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Controversies in the Technical Aspects of ACL Reconstruction pp 313–324Cite as

ACL Augmentation

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Abstract

Anatomic anterior cruciate ligament (ACL) reconstruction has attracted much attention in the field of orthopedic sports medicine. Restoration of normal knee biomechanics by anatomic ACL reconstruction is one of the essential factors for successful ACL reconstruction. Not only that, early biological healing of the graft is also vital to obtaining satisfactory clinical results after ACL reconstruction. Accelerated graft remodeling, ligamentization, and reinnervation of the grafted tendon are necessary in order to restore excellent function and mechanical strength of the reconstructed ACL.

Recently, several studies have suggested that ACL augmentation (i.e., remnant-preserving ACL reconstruction) would produce satisfactory clinical outcomes because preservation of the ACL remnant may be beneficial in terms of proprioception, biomechanical functions, and vascularization of the graft. Several surgical techniques for remnant-preserving ACL reconstruction, including selective anteromedial or posterolateral bundle reconstruction and the remnant re-tensioning technique, have been described. ACL augmentation is used not only for partial rupture of the ACL but also for complete rupture.

This chapter shows roles of preserved ACL remnant, ACL augmentation technique, and clinical outcomes of ACL augmentation. The available evidence suggests that clinical outcomes of patients with the ACL augmentation technique are comparable with that of patients who underwent double-bundle ACL reconstruction. A significant controversy still remains regarding the clinical superiority of ACL augmentation compared to standard single-bundle reconstruction. Although longer follow-up studies and further comparative clinical studies are necessary before a definitive conclusion can be reached, we think that ACL augmentation is a reasonable treatment option for patients with favorable ACL remnants.

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Author information

Authors and Affiliations

  1. President of Hiroshima University, 1-3-2 Kagamiyama, Higashi-Hiroshima, 739-8511, Japan

    Mitsuo Ochi MD, PhD

  2. University of Ioannina, Dodonis 20-22, Ioannina, 45322, Greece

    Anastasios D. Georgoulis MD, PhD

  3. Department of Orthopaedic Surgery, Integrated Health Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan

    Atsuo Nakamae MD, PhD

Authors
  1. Mitsuo Ochi MD, PhD
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  2. Anastasios D. Georgoulis MD, PhD
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  3. Atsuo Nakamae MD, PhD
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Corresponding author

Correspondence to Mitsuo Ochi MD, PhD .

Editor information

Editors and Affiliations

  1. Institute for Medical Science in Sports, Osaka Health Science University, Osaka, Japan

    Norimasa Nakamura

  2. Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy

    Stefano Zaffagnini

  3. Hospital for Special Surgery, New York, New York, USA

    Robert G. Marx

  4. UPMC Center for Sports Medicine, Pittsburgh, Pennsylvania, USA

    Volker Musahl

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Ochi, M., Georgoulis, A.D., Nakamae, A. (2017). ACL Augmentation. In: Nakamura, N., Zaffagnini, S., Marx, R., Musahl, V. (eds) Controversies in the Technical Aspects of ACL Reconstruction. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-52742-9_29

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  • DOI: https://doi.org/10.1007/978-3-662-52742-9_29

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