History of ACL Treatment and Current Gold Standard of Care

M.M. Murray et al. (eds.), The ACL Handbook: Knee Biology, Mechanics, and Treatment, DOI 10.1007/978-1-4614-0760-7_2, © Springer Science+Business Media New York 2013 ACL injuries are increasingly common, with estimates as high as of 400,000 patients each year in the United States sustaining this injury (in comparison with 120,000 patients undergoing hip replacement surgery) [ 1 ]. The ACL injury is important, not only due to the number of people affected by the injury but also because of the sequelae of the injury. The ACL does not heal on its own, and as a result, many methods have been designed to treat the ACL-injured knee. However, even our gold standard of treatment, ACL reconstruction, cannot prevent the premature onset of arthritis for patients with ACL injuries. This is worrisome for those of us who care for patients with ACL injuries, and as such, we are extremely interested in fi nding improved solutions for people with ACL injuries. There has been a great deal of work done over the past two centuries regarding the diagnosis and treatment of the ACL. We will briefl y review some of the highlights that seem most relevant to these injuries and those that give us hints of what might work better. Certainly, any work in this fi eld “stands upon the shoulders” of these wonderful physicians and scientists who have laid a great foundation for future studies. The earliest reports of ACL injuries largely relied on the history and physical examination of the patient, two areas which remain critical to the accurate diagnosis of this injury today. The fi rst identifi cation of the ACL was attributed to Claudius Galen (150 A.D., Fig. 2.1 ) who cared for the gladiators and likely had the opportunity to visualize the ACL through gashes in the knee. In 1845, Amedee Bonnet of Lyon reported that patients who heard a snap and developed swelling and loss of function in the knee would most likely have a ligamentous injury, including ACL injury. Thirty years later, Georgios Noulis from Greece performed a series of cadaver studies where he found that forced anterior subluxation of the tibia could Chapter 2 History of ACL Treatment and Current Gold Standard of Care