Stump,pt,cscs,and dean maddalone, pta, cscs, an anterior cruciate ligament acl disruption of the knee can be a devastating injury to the. Anterolateral structure reconstruction unnecessary with anat. This technique merges the principles of footprint anatomy and anatomic acl reconstruction with the modified anteromedial portal. Can anatomic femoral tunnel placement be achieved using. In fact, acl reconstruction has become one of the most common orthopedic procedures with over 100,000 being performed annually. Postoperative rehabilitation and return to play after anterior cruciate ligament reconstruction roberta. The anatomy of the acl and its importance in acl reconstruction.
It is estimated that every year, about 43 acl reconstructions are performed per 100,000 people1. Anatomic femoral and tibial tunnel placement during. What is the unique anatomy and function of the anterior cruciate ligament acl and how do todays reconstruction techniques attempt to recreate it. In august 2011, orthopaedic surgeons from more than 20 countries attended a summit on anatomic anterior cruciate ligament acl reconstruction. These injuries rarely occur in isolation and are typically associated with anterior cruciate ligament acl or posterior cruciate ligament pcl. Published papers on anatomic anterior cruciate ligament acl reconstruction often lack details in the description of the surgical procedure, and there are large variations in anatomic acl reconstruction techniques. With nonanatomic tunnels, which are seen most commonly, the technique of primary anatomic acl reconstruction can be employed without modification, while ensuring adequate bony bridge between tunnels. Five panels with 36 panellists were conducted on key issues in acl surgery. Abstract introduction anterior cruciate ligament acl is a common injury and more than 00 acl reconstruction procedures are performed in the united. Anterior cruciate ligament acl reconstruction by anatomic method is the most popular method of reconstruction. Eleven subjects seven males and four females underwent anatomic doublebundle acl reconstruction 12. Todd, bs investigation performed at emory orthopaedic and spine center, atlanta, georgia background. An anatomic study should have to address, its biomechanical properties, its kinematics, its position and anatomic correlation and its functional properties. Because the surgeon is trained to be precise about the placement of the new acl, the anatomic acl procedure allows the ligament to perform and function just like the one the patient was born with.
The footprint anterior cruciate ligament technique. Morphology of anterior cruciate ligament attachments for anatomic reconstruction. The effect of an acl reconstruction in controlling rotational knee stability in knees with intact and physiologic laxity of secondary restraints as defined by tibiofemoral compartment. An anatomic acl reconstruction can be performed by using the patients own tendon or a donor tendon.
Anatomic anterior cruciate ligament reconstruction using distally. Longterm outcomes for anatomic acl reconstruction are unknown. Anatomic placement of an anterior cruciate ligament acl graft is critical to the success and clinical outcome of acl reconstruction. Individualised anatomic acl reconstruction concept the aim of individualised anatomic acl reconstruction is to functionally restore the acl to its native dimensions, orientation and. Acl reconstruction rehabilitation protocol 4 control pain and swelling crushed ice or an aircast knee cryocuff along with nonsteroidal antiinflammatory medications such as advil, nuprin, motrin, ibuprofen, aleve 2 tablets twice a day are used to help control pain and swelling. The overall outcome of the aclreconstruction is very satisfactory, however, some patients continue to experience dynamic instability and therefore reduced clinical outcome and lower return to sports rate even after a technically correct surgery. The evolution of anatomic anterior cruciate ligament reconstruction. Anatomic femoral and tibial tunnel placement during anterior. Pdf on mar 30, 2012, kristian samuelsson and others published anatomic anterior cruciate ligament reconstruction current evidence and. Anatomic, transepiphyseal anterior cruciate ligament. Anatomic acl graft placement is defined as positioning the acl femoral and tibial bone tunnels at the center of the native acl femoral and tibial attachment sites. Anatomic anterior cruciate ligament reconstruction aspects. Postoperative rehabilitation and return to play after. Pdf anterior cruciate ligament reconstruction is a frequently performed orthopaedic procedure.
Anterior cruciate ligament acl reconstruction is one of the most common knee procedures performed, with more than 200,000 surgical reconstruction performed annually in the united states us. Data collected and analyzed included a variety of surgical data. The anterior cruciate ligament acl anatomy is very significant if a reconstruction is attempted after its rupture. A partial or complete tear of your acl will cause your knee to become less stable and feel as though your knee is about. Anatomic all inside acl reconstruction by direct measurement gelreziekenhuizen. Anterior cruciate ligament acl reconstruction is an operation performed frequently by orthopedic surgeons throughout the world. Aspetar sports medicine journal anatomic acl reconstruction. A total of twentytwo subjects eleven subjects with acl reconstruction and eleven controls participated in this study. Individualized anatomic anterior cruciate ligament reconstruction. Anatomic anterolateral ligament reconstruction vumedi. However, it is important to recognise that restoring the two functional bundles of the acl does not always require the surgeon to perform a db acl reconstruction. Anatomic acl reconstruction written by charles brown jr, united arab emirates. Anatomic acl reconstruction using the clancy t flexible drill. Anatomic anterior cruciate ligament reconstruction an mribased study john w.
Individualized anatomic anterior cruciate ligament. Anterolateral structure reconstruction unnecessary with. Anatomic acl reconstruction is defined as reconstruction using the anatomic insertion area of both the tibial and femoral tunnels by. Clinics in sports medicine anatomic acl reconstruction. Outcomes following anatomic fibular lateral collateral. While acl reconstruction is nowadays readily performed, the first acl. It is a strong fibrous tissue that connects the femur to the tibia. Anatomic singlebundle acl reconstruction request pdf. The importance of individualized, anatomic anterior. Pdf single bundle anatomic anterior cruciate ligament. What is a current technique of an acl reconstruction and what is its rationale. Secondary to the constraints imposed by a coupled drilling technique, the ability to achieve an anatomic femoral tunnel during transtibial hamstring acl reconstruction may be limited.
The role of anatomic acl reconstruction in acl revision. A numerical investigation of anatomic anterior cruciate. This technical note describes 2 tibial tunnelindependent. When tunnels are anatomic, evidence of tunnel widening must be considered. Anatomic anterior cruciate ligament reconstruction utilizing the. Anterior cruciate ligament acl injury and reconstruction in the skeletally immature patient are becoming. Anatomic acl reconstruction is a concept and not a. Materials and methods all patients 18 years or older who underwent isolated or combined. Combined anterior cruciate ligament and anatomic anterolateral ligament reconstruction. The acl is the primary restraint to anteroposterior joint translation and play an important role in controlling rotational stability. All subjects with acl reconstruction were free from other cartilage, meniscus, or.
Anatomic landmarks utilized for physealsparing, anatomic. Acl technique anatomic single bundle awareness of the importance of anatomic placement increased failure of an acl reconstruction with non anatomic placement anatomic tibial tunnel placement femoral tunnel placed independent of the tibial tunnel double bundle issues increased operating time double the number of tunnels. A partial or complete tear of your acl will cause your knee to become less stable and feel as though your knee is. Anatomic anterior cruciate ligament acl reconstruction vs. The anterior cruciate ligament acl is composed of two bundles, which work together. Anatomical individualized acl reconstruction the archives of. Anatomic anterior cruciate ligament reconstruction with quadriceps tendon autograft stephen j. Acl reconstruction techniques aim to better restore the normal anatomy and biomechanics of the knee, and are hypothesized to potentially.
Anatomic anterior cruciate ligament acl reconstruction. Anterior cruciate ligament acl reconstruction is one of the most common knee surgical procedure. As the number of primary acl reconstructions continues to increase, so will the need for revision surgery. Can anatomic femoral tunnel placement be achieved using a. Pdf on oct 10, 2018, adinun apivatgaroon and others published anatomic singlebundle acl reconstruction with remnant augmentation technique find, read and cite all the research you need on. Transtibial anatomic acl reconstruction utilizing the versitomic flexible reamer system duration. Anterior cruciate ligament acl injuries are common in the athletic population. In this paper, the different aspects of anatomic acl reconstruction will be discussed. The anatomic anterior cruciate ligament acl reconstruction concept has developed in part from renewed interest in the insertional anatomy of the acl, using surgical techniques that can reproduce this anatomy reliably and accurately during surgical reconstruction. The summit offered a unique opportunity to discuss current concepts, approaches, and techniques in the field of acl reconstruction among leading surgeons in the field. The size limitations imposed by the smalldiameter tibial tunnel. The importance of individualized, anatomic anterior cruciate.
Pdf morphology of anterior cruciate ligament attachments. Dec 03, 2018 the pittsburgh approach to anatomic revision acl reconstruction preoperative evaluation. Tunnel malposition is one of the most common technical reasons for anterior cruciate ligament reconstruction failure. Anterior cruciate ligament acl reconstruction surgery has emerged as one of the most frequently performed orthopaedic procedures in the united states.
An anatomic single or doublebundle reconstruction is performed with a goal of reproducing the characteristics of the native acl. It was hypothesized that anatomic fcl reconstruction would result in improved subjective clinical outcomes and a high patient satisfaction with outcome. Anatomic acl reconstruction restores rotational knee stability. This procedure is usually done arthroscopically and involves making tunnels in the femur and tibia, allowing passage of. The selection criteria were studies that reported on a surgical technique for anatomic doublebundle acl reconstruction on skeletally mature living human subjects and were written in english. The evolution of anatomic anterior cruciate ligament. Acl reconstruction acl reconstruction involves replacing the torn acl with tissue taken from the patient autograft or taken from a tissue donor allograft. Anatomic anterior cruciate ligament reconstruction using.
Acl reconstruction is performed, adherence to the anatomic reconstruction concept seems to be an important factor in. In fact, it is estimated that more than 200,000 acl reconstructions are performed each year in the united states alone. Anatomic anterior cruciate ligament reconstruction. David geier is an orthopedic surgeon and sports medicine specialist in charleston, south carolina. Anatomic all inside acl reconstruction by direct measurement. The concept of individualized anatomic acl reconstruction can best be summarized by the senior authors recent summary statement on the acl. Ifyouhavesufferedanacuteaclinjuryandsurgeryisplanned,thetimebetweeninjuryand. The causes of failure are numerous and multifactorial. Acl reconstruction in an effort to restore normal knee kinematics and stability. Curved anatomic soft tissue acl reconstruction using.
Anatomic tunnel placement in anterior cruciate ligament. Despite extensive research on the topic, the optimal surgical technique to accomplish this is still the subject of debate. I believe that the concept of anatomic acl reconstruction and rotational knee stability represents one of the most important recent advances in acl surgery, and the current research activities in. Pdf the evolution of anatomic anterior cruciate ligament.
In our experience, the key for successful anatomic revision acl reconstruction is a thorough preoperative workup. Methods a systematic electronic search was performed by use of the medline and embase databases. Our technique for physealsparing, anatomic anterior cruciate ligament acl reconstruction reliably produces femoral tunnels that are of adequate length and that safely avoid the femoral physis without the addition of timeconsuming surgical methods or substantial utilization of fluoroscopy. Sep 22, 2012 the anterior cruciate ligament acl anatomy is very significant if a reconstruction is attempted after its rupture. Considering the anatomic insertion areas of the native acl is the key to optimal results regarding biomechanical properties and resulting knee stability after acl reconstruction. It is our belief that anatomic restoration of acl anatomy in the revision setting is best accomplished using the doublebundle technique in the majority of cases.
Torn acl anatomic footprint acl reconstruction the anterior cruciate ligament acl is one of four ligaments that are crucial to the stability of your knee. This paper evaluates the basis for doublebundle acl reconstruction including anatomy, biomechanics and kinematics, describes our surgical technique, and discusses why we prefer anatomic doublebundle acl reconstruction, as well as its outcome, the choices. In the absence of widening, anatomical tunnels may be reused in the revision reconstruction. Anatomic anterior cruciate ligament acl reconstruction is a concept that has gained in interest and it aims to more effectively restore native acl anatomy and function.
Restoration of sagittal and transverse plane proprioception. Pdf anatomic anterior cruciate ligament reconstruction current. Small changes in tunnel placement can result in significant differences in outcome. Intraarticular landmarks for anterior cruciate ligament reconstructions. Anatomic acl reconstruction using the clancy t flexible.
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