Arthroscopically Aided ACL Reconstruction

• Treatment can be operative or nonoperative.
• There are several variables that determine operative versus nonoperative treatment.
  • Sports activity level
    • Jumping, hard cutting, and pivoting sports: football, basketball, soccer
      • Clear candidates for anterior cruciate ligament reconstruction
    • Lateral motion with less jumping or hard cutting: baseball, skiing, racquet sports
      • Consider anterior cruciate ligament reconstruction
    • Linear sports: track, running
      • Possible nonoperative treatment
  • Sport skill level
    • Recreational athletes may be more willing to undergo nonoperative treatment.
  • Age
    • More elderly patients may benefit from nonoperative treatment.
  • Associated injuries
    • Lateral meniscal tears are commonly observed in acute anterior cruciate ligament tears.

• Patients with associated medial collateral ligament injury may have impaired flexion that impairs rehabilitation. Flexion should be restored prior to surgery.

• Standard knee arthroscopy set
• Depending on the graft used, specific guides for placement of the graft

• The anterior cruciate ligament consists of two functional bundles
  • Anteromedial
  • Posterolateral
    • These are named based on their insertion point into the tibia.
• The relationship between the two bundles is dependent on the flexion angle of the knee.
  • In extension, bundles are parallel
    • Posterolateral bundle tightens in extension
      • The posterolateral bundle also tightens during internal and external rotation of the knee.
  • In flexion, bundles are crossed
    • Anteromedial bundle tightens in flexion, while posterolateral bundle loosens.

The full content of this section includes:

• Step-by-step text instructions for performing the procedure
  
• Clinical pearls providing practical clinical tips from medical experts
• Patient safety guidelines consistent with Joint Commission and OHSA standards
• Links to medical evidence and related procedures

Figure 1 :  A, Saline arthroscopy bag is secured to table to assist in maintaining knee flexion. B, Prepared graft with No. 5 suture and bone plug. C, Complete resection of soft tissue to back of notch for clear viewing of over-the-top spot. D, Increase in tibial guide angle. Length of tunnel can be increased. E, Tibial guide is positioned so that Kirschner wire will enter joint at base of medial tibial spine just medial to center of intercondylar notch. F, Three reference points-inner edge of lateral meniscus, base of medial spine, and posterior cruciate ligament-are used for tibial guide wire. From Canale ST, Beaty JH (eds): Campbell's Operative Orthopaedics, 11th ed. Philadelphia, Elsevier, 2008.

View Larger Image