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      The Evolution of Anatomic Anterior Cruciate Ligament Reconstruction

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          Abstract

          Anterior cruciate ligament reconstruction has evolved significantly since the early 1900’s, back when an emphasis was placed on repair and not reconstruction. Over the past century, the technique has evolved from intra-articular non anatomic reconstruction, to extra articular reconstruction, back to intra articular (performed arthroscopically), to now, the advent of anatomic insertion site restoration. This review will aim to illustrate the changes that have occurred, describing the rational for this process, based upon anatomical, radiological, biomechanical and clinical studies, all of which have aimed to improve patient function following ACL injury.

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          Return to the preinjury level of competitive sport after anterior cruciate ligament reconstruction surgery: two-thirds of patients have not returned by 12 months after surgery.

          Julian A Feller, Clare L. Ardern, Nicholas F Taylor … (2011)
          An athlete's desire to return to sport after anterior cruciate ligament (ACL) injury is a major indication for ACL reconstruction surgery. Typical clearance to return is 6 to 12 months postoperatively. To investigate the return-to-sport rate and participation level of a large cohort at 12 months after ACL reconstruction surgery. Case series; Level of evidence, 4. Data were analyzed for 503 patients who participated in competitive-level Australian football, basketball, netball, or soccer after ACL reconstruction surgery using a quadruple-strand hamstring autograft. Inclusion criteria included participation in competitive sport before the ACL injury and clearance from the orthopaedic surgeon to return to sport postoperatively. Patients completed a self-report questionnaire regarding preoperative and postoperative sports participation and the Cincinnati Sports Activity Scale. The International Knee Documentation Committee (IKDC) knee evaluation form and hop tests were used to evaluate knee function. Sixty-seven percent of patients attempted some form of sports activity by 12 months postoperatively; 33% attempted competitive sport. Of those who did not attempt any sports activity by 12 months, 47% indicated that they were planning to return. Men were significantly more likely than women to return. Patients who played sports with a seasonal competition, versus a year-round competition, were significantly more likely to return by 12 months. Patients with normal postoperative knee function (IKDC category A), versus those with nearly normal function (IKDC category B), were no more likely to return, but patients with good hop test results (≥85% limb symmetry index) were more likely to return than patients with poor results (<85%). People may require a longer postoperative rehabilitation period than that typically advocated to facilitate a successful return to competitive sport after ACL reconstruction surgery. The relationship between postoperative knee function and return-to-sport outcomes at 12 months after surgery was inconclusive.
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            Post-traumatic osteoarthritis: improved understanding and opportunities for early intervention.

            Donald Anderson, Susan Chubinskaya, Farshid Guilak … (2011)
            Even with current treatments of acute joint injuries, more than 40% of people who suffer significant ligament or meniscus tears, or articular surface injuries, will develop osteoarthritis (OA). Correspondingly, 12% or more of all patients with lower extremity OA have a history of joint injury. Recent research suggests that acute joint damage that occurs at the time of an injury initiates a sequence of events that can lead to progressive articular surface damage. New molecular interventions, combined with evolving surgical methods, aim to minimize or prevent progressive tissue damage triggered by joint injury. Seizing the potential for progress in the treatment of joint injuries to forestall OA will depend on advances in (1) quantitative methods of assessing the injury severity, including both structural damage and biologic responses, (2) understanding of the pathogenesis of post-traumatic OA, taking into account potential interactions among the different tissues and the role of post-traumatic incongruity and instability, and (3) application of engineering and molecular research to develop new methods of treating injured joints. This paper highlights recent advances in understanding of the structural damage and the acute biological response following joint injury, and it identifies important directions for future research. Copyright © 2011 Orthopaedic Research Society.
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              Return-to-sport outcomes at 2 to 7 years after anterior cruciate ligament reconstruction surgery.

              Julian A Feller, Clare L. Ardern, Nicholas F Taylor … (2011)
              Most people have not returned to their preinjury level of sports participation at 12 months after anterior cruciate ligament (ACL) reconstruction surgery. Twelve months' follow-up may be too early to assess return-to-sport outcomes accurately. This study was undertaken to evaluate the medium-term return-to-sport outcomes after ACL reconstruction surgery. Case series; Level of evidence, 3. A self-report questionnaire was used to collect data at 2 to 7 years after ACL reconstruction surgery regarding preinjury sports participation, postoperative sports participation, and subjective knee function. The main inclusion criteria were participation in regular sports activity before injury and the attendance at routine surgical follow-up appointments. A total of 314 participants (mean age, 32.5 ± 10.2 years) were included at a mean 39.6 ± 13.8 months after ACL reconstruction surgery. At follow-up, 45% were playing sport at their preinjury level and 29% were playing competitive sport. Ninety-three percent of the study sample had attempted sport at some time after their ACL reconstruction surgery. Those who had not attempted their preinjury level of sport by 12 months after surgery were just as likely to have returned to preinjury level by 39 months after surgery as those who had played sport by 12 months (risk ratio, 1.1; 95% confidence interval, 0.76-1.6). Less than 50% of the study sample had returned to playing sport at their preinjury level or returned to participating in competitive sport when surveyed at 2 to 7 years after ACL reconstruction surgery. Return to the preinjury level of sport at 12 months after surgery was not predictive of participation at the preinjury level in the medium term, which suggests that people who return to sport within 12 months may not maintain their sports participation.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Open Orthop J
                Journal ID (iso-abbrev): Open Orthop J
                Journal ID (publisher-id): TOORTHJ
                Title: The Open Orthopaedics Journal
                Publisher: Bentham Open
                ISSN (Electronic): 1874-3250
                Publication date (Electronic): 27 July 2012
                Publication date Collection: 2012
                Volume: 6
                Pages: 287-294
                Affiliations
                University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Walsgrave, Coventry, CV2 2DX, UK
                Author notes
                [* ]Address correspondence to this author at the University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Walsgrave, Coventry, CV2 2DX, UK; Tel: +447980803194; E-mail: agetgood@ 123456btinternet.com
                Article
                Publisher ID: TOORTHJ-6-287
                DOI: 10.2174/1874325001206010287
                PMC ID: 3415664
                PubMed ID: 22905073
                SO-VID: deb0a6b1-c779-4964-ac13-a3262a0eb914
                Copyright © © Getgood and Spalding; Licensee Bentham Open.
                License:

                This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

                History
                Date received : 14 February 2012
                Date revision received : 2 March 2012
                Date accepted : 10 March 2012
                Categories
                Subject: Article
                Series title: Suppl 2

                ScienceOpen disciplines: Orthopedics
                Keywords: repair,surgical technique,reconstruction,anterior cruciate ligament,evolution.
                Data availability:
                ScienceOpen disciplines: Orthopedics
                Keywords: repair, surgical technique, reconstruction, anterior cruciate ligament, evolution.

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