The Acl Deficient Knee

A review of surgical and nonsurgical treatment options of anterior cruciate ligament (ACL) injuries. This text includes a discussion of ACL injuries, procedures and outcome evaluations.

This book approaches the ACL deficient knee from a different perspective than those of the previous classical ways. The common approach is the analysis of closed compartments; anatomy, biomechanics, physical findings, imaging, surgical treatment and rehabilitation. The approach of this book is completely opposite, focusing on questions, controversies, problem analyses and problem solving, besides analyzing the possibility of prevention. Therefore, in each chapter, the biomechanics, anatomy, and other areas that are relevant to the topic are reviewed. There are chapters where highly specialized surgical techniques are presented (acute ACL repair, double bundle reconstruction, chondral lesions treatment or meniscal transplant). These chapters are written by internationally renowned specialists that are pioneers in the topic analyzed. Another interesting aspect of this book are the step by step surgical techniques videos, that will allow a knee specialist to perform the technique presented by the author. Moreover, the videos will include anatomy and physical therapy techniques.

This book comprehensively discusses anterolateral rotatory instability in the ACL deficient knee, exploring anatomy, biomechanics, diagnostics, clinics, surgical techniques as well as short and long term outcomes. The author also offers an historical perspective ranging from the birth of modern anterior cruciate ligament surgery to the renewed global interest towards the role of secondary restraints and extra-articular reconstructions. Step-by-step guidance throughout each surgical technique further equips the reader to handle this complex condition. Covering all theoretical and practical aspects, as well as future perspectives, this book is a must-read for all orthopedic surgeons and sports physicians wanting to gain insights into this promising field.

Based on a workshop in Snowmass, Colo., July 1989. Summarizes the consensus on biomechanics, the immature knee, extraarticular surgery as the primary treatment, as secondary support, and as support for the chronic knee. Not a textbook. Annotation copyright Book News, Inc. Portland, Or.

This book is designed to equip the reader with the knowledge and tools required for provision of individualized ACL treatment based on the best available evidence. All major aspects of the assessment of rotatory knee instability are addressed in depth. A historical overview of arthrometers, both invasive and non-invasive, is provided, and newly developed devices for the measurement of rotatory knee laxity are considered. Recent advances with respect to the pivot shift test are explained and evidence offered to support a standardized pivot shift test and non-invasive quantification of the pivot shift. Specific surgical techniques for rotatory laxity are described, with presentation of the experience from several world-renowned centers. In addition, functional rehabilitation and “return to play” are discussed. In keeping with the emphasis on an individualized approach, the book highlights individualization of surgical reconstruction techniques in accordance with the specific injury pattern and grade of rotatory knee laxity as well as the use of individualized rehabilitation techniques. Numerous high-quality images illustrate key points and clear take-home messages are provided.

Written by internationally eminent authorities in sports medicine and knee surgery, this book thoroughly describes and illustrates the key principles in the diagnosis, surgical treatment, and rehabilitation of knee disorders. The information on surgical procedures, outcomes, and complications is evidence-based and documented from a database of over 15,000 cases. Coverage includes detailed descriptions and illustrations of three new surgical procedures—microfracture for chondral injuries, stimulation of the healing response in ligamentous injuries, and arthroscopic treatment of the degenerative knee. Specific postoperative rehabilitation protocols are included for many surgical procedures. Other topics covered include injury prevention, imaging, functional evaluation, and biomechanics. More than 300 outstanding illustrations complement the text.

Pushed by the progress of biology, technology and biomechanics, knee surgery has dramatically evolved in the last decades. This book is a "state of the art" concerning all aspects of knee surgery from ligament reconstruction to Total Knee Arthroplasty. An international panel of renowned authors have worked on this didactic fully illustrated book. It will help young surgeons to understand basic sciences and modern sugical techniques. The experienced surgeon will find help to deal with difficult cases and clarifications in recent technologic advances such as cartilage surgery, navigation and mini invasive surgery.

Background: Clinical examinations assess the ability of ACL reconstruction to restore stability to the knee joint. However, the ability of ACL reconstruction to restore contact mechanics at the tibiofemoral articulation is not well understood. Hypothesis/Purpose: The magnitude of tibiofemoral contact stresses will remain abnormal following ACL reconstruction, even though the stability of the ACL-deficient knee will be increased following reconstruction. Study Design: Controlled laboratory study. Methods: Six degrees of freedom robotic technology was used to load cadaveric knee joints mimicking common clinical tests of anterior and rotational stability of the knee. Eleven knees were tested with the ACL intact, after sectioning it, and after standard single bundle ACL reconstruction using tunnels drilled through the center of the footprints of the native ACL. Motion patterns were recorded. A stress transducer was fixed to tibial plateau and contact stress was recorded while performing the simulated exams. Mean contact stresses were calculated regionally in the medial and lateral compartments of the tibial plateau. Results: ACL reconstruction improved stability of the ACL-deficient knee under anterior and rotational loads within 2mm and 3ʻ of the ACL-competent knee. However, knee motions were constrained beyond their intact status at flexion angles less than 30ʻ. Mean contact stresses on the tibial plateau remained abnormal after ACL, reconstruction. Conclusions: Subtle changes in knee motion patterns can alter contact mechanics. Therefore, more sensitive methods to clinically assess knee stability following ACL reconstruction may be needed to assess and compare treatments for ACL rupture. Clinical Relevance: Altered contact mechanics may play an important role in onset and progression of OA following ACL injury and reconstruction.