Anterior Cruciate Reconstruction Through a Transligamentous Approach

  • A. Gächter

Abstract

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.

Keywords

Titanium Propylene Rounded Stripper Travin 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Alm A, Strömberg B (1974) Vascular anatomy of the patellar and cruciate ligaments. Acta Chir Scand [Suppl] 445: 25–35Google Scholar
  2. Arnoczky SP, Travin GB, Marshall JL (1982) Anterior cruciate ligament replacement using patellar tendon. An evaluation of graft revascularization. J Bone Joint Surg [Am] 64: 217Google Scholar
  3. Bair GR (1980) Effects of early mobilization vs. casting on A. C. L. reconstruction. Proc Orthop Res Soc, Atlanta, Georgia, p 108Google Scholar
  4. Clancy WG, Rosenberg T, Gmeiner J, Narchania RG, Wisnesfke D (1979) Anterior cruciate ligament reconstruction in primates and man: A biomechanical and microangiographic evaluation of patellar tendon substitution. 1st Congress of the International Society of the Knee, Lyon (Communication)Google Scholar
  5. Clancy WG, Nelson DA, Reider B, Narechania RG (1982) Anterior cruciate ligament reconstruction using one-third of the patellar ligament, augmented by extra-articular tendon transfers. J Bone Joint Surg [Am] 64: 352Google Scholar
  6. Eriksson E (1976) Reconstruction of the anterior cruciate ligament. Orthop Clin North 7: 167–179.Google Scholar
  7. Gächter A, Kohler O (1988) Transplantathypertrophie nach vorderer Kreuzbandplastik. In: Beck E (Hrsg) Fortschritte in der Arthroskopie, Bd 4. Enke, StuttgartGoogle Scholar
  8. Hefti F, Gächter A, Jenny H, Morscher E (1982) Replacement of the anterior cruciate ligament. A comparative study of four different methods of reconstruction. Arch Orthop Traumatol Surg 100: 93–94CrossRefGoogle Scholar
  9. Jones KG (1970) Reconstruction of the anterior cruciate ligament using the central one-third of the patellar ligament. J Bone Joint Surg [Am] 52: 1302–1308Google Scholar
  10. Kennedy JC (1983) The use of a ligament augmentation device (L. A. D.) in the anterior cruciate deficient knee. Presented at the American Academy of Orthopaedic Surgeons, AnaheimGoogle Scholar
  11. Palmer I (1938) On the injuries to the ligaments of the knee joint. A clinical study. Acta Chir Scand [Suppl 53] 81: 237Google Scholar
  12. Palmer J (1957) Injuries to the crucial ligaments of the knee joint as a surgical problem. Wiederherstellungschirurgie und Traumatologie (Basel). Reconstr Surg Traumatol 4: 181–196Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1992

Authors and Affiliations

  • A. Gächter

There are no affiliations available

Personalised recommendations