Anterior Cruciate Ligament Reconstruction: A Practical by Rainer Siebold, David Dejour, Stefano Zaffagnini

By Rainer Siebold, David Dejour, Stefano Zaffagnini

This functional and tutorial guidebook, written by way of foreign specialists in anterior cruciate ligament (ACL) reconstruction, covers all demanding facets of ACL rupture within the acute and persistent atmosphere. It covers the most recent, amazing anatomical findings, therapy of partial ACL tears, quite a few recommendations for unmarried- and double-bundle ACL reconstruction, and intricate ACL revision surgical procedure. vital surgical steps are essentially defined with the aid of instructive, fine quality pictures. vital advice, tips, and pitfalls are highlighted and intra- and postoperative issues, rehabilitation, and prevention of re-rupture are mentioned. All authors are widespread and skilled ACL surgeons.

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3 times the respective values of the older group. In addition, there was a significant difference in failure mode and site of failure in these ACLs. The ACLs from younger humans failed predominantly as midsubstance tear, whereas older humans also showed bony avulsions [46, 47]. The latter do not represent failure of the ligament per se. When older (40–60 years) ACLs failed midsubstance, they did not show lower ultimate load to failure than younger ones. Furthermore, it has been found in ACL experiments on rhesus monkeys that elongation of the ACL is similar at the slow and fast rate of deformation.

In unconstrained knee compression experiments, peak forces of 5kN were observed at flexion angles of 30°, 60°, 90°, and 120°. Interestingly, during this experiment, the tibia rotated internally until the ACL ruptured. Then, the tibia started to rotate externally [38, 42, 43]. The mean peak torque value at internal torsion test was 33 Nm with tibia internally rotated by 58° and in 20° of valgus [43]. As far as the ACL bundles are concerned, the AM bundle is oriented more vertically in the intercondylar notch in the coronal plane, and it is thought to have little ability to restrain tibial internal–external rotation as it is located close to the vertical axis of rotation.

Fleming BC et al (2001) The effect of weightbearing and external loading on anterior cruciate ligament strain. J Biomech 34(2):163–170 39. Andersen HN, Dyhre-Poulsen P (1997) The anterior cruciate ligament does play a role in controlling axial rotation in the knee. Knee Surg Sports Traumatol Arthrosc 5(3):145–149 40. Monaco E et al (2010) Navigated knee kinematics after tear of the ACL and its secondary restraints: preliminary results. Orthopedics 33(10 Suppl):87–93 41. Oh YK et al (2012) What strains the anterior cruciate ligament during a pivot landing?

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