL REVISION | 365 | ||
| ANATOMIC RECTANGULAR TUNNEL TECHNIQUE | 365 | ||
| SURGICAL PRINCIPLES FOR ANATOMIC RECTANGULAR TUNNEL TECHNIQUE | 366 | ||
| RESULTS OF ANATOMIC RECTANGULAR TECHNIQUE | 366 | ||
| For Graft Choice | 367 | ||
| With Previous Properly Placed Tunnels | 367 | ||
| With Improperly Placed Previous Tunnels | 367 | ||
| For Graft Fixation | 367 | ||
| OVER-THE-TOP TECHNIQUE | 367 | ||
| CASE EXAMPLE OF OVER-THE-TOP FEMORAL FIXATION IN MASSIVE BONE LOSS | 367 | ||
| POSTOPERATIVE REHABILITATION | 367 | ||
| 91 - Revision Anterior Cruciate Ligament Reconstruction—The Multicenter Anterior Cruciate Ligament Revision Study | 369 | ||
| XIX - Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients | 371 | ||
| 92 - Techniques and Complications of Transphyseal Anterior Cruciate Ligament Reconstruction in the Skeletally Immature Patient | 371 | ||
| INTRODUCTION | 371 | ||
| TRANSPHYSEAL ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION | 371 | ||
| ASSESSMENT OF SKELETAL MATURITY | 371 | ||
| THE TIME OF RECONSTRUCTION (ACUTE VERSUS DELAYED) | 372 | ||
| GRAFT TYPE | 372 | ||
| REHABILITATION | 372 | ||
| COMPLICATIONS | 373 | ||
| REVISION SURGERIES | 373 | ||
| CONCLUSION | 373 | ||
| 93 - An Overview of the Diagnosis and Treatment of the Torn Anterior Cruciate Ligament in the Skeletally Immature Athlete | 374 | ||
| INTRODUCTION | 374 | ||
| ANATOMY | 374 | ||
| RISK FACTORS | 374 | ||
| PATIENT EVALUATION AND DIAGNOSIS | 375 | ||
| IMAGING | 375 | ||
| NONOPERATIVE AND DELAYED SURGICAL TREATMENT | 375 | ||
| OPERATIVE TREATMENT AND TECHNIQUES | 375 | ||
| SURGICAL OUTCOMES | 376 | ||
| REHABILITATION | 376 | ||
| CONCLUSION | 377 | ||
| 94 - Operative Versus Nonoperative Treatment and Timing of Surgery in Skeletally Immature Patients with Anterior Cruciate Ligament Te... | 377 | ||
| INTRODUCTION | 377 | ||
| BODY | 378 | ||
| CONCLUSIONS | 379 | ||
| XX - Anterior Cruciate Ligament Partial Tears | 380 | ||
| 95 - Partial Tear of the Anterior Cruciate Ligament: Management with One-Bundle Augmentation Technique | 380 | ||
| INTRODUCTION | 380 | ||
| DIAGNOSIS | 380 | ||
| NATURAL HISTORY OF PARTIAL ANTERIOR CRUCIATE LIGAMENT TEARS | 380 | ||
| SURGICAL MANAGEMENT | 381 | ||
| 96 - Acute Anterior Cruciate Ligament Rupture: A Biological Approach through Primary Anterior Cruciate Ligament Repair, Augmentation ... | 382 | ||
| INTRODUCTION | 382 | ||
| Is Anterior Cruciate Ligament Repair Feasible? | 382 | ||
| Primary Anterior Cruciate Ligament Repair—Healing Stimulation | 383 | ||
| Cellular Therapies—Mesenchymal Stem Cells | 383 | ||
| Platelet Rich Plasma and Growth Factors | 383 | ||
| STUDY GROUP | 383 | ||
| Surgical Technique | 383 | ||
| Rehabilitation Protocol | 383 | ||
| Results | 384 | ||
| DISCUSSION | 384 | ||
| CONCLUSION | 385 | ||
| 97 - Isolated Single-Bundle Reconstruction | 386 | ||
| INTRODUCTION | 386 | ||
| BACKGROUND | 386 | ||
| HISTORY | 386 | ||
| PHYSICAL EXAMINATION | 386 | ||
| IMAGING | 386 | ||
| INDICATIONS | 386 | ||
| SURGICAL TECHNIQUE | 386 | ||
| TECHNIQUE FOR RECONSTRUCTION (POSTEROLATERAL BUNDLE) | 387 | ||
| TECHNIQUE FOR RECONSTRUCTION (ANTEROMEDIAL BUNDLE) | 387 | ||
| REHABILITATION | 388 | ||
| COMPLICATIONS | 388 | ||
| RESULTS | 388 | ||
| 98 -Sonographically Guided Anterior Cruciate Ligament Injection: Technique and Potential Use for the Treatment of Partial Anterior C... | 390 | ||
| INTRODUCTION | 390 | ||
| CONCLUSION | 392 | ||
| XXI - Associated Injuries and Disorders: Ligament, Meniscus, Articular Cartilage, Bone, Malalignment, and Ganglion Cyst | 393 | ||
| 99 - Anterior Cruciate Ligament Injury Combined with Medial Collateral Ligament, Posterior Cruciate Ligament, and/or Lateral Collateral Ligament Injury | 393 | ||
| INTRODUCTION | 393 | ||
| LIGAMENT HEALING | 393 | ||
| Anterior Cruciate Ligament | 393 | ||
| Posterior Cruciate Ligament | 393 | ||
| Medial Collateral Ligament | 394 | ||
| Lateral-Side Structures | 394 | ||
| CLINICAL EXAMINATION | 394 | ||
| ASSOCIATED NEUROVASCULAR INJURY | 395 | ||
| IMAGING | 395 | ||
| TREATMENT PHILOSOPHY (PRINCIPLES) | 396 | ||
| Combined Anterior Cruciate Ligament, Posterior Cruciate Ligament, and Medial Collateral Ligament Injury | 396 | ||
| Combined Anterior Cruciate Ligament, Posterior Cruciate Ligament, and Lateral-Side Knee Injury | 397 | ||
| Lateral-Side Repair | 397 | ||
| Postoperative Rehabilitation | 397 | ||
| SUMMARY | 397 | ||
| 100 - Treatment of Meniscus Tears with Anterior Cruciate Ligament Reconstruction | 398 | ||
| INTRODUCTION | 398 | ||
| MENISCUS TEARS TO LEAVE IN SITU | 398 | ||
| Lateral Meniscus Tears | 399 | ||
| Medial Meniscus Tears | 400 | ||
| MENISCUS TEARS TO REPAIR | 400 | ||
| Timing of Meniscus Repair with Anterior Cruciate Ligament Surgery | 402 | ||
| CONCLUSIONS | 403 | ||
| 101 - Meniscal Repair with Anterior Cruciate Ligament Reconstruction | 403 | ||
| INTRODUCTION | 403 | ||
| EPIDEMIOLOGY OF MENISCUS TEARS IN ANTERIOR CRUCIATE LIGAMENT INJURY | 403 | ||
| MENISCUS—BASIC SCIENCE | 404 | ||
| Blood Supply | 404 | ||
| Load Transmittance | 404 | ||
| Knee Stability | 404 | ||
| MENISCAL HEALING AFTER REPAIR | 404 | ||
| Meniscal “Healing” | 404 | ||
| MENISCAL TEARS TO REPAIR | 405 | ||
| Leaving Meniscal Tears In Situ Without Treatment | 405 | ||
| Indications for Lateral Meniscus Repair | 405 | ||
| Indications for Medial Meniscus Repair | 405 | ||
| SURGICAL SETUP/AUTHORS PREFERENCE | 406 | ||
| REPAIR TECHNIQUE | 406 | ||
| 102 - Anterior Cruciate Ligament Reconstruction Combined with High-Tibial Osteotomy, Autologous Chondrocyte Implantation, Microfractur... | 407 | ||
| INTRODUCTION | 407 | ||
| INDIVIDUALIZATION | 407 | ||
| SURGEON FACTORS | 408 | ||
| SUCCESS RATES | 408 | ||
| PATIENT EXPECTATIONS | 408 | ||
| RESTORATION OF MOTION | 408 | ||
| ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION AND MICROFRACTURE | 408 | ||
| ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION AND AUTOLOGOUS CHONDROCYTE IMPLANTATIONS OR SIMILAR PROCEDURES | 409 | ||
| ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION AND MENISCAL ALLOGRAFT IMPLANTATION | 409 | ||
| ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION AND OSTEOCHONDRAL ALLOGRAFT OR OSTEOCHONDRAL AUTOGRAFT TRANSFER SYSTEM | 410 | ||
| ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION AND HIGH-TIBIAL OSTEOTOMY | 410 | ||
| MULTIPLE CARTILAGE RESTORATIVE PROCEDURES | 412 | ||
| CARTILAGE PRESERVATION VERSUS ARTHROPLASTY | 412 | ||
| CONCLUSIONS | 412 | ||
| 103 - Anterior Cruciate Ligament Deficiency in the Varus-Angulated Knee: Diagnosis, Surgical Techniques, and Clinical Outcomes | 413 | ||
| INTRODUCTION | 413 | ||
| CLINICAL EVALUATION | 413 | ||
| PREOPERATIVE PLANNING | 414 | ||
| Calculations for High Tibial Osteotomy | 414 | ||
| Timing of Procedures | 414 | ||
| Opening Versus Closing Wedge Osteotomy | 415 | ||
| Anterior Cruciate Ligament Graft Options | 415 | ||
| HIGH TIBIAL OSTEOTOMY OPERATIVE TECHNIQUE | 416 | ||
| AUTHORS’ CLINICAL STUDIES | 418 | ||
| Opening Wedge High Tibial Osteotomy | 418 | ||
| PROSPECTIVE COMPARISON OF ILIAC CREST AUTOGRAFT AND FREEZE-DRIED ALLOGRAFT ON HEALING OF OPENING WEDGE OSTEOTOMY | 422 | ||
| OPENING WEDGE SURVIVAL STUDIES | 422 | ||
| 104 - The Treatment of Combined Posterolateral Knee Injuries and Anterior Cruciate Ligament Tears | 423 | ||
| INTRODUCTION | 423 | ||
| ANATOMY OF THE POSTEROLATERAL CORNER OF THE KNEE | 423 | ||
| DIAGNOSIS OF POSTEROLATERAL KNEE INJURIES | 424 | ||
| Clinical Examination of Posterolateral Knee Injuries | 424 | ||
| RADIOGRAPHIC DIAGNOSIS OF POSTEROLATERAL KNEE INJURIES | 424 | ||
| TREATMENT OF ACUTE COMBINED POSTEROLATERAL CORNER KNEE INJURIES AND ANTERIOR CRUCIATE LIGAMENT TEARS | 425 | ||
| Treatment of Chronic Combined Posterolateral Corner and Anterior Cruciate Ligament Injuries | 425 | ||
| Posterolateral Corner Reconstruction Techniques with Combined Chronic Posterolateral and Anterior Cruciate Ligament Tears | 426 | ||
| 105 - Anterior Cruciate Ligament Reconstruction–Related Bone Contusions: Association with Intra-Articular Injury, Pain, and Outcomes | 427 | ||
| SUMMARY | 427 | ||
| INTRODUCTION | 427 | ||
| INTRA-ARTICULAR INJURIES | 428 | ||
| Cartilage Injuries | 428 | ||
| Meniscus Tears | 428 | ||
| PAIN | 429 | ||
| OUTCOMES | 429 | ||
| Clinical and Functional Outcomes | 429 | ||
| Complications | 430 | ||
| CONCLUSION | 430 | ||
| 106 - Ganglion Cyst | 431 | ||
| INTRODUCTION | 431 | ||
| EPIDEMIOLOGY | 431 | ||
| PATHOPHYSIOLOGY | 431 | ||
| CLINICAL FINDINGS | 432 | ||
| IMAGING FINDINGS | 432 | ||
| ARTHROSCOPIC FINDINGS | 433 | ||
| HISTOLOGY | 433 | ||
| TREATMENT | 433 | ||
| CONCLUSION | 435 | ||
| XXII - Anterior Cruciate Ligament Reconstruction and Unicondylar Knee Arthroplasty | 437 | ||
| 107 - Indications for Anterior Cruciate Ligament Reconstruction in Anterior Cruciate Ligament– Deficient Patients Undergoing Unicondylar Knee Arthroplasty | 437 | ||
| INTRODUCTION AND PATHOPHYSIOLOGY | 437 | ||
| SURGICAL OPTIONS | 437 | ||
| SURGICAL TECHNIQUE | 437 | ||
| EVIDENCE FOR COMBINED ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION AND UNICONDYLAR KNEE ARTHROPLASTY | 438 | ||
| UNICONDYLAR KNEE ARTHROPLASTY WITHOUT ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION | 438 | ||
| UNICONDYLAR KNEE ARTHROPLASTY AND POSTERIOR SLOPE IN ANTERIOR CRUCIATE LIGAMENT DEFICIENCY | 438 | ||
| SUMMARY | 438 | ||
| XXIII - Rehabilitation, Prehabilitation, and Bracing | 440 | ||
| 108 - Anterior Cruciate Ligament Strain Behavior During Rehabilitation Exercises | 440 | ||
| DESCRIPTION OF THE DEVICES, METHODS, AND APPROACHES USED TO MEASURE ANTERIOR CRUCIATE LIGAMENT BIOMECHANICS IN VIVO | 440 | ||
| REVIEW OF STUDIES THAT HAVE CHARACTERIZED ANTERIOR CRUCIATE LIGAMENT STRAIN BEHAVIOR DURING REHABILITATION EXERCISES | 441 | ||
| REVIEW OF STUDIES THAT HAVE MEASURED THE STRAIN OF THE BONE–PATELLAR TENDON–BONE GRAFT | 443 | ||
| REVIEW OF STUDIES INVESTIGATING HOW FUNCTIONAL KNEE BRACING AFFECTS ANTERIOR CRUCIATE LIGAMENT STRAIN BEHAVIOR | 443 | ||
| REVIEW OF WORK FOCUSED ON HOW THE GEOMETRY OF ARTICULAR STRUCTURES OF THE KNEE AFFECTS ANTERIOR CRUCIATE LIGAMENT BIOMECHANICS | 443 | ||
| CONCLUSION | 444 | ||
| 109 - Principles of Anterior Cruciate Ligament Rehabilitation | 444 | ||
| INTRODUCTION | 444 | ||
| PREOPERATIVE REHABILITATION | 445 | ||
| POSTOPERATIVE REHABILITATION | 445 | ||
| Ipsilateral or Contralateral Graft | 445 | ||
| Operative Considerations | 446 | ||
| Phase I: Early Postoperative Period | 446 | ||
| Postoperative Rehabilitation Phase II | 448 | ||
| Postoperative Rehabilitation Phase III: Advanced Strengthening | 448 | ||
| Postoperative Rehabilitation Phase IV: Return to Competition | 449 | ||
| COMMENT | 449 | ||
| 110 - The Stability-Conservative Anterior Cruciate Ligament Reconstruction Rehabilitation Protocol | 450 | ||
| INTRODUCTION | 450 | ||
| Premises | 450 | ||
| Principles | 450 | ||
| HISTORY | 450 | ||
| SYMMETRIC STABILITY AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IS NOT ASSURED | 451 | ||
| Fixation Point Healing | 451 | ||
| Graft Strength | 451 | ||
| MUSCULAR INHIBITION AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION | 451 | ||
| CYCLICAL LOADING DOES CAUSE LAXITY | 451 | ||
| WHY AVOID HYPEREXTENSION? | 451 | ||
| WHY INSIST ON FULL EXTENSION AND HOW TO ACHIEVE IT | 452 | ||
| WHY AVOID FULL FLEXION? | 452 | ||
| THE TIMING OF STRENGTHENING IN PHYSICAL THERAPY | 452 | ||
| QUADRICEPS STRENGTHENING | 452 | ||
| HAMSTRING STRENGTHENING | 452 | ||
| ADDUCTOR/ABDUCTOR STRENGTHENING | 453 | ||
| THE GASTROCNEMIUS AND TRICEPS SURAE | 453 | ||
| STAIRS | 453 | ||
| LOWER EXTREMITY CYCLICAL LOADING | 453 | ||
| Cycling, Running, and Elliptical Training | 453 | ||
| GAIT TRAINING | 453 | ||
| PROPRIOCEPTION | 453 | ||
| HAMSTRING VERSUS BONE–PATELLAR TENDON–BONE | 453 | ||
| ALLOGRAFT REHABILITATION | 453 | ||
| HOME VERSUS CLINIC THERAPY | 453 | ||
| EQUIPMENT | 453 | ||
| STRENGTH TESTING | 453 | ||
| RESULTS | 454 | ||
| SUMMARY OF PROTOCOL | 454 | ||
| 111 - Proprioception and Anterior Cruciate Ligament Reconstruction | 455 | ||
| INTRODUCTION | 455 | ||
| EVALUATING PROPRIOCEPTION | 455 | ||
| ANTERIOR CRUCIATE LIGAMENT-DEFICIENT KNEES | 455 | ||
| ANTERIOR CRUCIATE LIGAMENT-RECONSTRUCTED KNEES | 455 | ||
| ANTERIOR CRUCIATE LIGAMENT REMNANT-PRESERVATION TECHNIQUES | 457 | ||
| REHABILITATION FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION | 458 | ||
| CONCLUDING COMMENTS | 458 | ||
| 112 - Functional Bracing for Anterior Cruciate Ligament Injuries: Current State and Future Direction | 459 | ||
| INTRODUCTION | 459 | ||
| BIOMECHANICAL FINDINGS | 459 | ||
| CLINICAL FINDINGS | 460 | ||
| FUTURE DIRECTIONS | 461 | ||
| CONCLUSIONS | 461 | ||
| 113- Prehabilitation Before Anterior Cruciate Ligament Reconstruction | 462 | ||
| INTRODUCTION | 462 | ||
| PROPRIOCEPTION AND NEUROMUSCULAR TRAINING | 462 | ||
| COMBINED LOWER LIMB RESISTANCE AND NEUROMUSCULAR TRAINING | 463 | ||
| THE PERFECT BALANCE? | 463 | ||
| XXIV - Outcomes After Anterior Cruciate Ligament Reconstruction | 464 | ||
| 114 - Stability Results After Anterior Cruciate Ligament Reconstruction | 464 | ||
| THE DEFINITION OF STABILITY AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION | 464 | ||
| THE SIGNIFICANCE OF STABILITY AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION | 464 | ||
| LEVEL OF EVIDENCE | 464 | ||
| BONE–TENDON–BONE VERSUS HAMSTRING | 464 | ||
| HAMSTRING GRAFTS IN FEMALES | 465 | ||
| QUADRICEPS TENDON AUTOGRAFT | 465 | ||
| ALLOGRAFT VERSUS AUTOGRAFT | 465 | ||
| CONCLUSIONS | 465 | ||
| 115 - Quality of Life After Anterior Cruciate Ligament Reconstruction | 466 | ||
| WHAT IS QUALITY OF LIFE? | 466 | ||
| Health-Related Quality of Life | 466 | ||
| Knee-Related Quality of Life | 466 | ||
| WHY SHOULD WE MEASURE QUALITY OF LIFE AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION? | 466 | ||
| HOW DO WE MEASURE QUALITY OF LIFE FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION? | 466 | ||
| How Do We Choose an Appropriate Quality of Life Measure? | 466 | ||
| Potential Limitations of Patient-Reported Quality of Life Measures in Anterior Cruciate Ligament-Ruptured Populations | 466 | ||
| Comparison to Population Norms and Reference Groups | 466 | ||
| Quality of Life Within the First 5 Years of Anterior Cruciate Ligament Reconstruction | 467 | ||
| Quality of Life More Than 5 Years Following Anterior Cruciate Ligament Reconstruction | 467 | ||
| Quality of Life After Conservative Management of Anterior Cruciate Ligament Rupture | 468 | ||
| CLINICAL RECOMMENDATIONS | 468 | ||
| Which Quality of Life Measure Should I Use? | 468 | ||
| Further Questioning | 468 | ||
| Interpreting Low Scores and Change Over Time | 468 | ||
| CONCLUSION | 468 | ||
| 116 - Allografts Have Higher Failure Rates Than Autografts in Anterior Cruciate Ligament Reconstruction in Young, Active Patients | 470 | ||
| INTRODUCTION | 470 | ||
| GRAFT PREPARATION | 470 | ||
| BASIC SCIENCE | 471 | ||
| OUTCOME STUDIES | 471 | ||
| CONCLUSIONS | 471 | ||
| 117 - Factors Associated with Increased Allograft Failure Rate in Anterior Cruciate Ligament Reconstruction | 472 | ||
| INTRODUCTION | 472 | ||
| GRAFT PROCESSING | 472 | ||
| Proprietary Techniques | 473 | ||
| Irradiation | 473 | ||
| GRAFT TYPE | 474 | ||
| GRAFT DONOR AGE | 474 | ||
| PATIENT AGE AND GENDER | 474 | ||
| CONCLUSION | 474 | ||
| 118 - Arthrosis Following Anterior Cruciate Ligament Tear and Reconstruction | 475 | ||
| INTRODUCTION | 475 | ||
| ANIMAL MODELS | 475 | ||
| BIOMARKERS AND PATHOPHYSIOLOGY OF OSTEOARTHRITIS FOLLOWING ANTERIOR CRUCIATE LIGAMENT INJURY | 476 | ||
| BIOMECHANICS | 476 | ||
| MENISCUS TEARS | 476 | ||
| CHONDRAL LESIONS | 477 | ||
| NATURAL HISTORY OF THE ANTERIOR CRUCIATE LIGAMENT-DEFICIENT KNEE | 477 | ||
| ARTHROSIS FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION | 477 | ||
| Graft Choice and Surgical Technique | 478 | ||
| TIMING OF SURGERY | 478 | ||
| KNEE ARTHROPLASTY AFTER ANTERIOR CRUCIATE LIGAMENT INJURY | 478 | ||
| CONCLUSION | 479 | ||
| 119 - Criteria for Return to Play After Anterior Cruciate Ligament Reconstruction | 480 | ||
| INTRODUCTION | 480 | ||
| PREOPERATIVE FACTORS AFFECTING RETURN TO PLAY | 480 | ||
| INTRAOPERATIVE FACTORS AFFECTING RETURN TO PLAY | 480 | ||
| POSTOPERATIVE FACTORS AFFECTING RETURN TO PLAY | 480 | ||
| SPORT-SPECIFIC REHABILITATION | 481 | ||
| OBJECTIVE GUIDELINES FOR RETURN TO PLAY | 481 | ||
| TIMING OF RETURN TO PLAY | 482 | ||
| FUNCTIONAL BRACING | 482 | ||
| PSYCHOLOGICAL FACTORS AFFECTING RETURN TO PLAY | 483 | ||
| SPECIAL CONSIDERATION—GENDER DIFFERENCES | 483 | ||
| SUMMARY | 483 | ||
| 120 - A Comparison of the Standardized Rating Forms for Evaluation of Anterior Cruciate Ligament Injured or Reconstructed Patients | 484 | ||
| INTRODUCTION | 484 | ||
| PATIENT REPORTED OUTCOME MEASURES | 485 | ||
| International Knee Documentation Committee Subjective Knee Form | 485 | ||
| Knee Injury and Osteoarthritis Outcome Score | 485 | ||
| Lysholm Rating Scale | 485 | ||
| Tegner Activity Score | 485 | ||
| Cincinnati Knee Rating System | 488 | ||
| Marx Activity Rating Scale | 488 | ||
| Anterior Cruciate Ligament—Quality of Life | 488 | ||
| Anterior Cruciate Ligament—Return to Sport After Injury | 488 | ||
| Miscellaneous | 488 | ||
| GENDER DIFFERENCES | 488 | ||
| PATIENT REPORTED OUTCOME MEASURES IN CHILDREN | 488 | ||
| CONCLUSION | 489 | ||
| XXV - Patient Factors That Contribute to Success or Failure | 490 | ||
| 121 - Anterior Cruciate Ligament Reconstruction Outcomes as a Function of Age | 490 | ||
| INTRODUCTION | 490 | ||
| CLINICAL OUTCOMES | 490 | ||
| GRAFT CHOICE | 490 | ||
| Patellar Tendon Allograft Versus Patellar Tendon Autograft | 490 | ||
| Hamstring Autografts | 492 | ||
| Hamstring Autograft Versus Patellar Tendon Autograft | 492 | ||
| RETURN TO SPORT | 492 | ||
| AGE AS A RISK FACTOR FOR REINJURY | 492 | ||
| CONCLUSION | 493 | ||
| 122 - The Multicenter Orthopaedics Outcomes Network Group and the Effects of Obesity and Body Weight on the Results of Anterior Crucia... | 494 | ||
| MULTICENTER ORTHOPAEDICS OUTCOMES NETWORK GROUP | 494 | ||
| OBESITY AND ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION | 494 | ||
| CONCLUSION | 494 | ||
| 123 - The Effects of Smoking on Anterior Cruciate Ligament Reconstruction Outcomes | 495 | ||
| INTRODUCTION | 495 | ||
| BASIC STUDIES | 495 | ||
| CLINICAL STUDIES | 496 | ||
| PATHOPHYSIOLOGIC PROCESS | 497 | ||
| CONCLUSION | 497 | ||
| 124 - Psychological Predictors of Anterior Cruciate Ligament Recovery Outcomes | 498 | ||
| INTRODUCTION | 498 | ||
| FEAR OF REINJURY/KINESIOPHOBIA | 498 | ||
| SHIFTS IN PRIORITIES/SOCIAL CONSIDERATIONS | 499 | ||
| PERSONALITY | 499 | ||
| PSYCHOSOCIAL FACTORS AS A PREDICTIVE TOOL FOR RETURN TO SPORT | 500 | ||
| CONCLUSION | 500 | ||
| 125 - Anterior Cruciate Ligament Reconstruction in Patients with Hereditary Abnormalities Involving Connective Tissue | 501 | ||
| INTRODUCTION | 501 | ||
| BODY | 501 | ||
| Osteogenesis Imperfecta | 501 | ||
| Ehlers-Danlos Syndrome | 501 | ||
| Marfan Syndrome | 501 | ||
| Clinical Evaluation | 501 | ||
| History | 502 | ||
| Physical Examination | 502 | ||
| Additional Testing | 502 | ||
| Surgical Reconstruction | 502 | ||
| Perioperative Considerations | 502 | ||
| Surgical Considerations | 503 | ||
| Postoperative Rehabilitation | 503 | ||
| Case Example | 503 | ||
| CONCLUSION | 503 | ||
| XXVI - Return to Sports | 505 | ||
| 126 - Performance and Return to Sport after Anterior Cruciate Ligament Reconstruction in Skiers and Snowboarders | 505 | ||
| INTRODUCTION | 505 | ||
| INJURY EPIDEMIOLOGY | 505 | ||
| INJURY MECHANISM | 505 | ||
| INJURY EVALUATION AND MANAGEMENT | 506 | ||
| OUTCOMES | 508 | ||
| 127 - Return to Play and Future Anterior Cruciate Ligament Injury Risk after Anterior Cruciate Ligament Reconstruction in Soccer Playe... | 509 | ||
| 128 - Return to American Football after Anterior Cruciate Ligament Reconstruction | 510 | ||
| INTRODUCTION | 510 | ||
| Literature Review | 510 | ||
| CONCLUSION | 511 | ||
| XXVII - Complications | 513 | ||
| 129 - Septic Arthritis in Anterior Cruciate Ligament Surgery | 513 | ||
| INTRODUCTION | 513 | ||
| PREVALENCE OF INFECTION | 513 | ||
| PATHOGENESIS—PREDISPOSING FACTORS | 513 | ||
| Patient Factors | 513 | ||
| Local Factors | 513 | ||
| Graft Type | 513 | ||
| Contamination of Instruments | 514 | ||
| Graft Contamination | 514 | ||
| Allografts and Infections in Anterior Cruciate Ligament Surgery | 514 | ||
| Biofilm Formation | 514 | ||
| DIAGNOSIS | 515 | ||
| Clinical Findings | 515 | ||
| Laboratory Findings | 515 | ||
| Imaging Studies | 515 | ||
| Microbiology | 515 | ||
| MANAGEMENT PROTOCOL | 515 | ||
| Antibiotic Administration | 515 | ||
| Surgical Management | 516 | ||
| Initial Management with Irrigation and Débridement | 516 | ||
| Graft Retention Versus Removal | 516 | ||
| Postoperative Management | 516 | ||
| Management of Persistent Cases | 516 | ||
| Authors’ Protocol for Persistent Septic Arthritis of the Knee | 517 | ||
| 130- Osteoporosis after Anterior Cruciate Ligament Reconstruction | 518 | ||
| ANTERIOR CRUCIATE LIGAMENT INJURIES AND THEIR TREATMENT | 518 | ||
| PEAK BONE MASS AND NATURAL BONE LOSSES | 518 | ||
| Osteoporosis | 518 | ||
| BONE LOSS AND MUSCULOSKELETAL INJURIES | 519 | ||
| ANTERIOR CRUCIATE LIGAMENT SURGERY AND THE EFFECT ON BONE TISSUE | 519 | ||
| SURGERY: A RISK FACTOR FOR OSTEOPOROSIS? | 520 | ||
| 131 - Tunnel Widening after Anterior Cruciate Ligament Reconstruction | 521 | ||
| INTRODUCTION | 521 | ||
| METHODS OF ANALYZING TUNNEL WIDENING | 521 | ||
| Quantifying Tunnel Widening | 521 | ||
| Literature Analysis | 521 | ||
| Hamstring Versus Bone–Patellar Tendon–Bone Graft | 521 | ||
| Allograft Versus Autograft | 521 | ||
| Fixation Type | 521 | ||
| Fixation Location | 522 | ||
| Aggressive Versus Conservative Rehabilitation | 522 | ||
| Synovial Fluid Infiltration | 522 | ||
| DOUBLE- VERSUS SINGLE-BUNDLE ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION | 523 | ||
| Osteoconductive Interference Screw Fixation | 523 | ||
| OSTEOCONDUCTIVE OR OSTEOINDUCTIVE GRAFT HYBRIDIZATION | 523 | ||
| Platelet Rich Plasma | 523 | ||
| Compaction Drilling | 523 | ||
| ADVERSE EFFECTS | 523 | ||
| Effects on Stability | 523 | ||
| Direct Adverse Effects | 523 | ||
| Effects on Revision Surgery | 523 | ||
| CONCLUSIONS | 523 | ||
| 132 - Numbness/Saphenous Nerve | 524 | ||
| INTRODUCTION | 524 | ||
| BONE–TENDON–BONE AUTOGRAFT | 524 | ||
| HAMSTRING AUTOGRAFT | 524 | ||
| CLINICAL EXAMINATION | 524 | ||
| ANATOMICAL INVESTIGATIONS | 524 | ||
| DISCUSSION | 525 | ||
| 133 - Hardware Complications after Anterior Cruciate Ligament Reconstruction | 527 | ||
| INTRODUCTION | 527 | ||
| INTERFERENCE SCREWS | 527 | ||
| BUTTON FIXATION | 529 | ||
| CROSS-PIN FIXATION | 530 | ||
| TIBIA FIXATION | 530 | ||
| SKELETALLY IMMATURE PATIENTS | 530 | ||
| CONCLUSION | 530 | ||
| 134 - Vascular Complications after Anterior Cruciate Ligament Reconstruction and Deep Venous Thrombosis Prophylaxis | 533 | ||
| ARTERIAL COMPLICATIONS | 533 | ||
| Conclusion | 537 | ||
| VENOUS THROMBOEMBOLISM AND THROMBOPROPHYLAXIS | 537 | ||
| 135 - Fracture Complications after Anterior Cruciate Ligament Reconstruction | 538 | ||
| Conclusion | 538 | ||
| FEMUR FRACTURE | 539 | ||
| PATELLA FRACTURE | 541 | ||
| TIBIA FRACTURE | 543 | ||
| Tibial Plateau Fracture | 543 | ||
| Tibial Tubercle Fracture | 544 | ||
| 136 - Anterior Knee Problems after Anterior Cruciate Ligament Reconstruction | 545 | ||
| INTRODUCTION | 545 | ||
| Patellar Tendon and Hamstring Tendon Autografts | 545 | ||
| Central Quadriceps Tendon | 547 | ||
| Allografts | 547 | ||
| Injury to Sensory Nerves | 548 | ||
| Factors Related to Surgical Technique and Devices | 548 | ||
| ANTERIOR KNEE PROBLEMS RELATED TO REHABILITATION | 549 | ||
| How to Reduce Anterior Knee Symptoms after Anterior Cruciate Ligament Reconstruction | 549 | ||
| 137 - Stiffness: Prevention and Treatment | 550 | ||
| INTRODUCTION | 550 | ||
| ETIOLOGY | 550 | ||
| SURGICAL FACTORS | 550 | ||
| INFRAPATELLAR CONTRACTURE SYNDROME | 551 | ||
| REHABILITATION | 551 | ||
| OTHER CAUSES | 551 | ||
| TREATMENT | 552 | ||
| CONCLUSION | 553 | ||
| XXVIII - Tibial Eminence Fractures | 555 | ||
| 138 - Treatment of Tibial Eminence Fractures | 555 | ||
| INTRODUCTION | 555 | ||
| INCIDENCE | 555 | ||
| MECHANISM OF INJURY | 555 | ||
| PHYSICAL EXAMINATION | 555 | ||
| CLASSIFICATION | 555 | ||
| IMAGING | 555 | ||
| CONCOMITANT INJURIES | 555 | ||
| TREATMENT | 556 | ||
| Nonoperative Treatment: Displaced Fractures | 556 | ||
| Operative Treatment: Displaced Fractures | 556 | ||
| OPERATIVE TECHNIQUE | 556 | ||
| Outcome: Nonoperative Versus Operative Treatment of Displaced Fractures | 556 | ||
| Outcome: Screw Versus Suture Fixation | 557 | ||
| ADDITIONAL COMPLICATIONS | 557 | ||
| CONCLUSION | 557 | ||
| XXIX Gait Analysis and Extra-Articular Reconstruction | 558 | ||
| 139 - Motion Analysis in Anterior Cruciate Ligament Deficient and Reconstructed Knees | 558 | ||
| INTRODUCTION | 558 | ||
| Anterior Tibial Translation | 558 | ||
| Quadriceps Avoidance | 559 | ||
| Knee Internal Rotation | 560 | ||
| Gait Variability | 560 | ||
| Surgical Techniques: Double-Bundle Reconstruction | 562 | ||
| Surgical Techniques: Tunnel Placement | 562 | ||
| Excessive Knee Internal Rotation and Posttraumatic Osteoarthritis | 563 | ||
| CONCLUSION | 563 | ||
| 140 - Extra-Articular Tenodesis and Anterior Cruciate Ligament Reconstruction: Techniques and Outcomes | 564 | ||
| INTRODUCTION | 564 | ||
| THE ANTEROLATERAL LIGAMENT | 564 | ||
| SURGICAL TECHNIQUE | 565 | ||
| Isolated Extra-Articular Tenodesis | 565 | ||
| Extra-Articular Tenodesis with Anterior Cruciate Ligament Reconstruction | 565 | ||
| OUTCOMES | 565 | ||
| Cadaveric Studies | 565 | ||
| Intraoperative Studies | 567 | ||
| Clinical Outcomes | 567 | ||
| Over-the-Top Reconstruction | 567 | ||
| Reconstruction with a Femoral Tunnel | 567 | ||
| CONCLUSION | 568 | ||
| XXX - Tissue Engineering and the Future | 569 | ||
| 141 - Growth Factors and Other New Methods for Graft-Healing Enhancement | 569 | ||
| BASIC KNOWLEDGE TO ENHANCE THE GRAFT REMODELING IN ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION | 569 | ||
| Platelet-Derived Growth Factor-BB | 569 | ||
| Vascular Endothelial Growth Factor | 569 | ||
| Transforming Growth Factor-β and Endothelial Growth Factor | 570 | ||
| PLATELET RICH PLASMA | 570 | ||
| Intraosseous Healing | 571 | ||
| Bone Morphogenetic Proteins | 571 | ||
| Transforming Growth Factor-β | 571 | ||
| ENHANCEMENT OF GRAFT HEALING WITH GENE THERAPY | 571 | ||
| ENHANCEMENT OF GRAFT HEALING WITH CELL-BASED THERAPY | 571 | ||
| SUMMARY | 572 | ||
| 142 - Outlook for Tissue Engineering Strategies for Anterior Cruciate Ligament Reconstruction | 573 | ||
| INTRODUCTION | 573 | ||
| BIOMATERIAL SCAFFOLDS | 573 | ||
| CELL SOURCES | 574 | ||
| GROWTH FACTORS | 575 | ||
| MECHANICAL CONDITIONING | 575 | ||
| ANIMAL STUDIES | 575 | ||
| CONCLUSION | 576 | ||
| Index | 578 | ||
| A | 578 | ||
| B | 581 | ||
| C | 582 | ||
| D | 583 | ||
| E | 583 | ||
| F | 584 | ||
| G | 585 | ||
| H | 585 | ||
| I | 586 | ||
| J | 587 | ||
| K | 587 | ||
| L | 587 | ||
| M | 588 | ||
| N | 589 | ||
| O | 589 | ||
| P | 589 | ||
| Q | 590 | ||
| R | 591 | ||
| S | 593 | ||
| T | 594 | ||
| U | 595 | ||
| V | 595 | ||
| W | 595 | ||
| X | 595 | ||
| Y | 595 | ||
| Z | 595 | ||
| IFC | ES2 |