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Controversies in ACL Reconstruction

Fadale, Paul D. MD; Johnson, Donald H. MD

Sports Medicine and Arthroscopy Review: December 2009 - Volume 17 - Issue 4 - p 209
doi: 10.1097/JSA.0b013e3181c0cd19
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The management of torn anterior cruciate ligaments (ACLs) has not changed significantly for quite a number of years. However, recent laboratory findings and advanced clinical and surgical techniques are raising questions about previously accepted approaches to what is a growing clinical problem. In the past, the major controversy was the type of graft tissue used and how it was affixed to the joint. Now, the anatomy of the ACL itself has become the focus of attention and demands a reexamination of every aspect of treating torn ACLs. There is no better time to review “Controversies in ACL Reconstruction.”

Every article in this 2-volume publication describes cutting-edge approaches to the evaluation and management of torn ACLs. To increase understanding of the injury, we begin with a discussion of changing etiology and then, review the preventative measures that could reduce the number of torn ACLs among athletes. A better understanding of the anatomy of the ACL translates into better surgical decisions about tunnel placement, devices for fixation, and single versus double bundle reconstructions. In addition to discussing the possibilities for using more allografts, there are new ways of employing either hamstring or patella tendon grafts. Unfortunately, revisions to ACL reconstruction are becoming more common and to help surgeons address this trend, an evolving anatomic approach is presented. These volumes describe exciting opportunities for new graft sources, including prosthetics and scaffold, as well as ways to improve healing. Finally, rehabilitation is discussed, as a rapid return to preinjury level performance is critical to the success of our injured athletes.

ACL reconstruction remains one of the most common orthopedic procedures performed today. This timely, 2-volume series summarizes the controversies surrounding ACL reconstruction and it provides surgeons with a range of approaches from which to choose, tailored to the case at hand. The volumes describe both leading edge and practical techniques that are successful in managing ACL reconstruction and reducing the need for revisions among athletes at all levels.

© 2009 Lippincott Williams & Wilkins, Inc.