The anterior cruciate ligament—II

✍ Scribed by S Karmani; T Ember

• Publisher: Elsevier Science
• Year: 2004
• Tongue: English
• Weight: 217 KB
• Volume: 18
• Category: Article
• ISSN: 0268-0890
• DOI: 10.1016/s0268-0890(03)00103-8

✦ Synopsis

Surgical principles

A number of approaches have been adopted over time in dealing with the ACL deficient knee. These can be considered under several headings.

ACL repair

Primary repair was the earliest approach to the ACL problem, the first report in the literature being Mayo Robson 1 at Leeds General infirmary, England. He treated a miner who presented with 'lameness' following a cave-in. Robson sutured the cruciate ligaments to their normal femoral sites of attachment; the result at 6 years was excellent. Palmer 2 went on to describe anatomy, biomechanics and techniques but not results. It was O'Donoghue et al. 3 who first reported a follow-up of 25 patients with acute ACL injuries over 6-18 months. All 25 were functionally stable and 22/25 'objectively stable' but this term was not clearly defined. He advocated surgical repair of acute ACL ruptures within 2 weeks; for chronic injuries he adopted the approach of reconstruction.

Feagin and Curl 4 presented a 5-year follow-up of a technique using a chromic catgut or mersilene figure of eight suture in the ACL that was passed through drill holes in the lateral femoral condyle. Of the reported 32 cases, 94% had instability, 54% reinjury, 71% pain and stiffness and 66% complained of swelling. They concluded that primary repair alone was not sufficient to treat the ACL deficient knee and recommended the use of augmentation.