ACL Deficient Knee, an Approach to Patient Selection and Reconstruction.
نویسنده
چکیده
Rupture of the anterior cruciate ligament (ACL) is one of the most common injuries of the knee in the athletes and other group of patients who present to the knee clinics each year . Near to 250000 ACL ruptures occur in the Unites State each year. Almost 100000 ACL reconstructions are performed in the USA annually (1). This means that not all the patients with an ACL injury need operation. So, patient selection is an important step towards surgical treatment of ACL injury. Reconstruction of the anterior cruciate ligament is one of the most commonly performed orthopedic procedures in developed countries of the world. The goal of anatomic reconstruction is to restore normal motion and stability to the knee and thereby, presumably, to restore its function and allow the patient to return to normal activities, including sports. Another goal is to prevent early degenerative changes. In order to achieve these goals, the immediate objective of the operation is to reduce abnormal laxity by substituting the injured anterior cruciate ligament with a graft (2). We know about the natural history of a knee with an ACL rupture and the consequences of such an injury to the knee. This might include meniscal injury, stretching of other ligaments and degenerative changes in the knee joint. On the other hand not all patients with ACL injury are suitable or good candidates for reconstruction. We know that having an operation needs considerations such as social and work status of the patient, availability of skillful surgeon and well equipped operating room. One should balance the risks and benefits of a major reconstruction surgery with potential risks and complications. The patient usually needs general or regional anesthesia for his /her operation. They need to be off work for a couple of months and need extensive rehabilitation. Looking at all these points and problems encountered in surgical and non-surgical treatment of an ACL deficient knee we need to have a method of classification and criteria to choose the best means of treatment which suits each patient. Most of the patients with an ACL injury of the knee are in the young and active age group who might be keen to pursue their sport activities. They usually present with the chief complain of giving way. The main indication for reconstruction surgery is instability presenting as giving way. Some patients present to the knee clinic with a locked knee. They usually give a history of knee injury a couple of years ago and subsequent instability which was left untreated. A recent injury and giving way has damaged the meniscus, usually a bucket handle tear of medial meniscus with a typical pattern of image on the MRI scan. They need to be operated on as soon as possible for a meniscal repair or menisectomy and ACL reconstruction at the same time. An important issue in the treatment of an ACL deficient knee is patient selection. The technical issues such as graft selection, graft harvest and preparation, proximal fixation, tensioning and distal fixation with the knee in extension are also important. A period of rehabilitation before surgery and early range of motion and extensive physiotherapy and rehabilitation after surgery will complete the procedure. At our referral Knee and Shoulder center, Ghaem Hspital Medical Center, Mashhad, Iran, preferred method of reconstruction of ACL is BPB tendon autograft as the gold standard technique. Over 2000 patients have been operated on by the same technique in our center in the last 15 years. Overall results are satisfactory. Anterior knee pain and pain on kneeling is not as common as been previously
منابع مشابه
The Clinical Outcome of Simultaneous Lateral Closed- Wedge Distal Femoral Osteotomy and Anterior Cruciate Ligament Reconstruction in the ACL-deficient Knees with Symptomatic Femoral Varus Deformity
Background: Nowadays combined high tibial osteotomy and ACL reconstruction is accepted as a safe and effectivesurgery for patients with symptomatic varus osteoarthritis and anterior knee instability; however, the source of varusdeformity is sometimes the femoral bone. No studies have reported concomitant ACL reconstruction and distal femoralosteotomy in ACL-deficient knees wit...
متن کاملبررسی میزان پایداری زانو متعاقب بازسازی لیگامان صلیبی قدامی بهروش دو باندلی و تک باندلی
Background: Anterior cruciate ligament (ACL) reconstruction is a first choice treatment for ACL-deficient knees, and arthroscopic single-bundle reconstruction has been widely accepted around the world in this regard. Although, such single-bundle reconstructions result in sufficient knee stability in most cases, but some patients have not been satisfied with postsurgical results in both short-te...
متن کاملOutcome of ACL Reconstruction and Concomitant Articular Injury Treatment
Background: Articular cartilage injuries are a common clinical problem at the time of ACL reconstruction with an incidence rate of 16-46%. Good results of ACL reconstruction combined with the treatment of chondral lesions have been published in some studies. Method: After statistical analysis 30 patients were selected and divided in 2 groups. TheFfirst group consisted of 15 patients wite isol...
متن کاملDoes Intravenous or Intraarticular Tranexamic Acid (TXA) Reduce Joint Bleeding Following Arthroscopic Anterior Cruciate Ligament (ACL) Reconstruction and Arthroscopic Meniscectomy? Can Intraarticular Use be Harmful to Chondrocytes?
Arthroscopic knee surgery to perform partial meniscectomy and anterior cruciate ligament (ACL) reconstruction is frequent and effective, although a possible complication is postoperative intra-articular bleeding. When this complication occurs, in addition to the associated pain, the patient usually requires an arthrocentesis to avoid loss of joint mobility. Sometimes this problem ends up associ...
متن کاملAllograft anterior cruciate ligament reconstruction: indications, techniques, and outcomes.
The anterior cruciate ligament (ACL) is an important stabilizer of the knee against translational and rotational forces. The goal of anatomic reconstruction of the ACL-deficient knee is to re-create a stable knee that will allow for return to sport and prevent recurrent injury. Multiple graft options exist for ACL reconstruction, and each option has unique advantages and disadvantages. With app...
متن کاملEvidence-Based ACL Reconstruction
There is controversy in the literature regarding a number of topics related to anterior cruciate ligament (ACL)reconstruction. The purpose of this article is to answer the following questions: 1) Bone patellar tendon bone (BPTB) reconstruction or hamstring reconstruction (HR); 2) Double bundle or single bundle; 3) Allograft or authograft; 4) Early or late reconstruction; 5) Rate of return to sp...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
عنوان ژورنال:
- The archives of bone and joint surgery
دوره 1 2 شماره
صفحات -
تاریخ انتشار 2013