2009 FWI trends in anterior cruciate ligament reconstruction

In 2006, in a survey regarding anterior cruciate ligament (ACL) reconstruction mailed to physician members of the American Orthopaedic Society for Sports Medicine, a total of nearly 1000 responses were received from 1747 possible respondents (57%).

The number of ACL reconstructions per year ranged from 1 to 275 (mean=55).

Our own experience is slowly growing with mean 30 caseload per year for the last decade.

The most important factors in the timing of surgery were (?) knee range of motion and effusion.

Bone-patellar tendon-bone (BPTB) autograft was most commonly preferred (46%), followed by hamstring tendon autograft (32%) and allografts (22%).

Five years earlier, BPTB grafts are more frequent and hamstring tendon and allografts, less frequent (63%, 25%, and 12%, respectively).

A single-incision arthroscopic technique is used by 90%.

Most allowed return to full activity at 5 to 6 months, with a trend toward earlier return for BPTB grafts; quadriceps strength was an important factor in the decision (?).

There is limited experience (4%) with double-bundle and computer-assisted ACL reconstruction.

Arthroscopic-assisted (?), single-incision reconstruction using a BPTB autograft fixed with metal (?) interference screws remains the most common technique used for primary ACL reconstruction.

In the past 5 years, the use of alternative graft sources and methods of fixation has increased.

Consensus regarding the best

• graft type,
• fixation method, and
• postoperative protocol

is still lacking.

The effect of the posterolateral bundle in the anterior cruciate ligament reconstruction

The use of new technology in 3D laxity analysis in torn anterior cruciate ligament (ACL) knee should improve my ability to assess the effect of reconstruction on laxity control.

The aim of my current clinical study is to compare, in anatomic ACL reconstruction, the effect of each bundle, posterolateral (PL) and anteromedial (AM) on the residual laxity intraoperatively.

I do not use an optoelectronic navigation system to measure neither the translation nor the rotation during anterior drawer test, Lachman test and pivot shift test.

I evaluated a great number of my surgical patients with PL bundle reconstruction combined with AM bundle reconstruction.

Taking care to reconstruct PL bundle seems clearly to improve the translation and rotation laxity control during the Lachman and pivot shift test, while the AM bundle is still important in the translation control during the anterior drawer test.

Anatomic all bundles reconstruction improves the control of laxity intra and postoperatively.

Clinical, radiological and arthroscopic analysis of the ACL tear. A prospective study of mean 25 surgical annual caseload in 25 five years

My own prospective monocentric study concerns at least two hundreds  anterior cruciate ligament tears.

It correlates the anatomic data’s and the clinical and radiological data’s.

I identified, at least, four types of anterior cruciate ligament tears…

1. complete tears (no ligament left),
2. postero lateral bundle preserved,
3. healing on the posterior cruciate ligament and
4. healing in the notch.

I observed a highest laxity in the complete tear group with a highest rate of soft Lachman and gross pivot shift, and a high incidence of medial meniscus tears.

I also possibly noted and a longer delay between injury and surgery, years for the complete tear group and months for the postero lateral bundle group.

The mean medial compartment laxity, side to side, in the postero lateral bundle group was 4-5 mm and 7-8 mm in the complete tear group.

My own monocentric data might help the surgeon in his surgical planning in case of partial tears (???)