This document summarizes current management of anterior cruciate ligament (ACL) injuries, including anatomy, treatment options, surgical techniques, graft types, and rehabilitation. Key points include: ACL tears are common sports injuries; reconstruction is preferred over conservative treatment to prevent further damage; anatomic single- or double-bundle reconstruction aims to restore the native footprint; fixation and graft choices depend on patient factors; and rehabilitation focuses on regaining strength and function over 6-12 months before returning to sport. Surgical techniques and understanding continue to evolve based on research into knee biomechanics, healing, and failure rates.
Current trends in ACL surgery include a shift towards anatomical reconstruction techniques that more closely restore the native ACL footprint. While double bundle reconstruction aims to better restore knee rotation, high quality studies show no difference in outcomes compared to single bundle reconstruction. Autograft tissue like hamstring tendon is preferred over allograft for younger patients due to higher failure rates with allograft. Postoperative rehabilitation protocols emphasize early range of motion restoration and return to sport is recommended between 8 to 12 months following surgery accompanied by meeting specific strength and performance benchmarks.
Updated ACL and MCL Injuries for Postgraduate Orthopaedic Course in Newcastle...Professor Deiary Kader
This document discusses anterior cruciate ligament (ACL) injuries and reconstruction. It provides information on ACL anatomy, mechanisms of injury, clinical presentation, diagnosis, and treatment options. Regarding treatment, it describes non-operative treatment as well as surgical reconstruction techniques including graft options, tunnel placement techniques, and potential complications. It also briefly discusses medial collateral ligament injuries and tibial eminence fractures.
Updated HTO vs UniKnee for Postgraduate Orthopaedic Course in Newcastle March...Professor Deiary Kader
This document discusses osteotomy and unicompartmental knee replacement (UKR or "Uni Knee") for the treatment of varus malalignment and osteoarthritis in the knee. It provides details on the surgical techniques, outcomes, advantages, and contraindications of high tibial osteotomy (HTO) and UKR. Non-operative treatments for knee osteoarthritis like weight loss, exercise, and injections are also summarized.
The document discusses ACL injuries of the knee, including causes, symptoms, diagnosis, and treatment options. ACL injuries can range from grade I (microtears) to grade III (complete tear). Treatment may involve RICE, bracing, rehabilitation, or surgical reconstruction depending on the severity of injury and patient factors. Surgical reconstruction replaces the torn ACL with a tendon graft and aims to restore stability and function while allowing return to sports.
This document discusses the use of osteotomy procedures, specifically high tibial osteotomy (HTO), for treating osteoarthritis (OA) in younger patients with malalignment. It provides details on the purpose and techniques of HTO, including closed-wedge and open-wedge approaches. Ideal candidates for HTO are identified as those under age 60 with isolated medial compartment OA and varus malalignment of under 15 degrees. Complications of HTO procedures are outlined. Studies have found obesity, inadequate correction, and age over 50 to be negative prognostic factors, while joint line preservation is key to success.
Acl Reconstruction Surgery In Delhi Dr. Shekhar Srivastav 09971192233DelhiArthroscopy
ACL Reconstruction Surgery in Delhi by Dr. Shekhar Srivastav - Dr. Shekhar Srivastav is an Orthopedic Surgeon attached to Sant Parmanand Hospital, Delhi with special interest in Knee & Shoulder surgery. After obtaining his M.S. Orthopedics degree he has undergone training in various centers in India and Abroad which has helped him in understanding the Orthopedics problems and their Management. He did his AO/ ASIF fellowship at University Hospital, Salzburg, Austria in 2006 and recieved training in Arthroscopy & Sports Medicine at TUM, Munich (Germany) & Rush Orthopedics Centre, Chicago( USA). He has an experience of more than fifteen years of diagnosing and treating Orthopedics & Trauma patients.
Check Out Details at http://www.delhiarthroscopy.com
This document discusses graft selection considerations for ACL reconstruction surgery. It notes that while ACL surgery outcomes have improved, re-injury rates remain high. The best graft depends on factors like the patient's activity level and surgery goals. Autografts like hamstring tendon and bone-patellar tendon-bone have advantages and risks to consider such as donor site morbidity and graft integration/re-rupture rates. Allografts present issues like higher costs and failure rates. Evidence suggests hamstring autografts may have the best cost-effectiveness profile, though bone-patellar tendon-bone grafts have excellent integration; graft choice requires weighing these various factors.
This document presents the case of a 22-year-old Thai man who injured his right knee playing football. His physical examination revealed swelling, pain on motion, and a positive anterior drawer test of the right knee. An MRI confirmed a complete tear of the anterior cruciate ligament and a tear of the medial meniscus.
Current trends in ACL surgery include a shift towards anatomical reconstruction techniques that more closely restore the native ACL footprint. While double bundle reconstruction aims to better restore knee rotation, high quality studies show no difference in outcomes compared to single bundle reconstruction. Autograft tissue like hamstring tendon is preferred over allograft for younger patients due to higher failure rates with allograft. Postoperative rehabilitation protocols emphasize early range of motion restoration and return to sport is recommended between 8 to 12 months following surgery accompanied by meeting specific strength and performance benchmarks.
Updated ACL and MCL Injuries for Postgraduate Orthopaedic Course in Newcastle...Professor Deiary Kader
This document discusses anterior cruciate ligament (ACL) injuries and reconstruction. It provides information on ACL anatomy, mechanisms of injury, clinical presentation, diagnosis, and treatment options. Regarding treatment, it describes non-operative treatment as well as surgical reconstruction techniques including graft options, tunnel placement techniques, and potential complications. It also briefly discusses medial collateral ligament injuries and tibial eminence fractures.
Updated HTO vs UniKnee for Postgraduate Orthopaedic Course in Newcastle March...Professor Deiary Kader
This document discusses osteotomy and unicompartmental knee replacement (UKR or "Uni Knee") for the treatment of varus malalignment and osteoarthritis in the knee. It provides details on the surgical techniques, outcomes, advantages, and contraindications of high tibial osteotomy (HTO) and UKR. Non-operative treatments for knee osteoarthritis like weight loss, exercise, and injections are also summarized.
The document discusses ACL injuries of the knee, including causes, symptoms, diagnosis, and treatment options. ACL injuries can range from grade I (microtears) to grade III (complete tear). Treatment may involve RICE, bracing, rehabilitation, or surgical reconstruction depending on the severity of injury and patient factors. Surgical reconstruction replaces the torn ACL with a tendon graft and aims to restore stability and function while allowing return to sports.
This document discusses the use of osteotomy procedures, specifically high tibial osteotomy (HTO), for treating osteoarthritis (OA) in younger patients with malalignment. It provides details on the purpose and techniques of HTO, including closed-wedge and open-wedge approaches. Ideal candidates for HTO are identified as those under age 60 with isolated medial compartment OA and varus malalignment of under 15 degrees. Complications of HTO procedures are outlined. Studies have found obesity, inadequate correction, and age over 50 to be negative prognostic factors, while joint line preservation is key to success.
Acl Reconstruction Surgery In Delhi Dr. Shekhar Srivastav 09971192233DelhiArthroscopy
ACL Reconstruction Surgery in Delhi by Dr. Shekhar Srivastav - Dr. Shekhar Srivastav is an Orthopedic Surgeon attached to Sant Parmanand Hospital, Delhi with special interest in Knee & Shoulder surgery. After obtaining his M.S. Orthopedics degree he has undergone training in various centers in India and Abroad which has helped him in understanding the Orthopedics problems and their Management. He did his AO/ ASIF fellowship at University Hospital, Salzburg, Austria in 2006 and recieved training in Arthroscopy & Sports Medicine at TUM, Munich (Germany) & Rush Orthopedics Centre, Chicago( USA). He has an experience of more than fifteen years of diagnosing and treating Orthopedics & Trauma patients.
Check Out Details at http://www.delhiarthroscopy.com
This document discusses graft selection considerations for ACL reconstruction surgery. It notes that while ACL surgery outcomes have improved, re-injury rates remain high. The best graft depends on factors like the patient's activity level and surgery goals. Autografts like hamstring tendon and bone-patellar tendon-bone have advantages and risks to consider such as donor site morbidity and graft integration/re-rupture rates. Allografts present issues like higher costs and failure rates. Evidence suggests hamstring autografts may have the best cost-effectiveness profile, though bone-patellar tendon-bone grafts have excellent integration; graft choice requires weighing these various factors.
This document presents the case of a 22-year-old Thai man who injured his right knee playing football. His physical examination revealed swelling, pain on motion, and a positive anterior drawer test of the right knee. An MRI confirmed a complete tear of the anterior cruciate ligament and a tear of the medial meniscus.
The document discusses knee arthroplasty, including:
- Indications for total knee replacement including severe arthritis pain and dysfunction.
- Contraindications such as infection, vascular disease, and deformities.
- The goals of knee replacement surgery including restoring normal alignment and balance.
- Surgical techniques including exposures, balancing soft tissues, and landmarks for component rotation.
Evolution of tunnel placement in ACL reconstructionDhananjaya Sabat
One of my talks at Delhi Arthroscopy Club....... this presentation provides a insight regarding the conceptual evolution in tunnel placement during ACL reconstruction.
This document discusses posterior cruciate ligament (PCL) tears. It begins with an overview of PCL anatomy and mechanisms of injury. It then covers clinical evaluation including physical examination tests like the posterior drawer test. Investigations like MRI are discussed. Finally, the document outlines management approaches for PCL tears, including non-operative treatment for mild injuries and surgical reconstruction or repair for more severe injuries. Surgical techniques like single versus double bundle reconstruction using autografts or allografts are compared. Post-operative rehabilitation protocols are also summarized.
This document contains notes from a lecture on sports injuries and the knee. It discusses various topics including osteotomies around the knee, unicompartmental knee replacements, total knee replacements, and patellofemoral joint osteoarthritis. It also contains questions from candidates on these topics as well as non-operative treatments for osteoarthritis, principles of osteotomies, different knee prosthesis types, and coronal plane ligament releases in total knee replacements.
ALL (antero-lateral ligament) - extra articular ACL reconstruction - basicsMilind Tanwar
history, need, how to reconstruct, when to reconstruct.
References: *Bonasia, Davide Edoardo et al. "Anterolateral Ligament Of The Knee: Back To The Future In Anterior Cruciate Ligament Reconstruction". Orthopedic Reviews 7.2 (2015)
Biomechanical Results of Lateral Extra-articular
Tenodesis Procedures of the Knee:
A Systematic Review. Erik L. Slette, B.A., Jacob D. Mikula, B.S., Jason M. Schon, B.S., Daniel C. Marchetti, B.A.,
Matthew M. Kheir, B.S., Travis Lee Turnbull, Ph.D., and Robert F. LaPrade, M.D., Ph.D.
This document discusses high tibial osteotomy (HTO), a procedure that corrects knee alignment to relieve pressure from arthritic areas. It was first described in 1961 and involves cutting and reshaping the tibia to transfer weight from an arthritic to a healthier area of cartilage. The document outlines indications, contraindications, techniques like closing wedge and opening wedge osteotomy, management of the fibula, fixation methods, advantages and disadvantages of different techniques, expected results, and potential complications. HTO is a well-established procedure for unicompartmental knee arthritis with typical satisfactory results in 80% of cases.
Anterior cruciate ligament reconstruction- allograft versus autograftTunO pulciņš
1. The document compares allograft versus autograft options for anterior cruciate ligament (ACL) reconstruction surgery. Allografts use donor tissue while autografts use the patient's own tissue.
2. There are several factors to consider for each graft including patient characteristics, surgical factors, biological incorporation, and the risk of disease transmission. Younger, high-demand athletes often due better with autografts which incorporate faster and have lower re-tear rates.
3. However, allografts can be preferable for older, lower-demand patients due to benefits like avoiding donor site morbidity and faster return to activities of daily living. Overall graft selection requires weighing these various patient and graft-specific
This study aimed to provide an anatomical description of the anterolateral ligament (ALL) of the knee and characterize its biomechanics. The ALL was found in all 35 cadaver knees and was an important internal rotatory stabilizer, especially between 30-60 degrees of flexion. Cutting the ALL increased the pivot shift grade in the ACL-intact and deficient knee. The ALL was identified on 95.3% of MRI scans of ACL-injured patients, with lesions in 79.2%. The Segond fracture was delineated as a bony avulsion of the ALL.
Revision ACL Reconstruction - A Case Presentation and Literature ReviewJeremy Burnham
This document summarizes a case presentation of a 23-year-old male college student undergoing revision anterior cruciate ligament (ACL) reconstruction surgery due to a failed primary ACL reconstruction surgery two years prior. The patient reported pain, swelling, and instability in his right knee. His surgical history included an ACL reconstruction with a soft tissue allograft and partial meniscectomies two years ago. During the revision surgery, the surgeons found remnants of the previous ACL graft with few fibers left and new meniscus tears. The revision surgery involved constructing a new ACL graft and additional partial meniscectomies. Post-operatively, the patient was doing well with pain controlled and no complications.
The document summarizes a study on high tibial osteotomy with concomitant meniscal scaffold implantation. It discusses how osteotomies can transfer loading from arthritic to healthy cartilage areas. It also notes that meniscectomies increase contact stresses in the knee joint. The study involved 10 patients receiving collagen scaffolds, 10 receiving polyurethane scaffolds, and 20 control patients receiving osteotomy alone. Results found the osteotomies achieved good union and correction maintenance, and patients receiving meniscal repair showed superior clinical improvement compared to debridement alone, with no difference between scaffold types.
Updated PCL, PLC and Knee Dislocation for Postgraduate Orthopaedic Course in ...Professor Deiary Kader
The document discusses the posterior cruciate ligament (PCL) and posterolateral corner (PLC) of the knee. It provides details on the anatomy, mechanisms of injury, clinical assessment, treatment, and complications for injuries to these structures. For PCL injuries, the strongest ligament in the knee, treatment involves conservative management for isolated acute injuries or reconstruction for chronic symptomatic injuries. For PLC injuries, addressing all injured ligaments is important as isolated treatment can fail. Reconstruction of the lateral collateral ligament, popliteus tendon, and popliteofibular ligament is recommended for chronic complete injuries.
The document discusses various treatment options for osteoarthritis of the knee, including high tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA). It provides details on the surgical techniques, prerequisites, advantages, and disadvantages of both HTO (open vs closed wedge) and UKA. Key points covered include the ideal candidates for HTO, factors for successful osteotomy, complications rates between open vs closed wedge HTO, and that UKA provides better long-term functional results compared to HTO. Non-operative treatments such as weight loss, exercise and bracing are also summarized.
This document provides an overview of knee anatomy and surgical procedures related to the meniscus, ACL, MCL, PCL, and patellofemoral joint. It begins with meniscal anatomy and function, then discusses factors in meniscal repair versus resection and different repair techniques. Next, it covers ACL anatomy and evidence on surgical treatment. It also discusses anatomy and treatments for MCL, PCL, and posterolateral corner injuries. Finally, it summarizes patellar instability including causes, assessment, and imaging. Key surgical procedures are highlighted throughout like ACL reconstruction techniques and options for cartilage repair.
PCL Posterior Cruciate Ligament Knee Injury: Is it Benign I Dr.RAJAT JANGIR JAIPUR
#aclsurgeryjaipur #aclsurgeryhindia #aclsurgerytaekwondo
Acl reconstruction in jaipur | Acl reconstruction in taekwondo | Acl injury in football player surgery | Acl reconstruction surgery in football | acl surgery | Acl surgery ke baad physiotherapy | Acl surgery in jaipur | acl surgery recovery | Best acl surgeon in jaipur | Best ligament doctor in hindi | Best acl surgeon in india | Meniscus repair surgery in jaipur | Sports injury doctor | Acl injury in football players | Acl injury in taekwondo | acl tear | Best knee surgeon in jaipur
#allinsideacl #internalbrace #drrajatjangir #bestaclsurgeon #aclexpert #bestkneesurgeon
To Know more about ACL Injury, Click the links below:
1. ACL surgery 7 different Techniques we do at our center - "Not single technique best for all"
https://youtu.be/oWkIr8IXvr8
2. Everything about ACL Injury tear surgery in Hindi I
https://youtu.be/bqpjkAkwZ14
3. Best Screw for ACL tear surgery in Hindi
https://youtu.be/1LGpU1NHiIs
4. ACL Injury Tear Surgery Recovery : All your questions & queries solved by Dr.Rajat Jangir
https://youtu.be/SIAPWiMbOqs
5. Partial ACL Tear Surgery or not ! ACL आधा टूटा हो तो क्या करें ?
https://youtu.be/NEJRPKskJTI
6. 5 Symptoms of ACL Injury tear इंजरी के पांच लक्षण ?
https://youtu.be/EXpgy19Jxzw
7. PRP injection therapy in Partial ACL TEARs
https://youtu.be/qyG1EYgS87E
Dr.RAJAT JANGIR(Asso Prof.)
Senior Consultant Arthroscopy and Joint Replacement
(Specialist in Shoulder Knee Hip Surgery)
Ligament and Joints Clinic
67/34 Mansarovar Jaipur
Whatsapp: shorturl.at/gnAEP
Appointment: +91 8104855900
Email: ligamentsurgeon@gmail.com
Google Page: https://g.page/KNEE-Shoulder-SURGERY?...
Facebook: https://www.facebook.com/Ligamentandj...
* Vast experience and specialisation in the field of Arthroscopy and sports surgery.
* M.S. orthopaedics from BJ Medical College, Civil hospital, Ahmedabad
* Fellowship in Arthroscopy and Sports injury with Prof Joon Ho Wang at Samsung Medical Center, South Korea
* Diploma in Sports Medicine from InternationaI Olympic Committee
* Invited as Athlete Medical Doctor at Rio Olympic 2016
* Done Rajasthan's first "All Inside Physeal Preserving ACL reconstruction" in 13 year old Athlete
Dr.Rajat is rated as one of the best orthopedic surgeon with with excellence in Knee Shoulder Arthroscopy surgeries as replacements'
This document provides information on revision knee arthroplasty, including common causes of painful knee replacements, guidelines for diagnosing infection, factors that influence polyethylene wear, and technical considerations for revision surgery. It discusses various constrained condylar knee systems including their offset, stem, and hinge conversion options. Techniques for addressing metaphyseal bone loss like trabecular metal cones and sleeves are presented. The importance of surgeon experience with a given system and long-term outcome data is emphasized.
The document provides an overview of a knee surgeon's elective orthopaedics course on the topic of knees. It includes the surgeon's background and areas of specialty. It also includes sample cases and questions from attendees on topics like evidence-based treatment for osteoarthritis, different types of knee replacements and osteotomies, and principles of knee surgery procedures.
This document provides information on a revision course for sports injuries and the knee, focusing on conditions like patellofemoral joint issues, ACL injuries, and meniscal tears. It includes sections on:
1. The anatomy and biomechanics of the patellofemoral joint, ACL, and meniscus.
2. Evaluation and imaging of patellar instability, ACL tears, and meniscal tears.
3. Non-surgical and surgical treatment options for various knee conditions like patellar instability, ACL reconstruction, and meniscal repairs vs resection.
4. Post-surgical complications and evidence for treatments.
Sections provide details on mechanisms of injury, surgical techniques, graft options, and
Tunnel Enlargement in Single Bundle ACL Reconstruction Using Bio-Interference...TheRightDoctors
Tunnel Enlargement in Single Bundle ACL Reconstruction Using Bio-Interference Screw, Transfix and Tight Rope RT: A Comparitive Study Using Computed Tomography-Dr. Ankit Goyal
This document summarizes a presentation on medial opening wedge high tibial osteotomy. Key points include:
1) Preoperative planning is critical to determine the appropriate correction and wedge size.
2) Wedge geometry is complex, as the correction depends on both coronal and sagittal plane alignment.
3) Intraoperative assessment of alignment is challenging, and while the bovie cord provides a reasonable estimate, alternatives like radiolucent grids may improve accuracy by reducing parallax error.
The anterior cruciate ligament (ACL) is a key ligament in the knee that prevents anterior tibial translation and rotational loads. It frequently tears during high-impact sports. The ACL inserts on the femur and tibia and is composed of two bundles that restrain movement differently based on knee flexion angle. While partial ACL tears may be treated nonsurgically, complete tears typically require surgical reconstruction using a graft to replace the torn ligament. Postoperative rehabilitation focuses initially on regaining range of motion and strength before gradually progressing to sport-specific activities.
This document provides information from the American Academy of Orthopaedic Surgeons on adult reconstructive hip and knee surgery. It includes 7 cases with radiographs, descriptions of patients' symptoms and medical histories. Each case is followed by multiple choice questions testing understanding of the case. The document discusses preferred responses and provides references to support clinical reasoning for each response.
The document discusses knee arthroplasty, including:
- Indications for total knee replacement including severe arthritis pain and dysfunction.
- Contraindications such as infection, vascular disease, and deformities.
- The goals of knee replacement surgery including restoring normal alignment and balance.
- Surgical techniques including exposures, balancing soft tissues, and landmarks for component rotation.
Evolution of tunnel placement in ACL reconstructionDhananjaya Sabat
One of my talks at Delhi Arthroscopy Club....... this presentation provides a insight regarding the conceptual evolution in tunnel placement during ACL reconstruction.
This document discusses posterior cruciate ligament (PCL) tears. It begins with an overview of PCL anatomy and mechanisms of injury. It then covers clinical evaluation including physical examination tests like the posterior drawer test. Investigations like MRI are discussed. Finally, the document outlines management approaches for PCL tears, including non-operative treatment for mild injuries and surgical reconstruction or repair for more severe injuries. Surgical techniques like single versus double bundle reconstruction using autografts or allografts are compared. Post-operative rehabilitation protocols are also summarized.
This document contains notes from a lecture on sports injuries and the knee. It discusses various topics including osteotomies around the knee, unicompartmental knee replacements, total knee replacements, and patellofemoral joint osteoarthritis. It also contains questions from candidates on these topics as well as non-operative treatments for osteoarthritis, principles of osteotomies, different knee prosthesis types, and coronal plane ligament releases in total knee replacements.
ALL (antero-lateral ligament) - extra articular ACL reconstruction - basicsMilind Tanwar
history, need, how to reconstruct, when to reconstruct.
References: *Bonasia, Davide Edoardo et al. "Anterolateral Ligament Of The Knee: Back To The Future In Anterior Cruciate Ligament Reconstruction". Orthopedic Reviews 7.2 (2015)
Biomechanical Results of Lateral Extra-articular
Tenodesis Procedures of the Knee:
A Systematic Review. Erik L. Slette, B.A., Jacob D. Mikula, B.S., Jason M. Schon, B.S., Daniel C. Marchetti, B.A.,
Matthew M. Kheir, B.S., Travis Lee Turnbull, Ph.D., and Robert F. LaPrade, M.D., Ph.D.
This document discusses high tibial osteotomy (HTO), a procedure that corrects knee alignment to relieve pressure from arthritic areas. It was first described in 1961 and involves cutting and reshaping the tibia to transfer weight from an arthritic to a healthier area of cartilage. The document outlines indications, contraindications, techniques like closing wedge and opening wedge osteotomy, management of the fibula, fixation methods, advantages and disadvantages of different techniques, expected results, and potential complications. HTO is a well-established procedure for unicompartmental knee arthritis with typical satisfactory results in 80% of cases.
Anterior cruciate ligament reconstruction- allograft versus autograftTunO pulciņš
1. The document compares allograft versus autograft options for anterior cruciate ligament (ACL) reconstruction surgery. Allografts use donor tissue while autografts use the patient's own tissue.
2. There are several factors to consider for each graft including patient characteristics, surgical factors, biological incorporation, and the risk of disease transmission. Younger, high-demand athletes often due better with autografts which incorporate faster and have lower re-tear rates.
3. However, allografts can be preferable for older, lower-demand patients due to benefits like avoiding donor site morbidity and faster return to activities of daily living. Overall graft selection requires weighing these various patient and graft-specific
This study aimed to provide an anatomical description of the anterolateral ligament (ALL) of the knee and characterize its biomechanics. The ALL was found in all 35 cadaver knees and was an important internal rotatory stabilizer, especially between 30-60 degrees of flexion. Cutting the ALL increased the pivot shift grade in the ACL-intact and deficient knee. The ALL was identified on 95.3% of MRI scans of ACL-injured patients, with lesions in 79.2%. The Segond fracture was delineated as a bony avulsion of the ALL.
Revision ACL Reconstruction - A Case Presentation and Literature ReviewJeremy Burnham
This document summarizes a case presentation of a 23-year-old male college student undergoing revision anterior cruciate ligament (ACL) reconstruction surgery due to a failed primary ACL reconstruction surgery two years prior. The patient reported pain, swelling, and instability in his right knee. His surgical history included an ACL reconstruction with a soft tissue allograft and partial meniscectomies two years ago. During the revision surgery, the surgeons found remnants of the previous ACL graft with few fibers left and new meniscus tears. The revision surgery involved constructing a new ACL graft and additional partial meniscectomies. Post-operatively, the patient was doing well with pain controlled and no complications.
The document summarizes a study on high tibial osteotomy with concomitant meniscal scaffold implantation. It discusses how osteotomies can transfer loading from arthritic to healthy cartilage areas. It also notes that meniscectomies increase contact stresses in the knee joint. The study involved 10 patients receiving collagen scaffolds, 10 receiving polyurethane scaffolds, and 20 control patients receiving osteotomy alone. Results found the osteotomies achieved good union and correction maintenance, and patients receiving meniscal repair showed superior clinical improvement compared to debridement alone, with no difference between scaffold types.
Updated PCL, PLC and Knee Dislocation for Postgraduate Orthopaedic Course in ...Professor Deiary Kader
The document discusses the posterior cruciate ligament (PCL) and posterolateral corner (PLC) of the knee. It provides details on the anatomy, mechanisms of injury, clinical assessment, treatment, and complications for injuries to these structures. For PCL injuries, the strongest ligament in the knee, treatment involves conservative management for isolated acute injuries or reconstruction for chronic symptomatic injuries. For PLC injuries, addressing all injured ligaments is important as isolated treatment can fail. Reconstruction of the lateral collateral ligament, popliteus tendon, and popliteofibular ligament is recommended for chronic complete injuries.
The document discusses various treatment options for osteoarthritis of the knee, including high tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA). It provides details on the surgical techniques, prerequisites, advantages, and disadvantages of both HTO (open vs closed wedge) and UKA. Key points covered include the ideal candidates for HTO, factors for successful osteotomy, complications rates between open vs closed wedge HTO, and that UKA provides better long-term functional results compared to HTO. Non-operative treatments such as weight loss, exercise and bracing are also summarized.
This document provides an overview of knee anatomy and surgical procedures related to the meniscus, ACL, MCL, PCL, and patellofemoral joint. It begins with meniscal anatomy and function, then discusses factors in meniscal repair versus resection and different repair techniques. Next, it covers ACL anatomy and evidence on surgical treatment. It also discusses anatomy and treatments for MCL, PCL, and posterolateral corner injuries. Finally, it summarizes patellar instability including causes, assessment, and imaging. Key surgical procedures are highlighted throughout like ACL reconstruction techniques and options for cartilage repair.
PCL Posterior Cruciate Ligament Knee Injury: Is it Benign I Dr.RAJAT JANGIR JAIPUR
#aclsurgeryjaipur #aclsurgeryhindia #aclsurgerytaekwondo
Acl reconstruction in jaipur | Acl reconstruction in taekwondo | Acl injury in football player surgery | Acl reconstruction surgery in football | acl surgery | Acl surgery ke baad physiotherapy | Acl surgery in jaipur | acl surgery recovery | Best acl surgeon in jaipur | Best ligament doctor in hindi | Best acl surgeon in india | Meniscus repair surgery in jaipur | Sports injury doctor | Acl injury in football players | Acl injury in taekwondo | acl tear | Best knee surgeon in jaipur
#allinsideacl #internalbrace #drrajatjangir #bestaclsurgeon #aclexpert #bestkneesurgeon
To Know more about ACL Injury, Click the links below:
1. ACL surgery 7 different Techniques we do at our center - "Not single technique best for all"
https://youtu.be/oWkIr8IXvr8
2. Everything about ACL Injury tear surgery in Hindi I
https://youtu.be/bqpjkAkwZ14
3. Best Screw for ACL tear surgery in Hindi
https://youtu.be/1LGpU1NHiIs
4. ACL Injury Tear Surgery Recovery : All your questions & queries solved by Dr.Rajat Jangir
https://youtu.be/SIAPWiMbOqs
5. Partial ACL Tear Surgery or not ! ACL आधा टूटा हो तो क्या करें ?
https://youtu.be/NEJRPKskJTI
6. 5 Symptoms of ACL Injury tear इंजरी के पांच लक्षण ?
https://youtu.be/EXpgy19Jxzw
7. PRP injection therapy in Partial ACL TEARs
https://youtu.be/qyG1EYgS87E
Dr.RAJAT JANGIR(Asso Prof.)
Senior Consultant Arthroscopy and Joint Replacement
(Specialist in Shoulder Knee Hip Surgery)
Ligament and Joints Clinic
67/34 Mansarovar Jaipur
Whatsapp: shorturl.at/gnAEP
Appointment: +91 8104855900
Email: ligamentsurgeon@gmail.com
Google Page: https://g.page/KNEE-Shoulder-SURGERY?...
Facebook: https://www.facebook.com/Ligamentandj...
* Vast experience and specialisation in the field of Arthroscopy and sports surgery.
* M.S. orthopaedics from BJ Medical College, Civil hospital, Ahmedabad
* Fellowship in Arthroscopy and Sports injury with Prof Joon Ho Wang at Samsung Medical Center, South Korea
* Diploma in Sports Medicine from InternationaI Olympic Committee
* Invited as Athlete Medical Doctor at Rio Olympic 2016
* Done Rajasthan's first "All Inside Physeal Preserving ACL reconstruction" in 13 year old Athlete
Dr.Rajat is rated as one of the best orthopedic surgeon with with excellence in Knee Shoulder Arthroscopy surgeries as replacements'
This document provides information on revision knee arthroplasty, including common causes of painful knee replacements, guidelines for diagnosing infection, factors that influence polyethylene wear, and technical considerations for revision surgery. It discusses various constrained condylar knee systems including their offset, stem, and hinge conversion options. Techniques for addressing metaphyseal bone loss like trabecular metal cones and sleeves are presented. The importance of surgeon experience with a given system and long-term outcome data is emphasized.
The document provides an overview of a knee surgeon's elective orthopaedics course on the topic of knees. It includes the surgeon's background and areas of specialty. It also includes sample cases and questions from attendees on topics like evidence-based treatment for osteoarthritis, different types of knee replacements and osteotomies, and principles of knee surgery procedures.
This document provides information on a revision course for sports injuries and the knee, focusing on conditions like patellofemoral joint issues, ACL injuries, and meniscal tears. It includes sections on:
1. The anatomy and biomechanics of the patellofemoral joint, ACL, and meniscus.
2. Evaluation and imaging of patellar instability, ACL tears, and meniscal tears.
3. Non-surgical and surgical treatment options for various knee conditions like patellar instability, ACL reconstruction, and meniscal repairs vs resection.
4. Post-surgical complications and evidence for treatments.
Sections provide details on mechanisms of injury, surgical techniques, graft options, and
Tunnel Enlargement in Single Bundle ACL Reconstruction Using Bio-Interference...TheRightDoctors
Tunnel Enlargement in Single Bundle ACL Reconstruction Using Bio-Interference Screw, Transfix and Tight Rope RT: A Comparitive Study Using Computed Tomography-Dr. Ankit Goyal
This document summarizes a presentation on medial opening wedge high tibial osteotomy. Key points include:
1) Preoperative planning is critical to determine the appropriate correction and wedge size.
2) Wedge geometry is complex, as the correction depends on both coronal and sagittal plane alignment.
3) Intraoperative assessment of alignment is challenging, and while the bovie cord provides a reasonable estimate, alternatives like radiolucent grids may improve accuracy by reducing parallax error.
The anterior cruciate ligament (ACL) is a key ligament in the knee that prevents anterior tibial translation and rotational loads. It frequently tears during high-impact sports. The ACL inserts on the femur and tibia and is composed of two bundles that restrain movement differently based on knee flexion angle. While partial ACL tears may be treated nonsurgically, complete tears typically require surgical reconstruction using a graft to replace the torn ligament. Postoperative rehabilitation focuses initially on regaining range of motion and strength before gradually progressing to sport-specific activities.
This document provides information from the American Academy of Orthopaedic Surgeons on adult reconstructive hip and knee surgery. It includes 7 cases with radiographs, descriptions of patients' symptoms and medical histories. Each case is followed by multiple choice questions testing understanding of the case. The document discusses preferred responses and provides references to support clinical reasoning for each response.
The document discusses anterior cruciate ligament (ACL) reconstruction and graft selection. It describes the anatomy of the ACL and common causes of injury. Diagnosis involves clinical tests and MRI imaging. Three main graft options exist - bone-patellar tendon-bone autograft, hamstring autograft, and allograft. The bone-patellar tendon-bone autograft integrates more quickly but risks anterior knee pain, while the hamstring autograft has less donor site morbidity but slower healing. Rehabilitation begins shortly after surgery, focusing on regaining range of motion and strengthening muscles around the knee. Graft selection depends on factors like activity level and age.
Comparative study of functional outcome of lateral locking plate fixation an...Om Patil
This document presents a comparative study of functional outcomes between lateral locking plate fixation and dual plating for closed fractures of Schatzker's Grade V tibial condyles in adults. 40 patients with this injury were randomly assigned to either lateral locking plate fixation or dual plating. Patients were followed up to 6 months and evaluated based on range of motion, time to union, and functional scoring scales. Results found that dual plating provided greater stability but was associated with more soft tissue complications and longer surgery time compared to lateral locking plate fixation. Both approaches achieved high rates of fracture union and functional recovery of the knee.
1. This study aims to assess outcomes of arthroscopic reduction and fixation of ACL tibial eminence avulsion fractures using an arthroscopic pullout suture technique.
2. A retrospective and prospective study will be conducted on patients undergoing this technique for Types 2, 3, and 4 ACL tibial eminence fractures.
3. Functional outcomes will be evaluated using Lysholm and IKDC scores, and time to fracture union and restoration of knee anatomy will be assessed.
This document describes a technique for arthroscopically grafting cysts in the greater tuberosity during rotator cuff repair. The technique involves debriding the cyst, drilling a socket, and implanting a resorbable scaffold to fill the defect. The authors present a case of using this technique to successfully repair a rotator cuff tear and fill a associated greater tuberosity cyst. They believe this technique offers a minimally invasive option for addressing cysts during rotator cuff repair.
The document discusses meniscus transplants, including:
1) Meniscus transplantation can help reduce pain and improve function by restoring a biomechanically favorable environment in the knee.
2) A long-term study of 119 meniscus transplant cases found a 79% success rate, with the main factors affecting survival being increased age and number of previous surgeries.
3) Case studies demonstrate that meniscus transplantation, combined with cartilage repair procedures, can provide long-term benefits for patients with meniscus injuries and cartilage damage.
Several studies have found that augmenting rotator cuff repair (RCR) with bone marrow aspirate concentrate (BMAC) can improve healing outcomes:
- Two studies found higher healing rates (100% vs 67-70%) and tendon quality with BMAC at 6 months post-op.
- One study found BMAC prevented re-tears in 87% of patients vs 44% without BMAC at 10 years follow-up.
- A multicenter study found significant improvements in pain and function scores with BMAC treatment for rotator cuff tears and osteoarthritis.
This document discusses evidence-based medicine (EBM) and summarizes several studies comparing different treatment methods for distal femur fractures. EBM aims to optimize patient care by emphasizing evidence from well-designed research. Several articles compare outcomes of internal fixation with intramedullary nails versus locking plates. In general, nails provide better callus formation, stiffness, and less micromotion at the fracture site, while plates have higher nonunion rates and require more secondary procedures. Retrograde nailing appears to have advantages for distal femur fractures, including improved alignment and reduced complications.
This document summarizes a study that aims to evaluate knee stability following injury and reconstruction of the anterolateral ligament (ALL). It introduces the pivot shift test, a common method used to examine ACL stability by inducing internal rotation and a valgus force on the extended knee. The study seeks to determine the importance of the deep fibers of the iliotibial band as they relate to combined anterior tibial translation and internal rotation during a pivot shift test. It also aims to clarify the roles of the deep iliotibial band fibers and ALL in relation to the ACL and their overall contribution to knee stability. The study method involves using metal clamps and instrumentation to reproduce the strain of a pivot shift test on
This technical note describes an arthroscopic technique for addressing both a rotator cuff tear and a cyst within the greater tuberosity. The authors debrided the cyst cavity to create a socket, then implanted a resorbable scaffold to provide structure and promote bone ingrowth. This allowed the standard rotator cuff repair to then be performed. MRI at 6 months showed healing of both the cyst and rotator cuff tear. The technique provides a readily available option for surgeons facing this clinical challenge.
PIPJ Post-traumatic Arthritis: Arthrodesis vs ArthroplastyAlphonsus Chong
The document discusses surgical options for treating arthritis at the proximal interphalangeal (PIP) joint, including interpositional arthroplasty, fusion, and prosthetic replacement. Interpositional arthroplasty aims to preserve motion but has limited data on outcomes. PIP fusion is reliable for pain relief but results in complete loss of motion. Implant arthroplasty can maintain some motion but complications are higher than fusion and include loosening and fracture. Overall, both fusion and arthroplasty provide pain relief, while fusion sacrifices motion and arthroplasty carries higher risks of complications.
This document discusses several topics related to total knee arthroplasty (TKA), including:
1. Expectations for recovery after TKA are often misaligned between patients and surgeons, with over 50% of patients expecting higher levels of function than surgeons.
2. Moderate sports and physical activity after TKA do not appear to negatively impact implant durability or increase revision rates in the short or medium term. High-impact sports should still be avoided.
3. Knee rehabilitation protocols must account for numerous patient-specific variables to optimize outcomes, such as age, BMI, pre-operative activity level, type of implant, and adherence to home exercises. A one-size-fits-all approach is inadequate.
This study reviewed the long-term outcomes of total knee arthroplasty (TKA) in patients with severe valgus knee deformity (variant-III). 32 patients (37 knees) underwent TKA with an average follow up of 10 years. The mean preoperative valgus alignment of 33 degrees was corrected to nearly neutral alignment postoperatively. Clinical and functional outcomes significantly improved based on HSS knee scores and range of motion. No revisions were required. Complications included 3 transient peroneal nerve palsies and 2 DVTs, but no infections or loosening. TKA can successfully treat severe valgus deformity with proper soft tissue balancing and implant selection.
This technical note describes an arthroscopic technique for addressing both a rotator cuff tear and a cyst within the greater tuberosity. The authors present a 1-step procedure using porous, resorbable scaffolds to fill the cyst defect at the time of rotator cuff repair. The cyst is thoroughly debrided and a matching implant is placed flush with the bone. Standard rotator cuff repair is then performed. In a 57-year-old patient, MRI at 6 months showed healing of both the cyst and rotator cuff. The technique provides an option for surgeons facing this clinical challenge with minimal additional time or morbidity.
Total hip arthroplasty has been an important surgical operation in orthopaedics in the 20th century. After many trails, major advancement in Total Hip Arthroplasty was made by Sir John Charnley in 1962, who introduced low friction arthroplasty. This consists of a polyethylene cup and 22.2 mm head, both components being fixed with methacrylate cement. In the following years there were many changes to this basic principle (model) of total hip arthroplasty. Patient education has become an important factor in improvement of function following total hip replacement.
This document discusses the management of midshaft clavicle fractures, specifically whether they should be fixed operatively or treated non-operatively. It notes that while non-operative treatment was traditionally believed to result in good healing, more recent studies have found higher rates of nonunion, malunion, pain, and functional deficits with non-operative care. Specifically, displaced fractures have been shown to have nonunion rates up to 15% with non-operative treatment. The document advocates for operative fixation, especially with plates, for displaced midshaft fractures to improve healing and avoid long-term sequelae. It reviews plate designs and positioning and surgical techniques for plate fixation of these injuries.
Arthrolatarjet (Arthroscopic Latarjet Proc) Dr Sujit Jos keralaSujit Jos
Arthroscopic Latarjet procedure is gaining popularity in every part of the world as it combines the strength of Latarjet procedure while retaining the advantages of Arthroscopy. It is most useful shoulder recurrent dislocation associated with bone loss in the glenoid (Bony Bankart) or humeral head (Hill Sach's defect).
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Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
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4. Differentiate between intervals and segments
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Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Current management of ACL injury 2017
1. Current Management of
Anterior Cruciate Ligament Injury
What's in and What's out?
Ukris Gunadham M.D.
Department of Orthopedics
Trang Regional Hospital
Regional Sports Medicine Meeting 12/12/2017
4. ACL Injuries
ACL tears account for up to 64% of athletic knee injuries
in cutting and pivoting sports.
120,000–200,000 ACLRs performed annually in the
United States.
Acute ACL injuries: joint effusion, altered knee kinematics
and gait, muscle weakness, and reduced functional
performance
long term sequelae: meniscal tears, chondral lesions, and
posttraumatic osteoarthritis
Stannard JP, Sherman SL, Cook JL. Soft tissues about the knee.
In: Grauer JN, editor.AAOS Orthopaedic Knowledge Update 12. Ch. 36. 1-13. 2017.
6. Anatomy
Double bundle :
Anteromedial (AM)
Posterolateral (PL)
Ribbon-like midsubstance
Lateral intercondylar ridge
Lateral bifurcate ridge
Robert Migielski. Ribbonlike Anatomy of the Anterior Cruciate
Ligament from Its Femoral Insertion to the Midsubstance.
ESSKA 2014.
7. Anatomy
Tibial C-shape insertion runs
from along the medial tibial
spine to the anterior aspect
of the anterior root of LM
No ACL fibers inserted in
the center of the “C” nor
posterolateral (which was
the place of the bony
attachment of the anterior
root of the LM)
No PL bundle was found but
posteromedial (PM) fibers
Rainer Siebold.Tibial C-Shaped Insertion of the Anterior
Cruciate LigamentWithout Posterolateral Bundle. ESSKA
9. Treatment options
Non-operative management - poorly tolerated by
both adults and young patients
Leads to recurrent instability, chondral and meniscal
injuries
People participating in sports or work related
activities that require a lot of pivoting, cutting, or
jumping may decide to have surgery.
Stannard JP. AAOS Orthopaedic Knowledge Update 12. Ch. 36. 2017
Ajuied A. AJSM 2014
10. Surgical versus conservative
interventions for treating
anterior cruciate ligament injuries
No differences between surgical management (ACL
reconstruction followed by structured rehabilitation) and
conservative treatment (structured rehabilitation
only) in patient-reported outcomes of knee function at 2-
5 years after injury.
Many participants with an ACL rupture remained
symptomatic following rehabilitation and later opted for
ACL reconstruction surgery.
2016 Cochrane review
11. ACL reconstruction – Timing
ACL reconstructions performed beyond 3 weeks post-
injury were at significantly lower risk of developing
arthrofibrosis
Shelbourne et al.AJSM 1991
ACL reconstruction should preferably be performed
within 6 months from injury to avoid the risk of
additional damage (LM in acute setting and MM as time
elapses)
Kennedy J et al. JBJS Br 2010
12. ACL reconstruction – Timing
An increase in the number and grade of cartilage lesions
with increasing time from injury is a consistent finding
especially MFC
Tandogan RN, et al. Knee Surg SportsTraumatol Arthrosc 2004
Skeletally immature patients are at a similar risk of
developing secondary lesions and should be prioritized
for ACL reconstruction with appropriate physeal-sparing
techniques
Dumont GD, et al AJSM 2012
14. Non-anatomic ACLR
Traditional ACLRs are placing the graft outside of the
native insertion of the ACL. (clockwise ref.)
Vertically oriented grafts able to reconstitute stability in
the sagittal plane (anterior-posterior) but fail to provide
adequate rotational stability.
Non-anatomic tunnel placement can alter the forces
experienced by the graft and is one of the main reasons
grafts fail (continued instability or re-rupture) after ACLR.
Rahnemai-Azar AA, Sabzevari S, Irarrázaval S, ChaoT, Fu FH.Anatomical individualized ACL reconstruction.
Arch Bone Joint Surg 2016;4:291-7
17. Anatomic ACLR
attempt to restore the native ACL footprint on
both the tibial and femoral sides of the knee to recreate
the native functional kinematics
Single bundle reconstruction is indicated for
tibial insertion sites less than 14 mm in length,
narrow notches (less than 12 mm in width)
concomitant ligamentous injuries
severe bone bruising
severe arthritic changes (KL3-4)
in the setting of open physis
van Eck CF, Lesniak BP, SchreiberVM, Fu FH.Anatomic single- and double-bundle anterior
cruciate ligament reconstruction flowchart.Arthroscopy 2010;26:258-68.
19. Anatomic ACLR
Double bundle reconstruction - considered in
patients with
a large tibial insertion site (anteroposterior length >14 mm)
large intercondylar notch (length and width >14 mm)
absence of concomitant ligament injuries
absence of advanced arthritic changes (KL <3)
absence of severe bone bruising
closed physis
van Eck CF, Lesniak BP, SchreiberVM, Fu FH.Anatomic single- and double-bundle anterior
cruciate ligament reconstruction flowchart.Arthroscopy 2010;26:258-68.
20. DB anatomic ACLR
Shino K, Nakata K, Nakamura N et al. (2005) Arthroscopy 21:1402.e1–1402.e5
22. SB vs DB ACLR
DB ACLR is to reconstruct both the AM and PL bundles,
more closely reproducing the native knee
anatomy and kinematics
Paschos NK, Howell SM. EFORT Open Rev 2016
Biomechanical promise of DB fails to translate into
clinical significance and may predispose the graft to
impingement and excessive tension through the PL
bundle during knee extension, resulting early graft
rupture or attenuation
Rahnemai-Azar AA, Sabzevari S, Irarrázaval S, ChaoT, Fu FH.Anatomical individualized ACL reconstruction.
Arch Bone Joint Surg 2016
23. SB vs DB ACLR
When patients are individually assigned based on the
size of the ACL native insertion site and the intercondylar
notch width, prospective studies demonstrate no
difference in terms of anteroposterior and rotational
laxity between single or double-bundle reconstruction
techniques
Hussein M, van Eck CF, Cretnik A, Dinevski D, Fu FH. Individualized anterior cruciate ligament surgery:
Am J Sports Med 2012;40:1781-8.
24. SB vs DB ACLR
T. Järvelä and R. Siebold. in Anterior Cruciate Ligament Reconstruction
ESSKA 2014
25. Tunnel Drilling
Transtibial technique is falling more out of
practice (decreased from 56.4% in 2007 to 17.6% in
2014) as a growing number of surgeons perform an
outside-in technique or use guides placed through the AM
portal (increased from 41.3% in 2007 to 65.1% in 2014)
Outcome data including fewer persistently positive
Lachman and pivot shift tests, lower KT-1000 scores, and
higher Lysholm scores in the transportal groups further
support this paradigm shift.
Tibor L, Chan PH, FunahashiTT,Wyatt R, Maletis GB, Inacio MC, et al. Surgical technique trends in
primary ACL reconstruction from 2007 to 2014. J Bone Joint Surg Am 2016;98:1079-89.
26. Fixation Types
no clear consensus on superiority of aperture,
suspensory cortical, or button graft fixation or screw
(metal/biologic) versus button graft fixation.
Biologic screws can be associated with tunnel
widening, a complication infrequently observed in
metallic screw fixation. However, biologic screws
allow for advanced imaging of the knee
postoperatively without metal artifact.
Tibor L, Chan PH, FunahashiTT,Wyatt R, Maletis GB, Inacio MC, et al. Surgical technique trends in primary
ACL reconstruction from 2007 to 2014. J Bone Joint Surg Am 2016;98:1079-89.
27. Fixation Types
Decrease in use of first-generation bioabsorbable
screws for graft fixation and a shift toward
biocomposite fixation
When securing soft tissue grafts, recent studies favor
suspensory fixation which fosters better junctional
bone-tendon healing as well as stronger zero time
fixation
Stannard JP, Sherman SL, Cook JL. Soft tissues about the knee. In: Grauer JN, editor.
AAOS Orthopaedic Knowledge Update 12. Ch. 36. 1-13. 2017.
28. ACL remnant preserving
Intact remnants played an important role in mechanical
strength in the early postoperative period
Reservation of the blood supply aid in the healing process
of the graft
Maintenance of proprioceptive innervation with evident
benefits for the subjective outcome and return to sports
Optimization of the accuracy of the procedure by
improving the arthroscopic orientation and bone tunnel
placement at the insertion site
Borbon CA, Mouzopoulos G, Siebold R Knee Surg Sports Traumatol Arthrosc 2012.
30. Allograft vs Autograft
Selection should be based on patient factors
(patient age, skeletal maturity, and activity level)
2.6x higher rate of failure when using allograft vs
autograft in patients <25 years
Allograft - acceptable outcome in middle-aged or
recreational athlete
Allograft – need longer time for graft ligamentization
Stannard JP, Sherman SL, Cook JL. Soft tissues about the knee.
AAOS Orthopaedic Knowledge Update 12. 2017
31. Graft Types
HT - equivalent functional outcomes and less donor-
site morbidity, but increased risk of failure/revision,
persistently positive pivot shift test, diminished return
to preinjury levels of activity, and higher rates of
infection
BPTB - strong stiff graft, secure fixation, bone-to-bone
healing, and low failure rates, but higher incidence of
anterior knee pain and kneeling pain
GifstadT, Foss OA, Engebretsen L, Lind M, Forssblad M,Albrektsen G, et al.
A registry study based on 45,998 primary ACL reconstructions in Scandinavia.Am J Sports Med 2014.
32. Graft Types
QT - good strength, low donor-site morbidity, and
reliable long term outcomes
Quadriceps is an ACL antagonist, slightly impaired
function of this muscle may protect the ACL graft
against the quadriceps anteriorly directed force
Fischer F, et al. Knee Surg SportsTraumatol Arthrosc. 2017
Biomechanical studies demonstrate that the residual
strength of the QT after graft harvest is higher than
that of the intact PT.
Kim SJ, Kumar P, Oh KS.Arthroscopy 2009
34. Rehabilitation
Pre-op rehabilitation – preserve Q strength and knee
ROM
Post-op rehabilitation
Acute phase - restore ROM ,maintain Q strength, reduce
inflammation (0-3 wks.)
Recovery phase - improve lower limb muscle strength and
functional stability (3-6 wks.)
Functional phase - return to previous level of activity and
reduce risk of re-injury (6+ wks.)
35. Rehabilitation
Little consensus regarding rehab protocol
Early return to play – increased risk of graft failure
and injury to contralateral native ACL
Return to play when:
Time from surgery 8-12 months
Absence of pain and effusion
ROM comparable to contralateral knee
Negative Lachman / Pivot shift test
One leg hop test >85-90% of contralateral
Drop vertical jump without dynamic valgus
Ellman MB et al. JAAOS 2015
36. Return to Sports after ACLR
In the first 2 years after ACL reconstruction, 30 % of
people who returned to level I sports sustained a
reinjury compared to 8 % of those who participated in
lower level sports.
For every month that return to sport was delayed, until 9
months after ACL reconstruction, the rate of knee reinjury
was reduced by 51%.
More symmetrical quadriceps strength prior to
return to sport significantly reduced the knee reinjury rate.
Only 5.6 % of patients who passed RTS criteria before
returning to level I sports suffered reinjuries compared to
37.5 % of those who didn’t pass
Grindem et al (BJSM 2016)
38. Failed ACL Reconstruction
10-25% failure
0.7-8% recurrent instability
Caused of failure
Atraumatic
Technical errors (24%) most common
Biological (fail of graft incorporation) (7%)
Traumatic: early or late (32%)
Multicenter ACL Revision Study (MARS) AJSM 2010
39. Technical Cause of Failure
Cause %
Femoral tunnel malposition
Tibial tunnel malposition
Malalignment
Femoral fixation
Tibial fixation
Autograft source
Allograft source
Posteromedial laxity
Posterolateral laxity
Other
80
37
4
6
1
1
7
2
1
4
Multicenter ACL Revision Study (MARS) AJSM 2010
40. Controversial Subjects
ACL Repair
Internal Bracing
Synthetic grafts
ALL reconstruction
Biologic agent in ACLR
41. Take home message
The treatment of ACL injury is dynamic and evolving
Strategies changes from:
better understanding of the native knee kinematics
basic science of ligament healing
improved surgical techniques
rehabilitation programs
better recognition of major causes of ACL surgical failure
Important to reflect on where we have been and where
we are going
Learn from the success and failure of those who came
before us