Anterior Cruciate Reconstruction Through a Transligamentous Approach
Research involving the anterior cruciate ligament (ACL) began with Palmer (1938), but many years passed before his discoveries regarding the importance of the central pivot and its associated structures were practically applied. The results of an ACL reconstruction technique first described by Jones (1970) were not ideal, although use of the patellar tendon to replace the ACL appeared logical and technically feasible. For a time there were arguments raised in favor of extra articular reconstruction alone (technical simplicity, relatively short rehabilitation). Now, however, the trend is toward surgical procedures on the central pivot (Hefti et al. 1982). It makes sense to repair “in situ” a lesion that causes such a profound biomechanial imbalance. External reconstructions such as the biceps tendon transfer, lateral repair, and pes anserinus transfer are drastic procedures that can “decenter” the knee with the passage of time. The displacement of the center of rotation of the knee predisposes to cartilage damage from peak loads, distention of the capsule and ligaments, and meniscal pathology.
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