Document Title: Beynnon-AJSM-Nov05.shtml
Article Title: Clinical Sports Medicine Update: Treatment of Anterior Cruciate Ligament Injuries, Part 2
Authors: Bruce D. Beynnon, PhD, Robert J. Johnson, MD, Joseph A. Abate, MD, Braden C. Fleming, PhD and Claude E. Nichols, MD
Publication: American Journal of Sports Medicine, Baltimore, Maryland
Date: November 2005
Volume 33, pages 1751-1767
Keywords: anterior cruciate ligament, knee, reconstruction, hamstring, quadriceps, patellar-tendon autograft, allograft, menisci, articular cartilage, bone-bruising, concomitant injuries, posterolateral corner (PLC), posterolateral structures, female athlete ACL, multi-ligament reconstruction.

(Reference-denoting numbers appear in the same font and point size as the document text. As with all Knee Library documents, this article is provided in full-text form. This article does not contain any figures nor tables.)

Comments: This excellent article, in building on the solid foundation of part 1, expounds on the technical aspects of ACL surgery and follow-up aspects (including unbidden bone-tunnel widening, ligamentization of the graft, post-surgery rehabilitation, and potential confounding factors). The authors reviewed an absolutely astounding 3810 ACL-related studies published since 1994. They make a number of very astute observations, and note the importance of the services of a seasoned physiotherapist.

Note: Part 1, the predecessor to this article, can be found here.

ABSTRACT

Anterior cruciate ligament tears, common among athletes, are functionally disabling; they predispose the knee to subsequent injuries and the early onset of osteoarthritis. A total of 3810 studies published between January 1994 and the present were identified and reviewed to determine the current state of knowledge regarding the treatment of anterior cruciate ligament injuries. Part 1 of this article focused on studies pertaining to the biomechanical behavior of the anterior cruciate ligament, the prevalence of and risk factors for injuries related to it, the natural history of the ligament-deficient knee, injuries associated with anterior cruciate ligament disruption, indications for the treatment of anterior cruciate ligament injuries, as well as nonoperative and operative treatments. Part 2 includes technical aspects of anterior cruciate ligament surgery, bone tunnel widening, graft healing, rehabilitation after anterior cruciate ligament reconstruction, and the effects of sex, age, and activity level on the outcome of such reconstructive surgery.

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