The Anterior Cruciate Ligament: Reconstruction and Basic Science E-Book , livre ebook

The Anterior Cruciate
Ligament
Reconstruction and Basic Science
Chadwick C. Prodromos, MD
President, Illinois Sports Medicine and Orthopaedic Centers
Assistant Professor, Orthopaedic Surgery Section of Sports Medicine, Rush University
Medical Center, Chicago, Illinois
S a u n d e r sTable of Contents
Cover image
Title page
Copyright
Dedication
About this Book
Acknowledgments
List of Contributors
Section I – Anterior Cruciate Ligament Injury
Part A: Anatomy, Physiology, Biomechanics, Epidemiology
Chapter 1: Anatomy and Biomechanics of the Anterior Cruciate Ligament
Introduction
Anterior Cruciate Ligament Anatomy
Biomechanics
Conclusion
Chapter 2: Mechanisms of Noncontact Anterior Cruciate Ligament Injuries
Chapter 3: Risk and Gender Factors for Noncontact Anterior Cruciate Ligament
Injury
Introduction
Environmental Risk FactorsAnatomical Risk Factors
Hormonal Risk Factors
Neuromuscular Risk Factors
Familial Tendency to Noncontact Anterior Cruciate Ligament Injury
Summary
Chapter 4: The Incidence of Anterior Cruciate Ligament Injury as a Function of
Gender, Sport, and Injury-Reduction Programs
Introduction
Purpose
Methods
Exposures
Data Conversions
Individual Sports
The Overall Risk of Anterior Cruciate Ligament Tear
Female–Male Injury Risk Ratio
Anterior Cruciate Ligament Tear-Prevention Programs
Implications for Future Anterior Cruciate Ligament Injury-Reduction Research
Conclusions
Chapter 5: Analysis of Anterior Cruciate Ligament Injury-Prevention Programs for
the Female Athlete
Introduction
Anterior cruciate ligament Injury-Prevention Studies
Areas for Further Research
Conclusion
Part B: Clinical
Chapter 6: Diagnosis of Anterior Cruciate Ligament Tear
Introduction
Diagnosis in the Acute Versus the Chronic Setting
Partial TearsHistory
Physical Exam
Conclusions
Chapter 7: Nonoperative Management of Anterior Cruciate Ligament Deficient
Patients
Anterior Cruciate Ligament Deficiency: The Need for Muscle Strengthening
Importance of the Hamstrings, Especially in Soccer Players: Our Research
Review of the Literature on the Role of the Quadriceps and Hamstrings in Anterior
cruciate ligament Deficient Knees
Bracing in anterior cruciate ligament Deficient Patients: Is It Effective?
Rehabilitation
Summary
Chapter 8: Arthrosis Following Anterior Cruciate Ligament Tear and Reconstruction
Introduction
Pathophysiology of Osteoarthritis Following Anterior Cruciate Ligament Injury
Natural History of the Untreated Anterior Cruciate Ligament Deficient Knee
Arthrosis Following Anterior Cruciate Ligament Reconstruction
Conclusion
Section II – Anterior Cruciate Ligament Reconstruction
Chapter 9: The Economics of Anterior Cruciate Ligament Reconstruction
Background
Purpose
Whose Costs are being Considered?
Sources of Cost Information
Third-Party Payer Payments
Institutional Fixed Costs
Conclusions
Part A: Graft Mechanical Properties
Chapter 10: The Relative Strengths of Anterior Cruciate Ligament Autografts andChapter 10: The Relative Strengths of Anterior Cruciate Ligament Autografts and
Allografts
Introduction
Methods
Comparison of Graft Strengths
Effect of Ligamentization
Allograft Strengths
Quadriceps Tendon Graft Strength
Relative Strength of Hamstring and Bone–patellar tendon–bone Grafts
Overall Relative Graft Strengths
Conclusions
Chapter 11: Why Synthetic Grafts Failed
History of Synthetic Grafts for Anterior Cruciate Ligament Reconstruction
Types of Synthetic Grafts
Causes of Failure of Synthetic Grafts
Other Problems with Synthetic Grafts
The Future
Part B: Autograft Harvest Techniques
Chapter 12: Hamstring Harvest Technique for Anterior Cruciate Ligament
Reconstruction
Abstract
Technique of Hamstring Graft Harvest
Skin Incision
Exposure of the Tendon
Tendon Release
Stripping of the Tendon
Preparation of the Graft
Tips for Harvesting the Hamstring Grafts to avoid complications
Chapter 13: Posterior Mini-Incision Hamstring Harvest Approach for AnteriorCruciate Ligament Reconstruction
Overview
Anatomy
Surgical Technique
Harvest Problems with the Traditional Approach and Solutions Using the Combined
Posterior/Anterior Mini-Incision Approach
Clinical Experience
Who Should Use this Technique?
Chapter 14: Technique for Harvesting a Mid-Third Patella Tendon Graft for Anterior
Cruciate Ligament Reconstruction
Introduction
Skin Incision
Exposure
Taking the Graft
Fashioning the Graft
Closure
Chapter 15: The Central Quadriceps Free Tendon for Anterior Cruciate Ligament
Reconstruction
Introduction
Technique
Troubleshooting Central Quadriceps Free Tendon Harvest
Fixation of the Central Quadriceps Free Tendon Graft
Part C: Hamstring Graft Configurations
Chapter 16: Hamstring Anterior Cruciate Ligament Reconstruction with a
Quadrupled or Tripled Semitendinosus Tendon Graft
Introduction
Scientific Rationale for a Quadrupled Construct
Surgical Technique
ConclusionChapter 17: 2ST/2Gr, 4ST, and 3ST/2Gr Techniques: Deciding Which Hamstring
Configuration to Use
Introduction
The Parameters for Choosing A Hamstring Graft Configuration
Graft Preparation Techniques
Troubleshooting
Five Strand Using 3ST/2Gr
Four-Strand St Graft Preparation Technique
Conclusions
Part D: Principles of Tunnel Formation
Single Femoral-Tunnel Formation
Chapter 18: Use of the Transtibial Technique to Avoid Posterior Cruciate Ligament
and Roof Impingement of an Anterior Cruciate Ligament Graft
Introduction
Definition, Complications, and Diagnosis of Posterior Cruciate Ligament
Impingement
Definition, Complications, and Diagnosis of Roof Impingement
The Tibial Tunnel: The Key Tunnel in the Transtibial Technique
Rationale for Widening the Notch to Prevent Posterior Cruciate Ligament
Impingement
Principle for Avoiding Posterior Cruciate Ligament and Roof Impingement
Surgical Technique for Avoiding Posterior Cruciate Ligament and Roof Impingement
and Replicating the Tension Pattern of the Intact Anterior Cruciate Ligament
Validation of Tibial Guide
Summary
Chapter 19: The Anteromedial Portal for Anterior Cruciate Ligament Reconstruction
Introduction
Advantages
Technique
Possible ComplicationsChapter 20: The Retrodrill Technique for Anterior Cruciate Ligament Reconstruction
Introduction
Femoral Tunnel Placement
Surgical Technique
Preliminary Results and Conclusions
Chapter 21: Femoral Tunnel Placement to Restore Normal Knee Laxity After Anterior
Cruciate Ligament Reconstruction
Introduction
Functional Anatomy of the Anterior Cruciate Ligament Related to Graft Tunnels
Anterior Cruciate Ligament Isometry and Reconstruction
Anatomical Single-Bundle Anterior Cruciate Ligament Reconstruction
Anatomical Double-Bundle Anterior Cruciate Ligament Reconstruction
Discussion
Double Anteromedial and Posterolateral Femoral-Tunnel Formation
Chapter 22: Anatomical Double-Bundle Anterior Cruciate Ligament Reconstruction
Procedure Using the Semitendinosus and Gracilis Tendons
Introduction
Procedure
Clinical Results
Chapter 23: Anatomical Anterior Cruciate Ligament Reconstruction with
DoubleBundle, Double-Stranded Hamstring Autografts: A Four-Tunnel Technique
Introduction
Surgical Procedure
Discussion
Conclusion
Chapter 24: Anatomical Double-Bundle Anterior Cruciate Ligament Reconstruction
with a Semitendinosus Hamstring Tendon Graft
Introduction
Anatomy of the Anterior Cruciate LigamentScientific Rationale
Surgical Technique
Preliminary Results
Other Applications
Special Considerations
TroubleShooting
Chapter 25: Anatomical Double-Bundle Reconstruction of the Anterior Cruciate
Ligament
Introduction
Preoperative Considerations
Surgical Technique
Postoperative Considerations
Conclusion
Notchplasty and Navigation
Chapter 26: Notchplasty
Anatomy
Indications and Potential Risks
Techniques and Avoiding Complications
Chapter 27: Computer-Assisted Navigation for Anterior Cruciate Ligament
Reconstruction
Rationale
Need for Precision in Tunnel Placement
Current Accuracy without Navigation
Techniques of Computer-Assisted Navigation
Results
Discussion
Part E: Fixation Biomechanics
Chapter 28: Biomechanics of Intratunnel Anterior Cruciate Ligament Graft FixationIntroduction
Limitations of Biomechanical Studies
Bone Mineral Density
Bone–Patellar Tendon–Bone Fixation
Guidelines and Recommendations for Intratunnel Fixation of Bone–Tendon–Bone
Grafts
Soft Tissue Grafts
Alternative Intratunnel Tibial Fixation Techniques
Future Directions
Chapter 29: High-Stiffness, Slippage-Resistant Cortical Fixation Has Many
Advantages over Intratunnel Fixation
Introduction
Fixation Stiffness and Slippage: Critical Factors in Restoring Anterior Laxity
Definition and Examples of High- and Low-Stiffness Fixation
Comment About Intratunnel Fixation with an Interference Screw
Example of Stiffness Principle
Biological and Mechanical Advantages of Cortical Fixation Over Intratunnel Fixation
Preferred