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Anterior Cruciate Ligament Reconstruction in Patients with Hereditary Abnormalities Involving Connective Tissue

Introduction Hereditary abnormalities involving connective tissue are among the most common genetic diseases in human beings. Individuals with these disorders demonstrate an array of disease severity and phenotypes, and athletes with these disorders are at increased risk of anterior cruciate ligament (ACL) injury. Surgery to reconstruct the ACL in these patients is associated with a significantly increased risk of complications, and special consideration must be given…

Psychological Predictors of Anterior Cruciate Ligament Recovery Outcomes

Introduction Anterior cruciate ligament (ACL) injury occurs most frequently in active individuals. Often ACL deficiency does not allow an individual to continue participation in sports at the same level. One of the primary early objectives of ACL reconstruction is to allow an injured individual to return to an active lifestyle and often a specific sporting activity. Despite the advancements in ACL reconstruction techniques and rehabilitation, fewer…

The Effects of Smoking on Anterior Cruciate Ligament Reconstruction Outcomes

Introduction The outcomes of anterior cruciate ligament (ACL) reconstruction have been known to be affected by many factors, including operative factors such as nonanatomic tunnel placement, improper graft tensioning and inadequate graft fixation, biologic failure according to the type of graft, untreated concomitant ligament injury, generalized laxity, and traumatic failure. In addition to these factors, cigarette smoking can be considered as one of the factors causing…

The Multicenter Orthopaedics Outcomes Network Group and the Effects of Obesity and Body Weight on the Results of Anterior Cruciate Ligament Reconstruction

Approximately 175,000–200,000 anterior cruciate ligament (ACL) reconstructions occur each year at a cost to society of 1–2 billion dollars. These injuries generally occur in younger, more active individuals, with the goal of surgical reconstruction to restore knee biomechanics that allow patients to return to cutting and pivoting sports. Additionally, this procedure can help decrease the risk of subsequent menisci and articular cartilage damage, thus potentially slowing…

Anterior Cruciate Ligament Reconstruction Outcomes as a Function of Age

Introduction Anterior cruciate ligament (ACL) reconstruction is a relatively common procedure in young adults, with the majority of surgery being undertaken in patients aged between 16 and 35 years. The mean age of patients in outcome studies of ACL reconstruction is typically in the mid-20s. Overall, this reflects the activity and sporting profile of this age group. However, there is evidence of an increasing incidence of…

A Comparison of the Standardized Rating Forms for Evaluation of Anterior Cruciate Ligament Injured or Reconstructed Patients

Introduction It is important to monitor patients after anterior cruciate ligament (ACL) injury over time to evaluate their recovery after nonoperative or operative treatment so that the rehabilitation program can be monitored and adjusted if necessary. Furthermore, monitoring is essential to determine the effectiveness of different interventions during clinical studies. Mid- and long-term evaluation is also important for assessing the mid- and long-term consequences after an…

Criteria for Return to Play After Anterior Cruciate Ligament Reconstruction

Introduction Modern surgical techniques and rehabilitation protocols have led to improved surgical outcomes following anterior cruciate ligament (ACL) injury and have made return to play (RTP) a realistic goal for athletes. The incidence of anterior cruciate ligament reconstruction (ACLR) surgery has been increasing in recent decades, and the desire to return to preinjury activity levels acts as a motivator for surgery in many patients. Ardern et al.…

Arthrosis Following Anterior Cruciate Ligament Tear and Reconstruction

Introduction The development of degenerative changes within the knee following anterior cruciate ligament (ACL) injury is well recognized. However, defining the exact prevalence of osteoarthritis (OA) after ACL injury or reconstruction of the ACL is a challenge for several reasons. Long-term clinical follow-up studies are difficult to perform, since most patients presenting with an ACL injury are young and many will change geographic location in the…

Factors Associated with Increased Allograft Failure Rate in Anterior Cruciate Ligament Reconstruction

Acknowledgments I would to thank my KPACLRR colleagues Gregory B. Maletis, MD; Tadashi T. Funahashi, MD; Jason Chen, MA; and Rebecca Love, MPH, RN, for their invaluable collaboration on our research, and the many Kaiser Permanente orthopaedic surgeons who contribute to the KPACLRR every year. Introduction Allograft tissue is a common graft choice for anterior cruciate ligament reconstruction (ACLR). A 2013 survey conducted by the American…

Allografts Have Higher Failure Rates Than Autografts in Anterior Cruciate Ligament Reconstruction in Young, Active Patients

Introduction Anterior cruciate ligament (ACL) injury is a common knee injury suffered predominantly by active individuals. Groups at highest risk for ACL tear include professional and amateur athletes, with annual incidence rates estimated to be between 0.15% and 3.67% and 0.03% and 1.62%, respectively. The treatment of ACL tears has evolved considerably over the last several decades, and in young, active patients generally involves surgical reconstruction…

Quality of Life After Anterior Cruciate Ligament Reconstruction

What is Quality of Life? The World Health Organization has defined quality of life (QOL) as an individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns . The concept of QOL encompasses the following three principles: QOL reflects an individual’s perceived discordance between their ideal…

Stability Results After Anterior Cruciate Ligament Reconstruction

The Definition of Stability After Anterior Cruciate Ligament Reconstruction The truest definition of stability after anterior cruciate ligament reconstruction (ACLR) would be the normalization of the pivot shift in the anesthetized patient, which is obviously never measured in a follow-up study. The pivot shift in the conscious patient is not reliable. The next best measure is the instrumented Lachman test. This is usually a KT-1000 (Medmetric…

Prehabilitation Before Anterior Cruciate Ligament Reconstruction

Introduction Prehabilitation was coined in the 1980s, defined as the process enhancing functional capacity of the individual to enable them to withstand the stressor of inactivity . Although not initially used in the setting of anterior cruciate ligament (ACL) injury rehabilitation, its significance has been kindled when medium- and long-term studies showed significant decrease in functional, strength, and proprioceptive capabilities in the ACL-deficient knee. Noyes et al.…

Functional Bracing for Anterior Cruciate Ligament Injuries: Current State and Future Direction

Introduction Anterior cruciate ligament (ACL) tears are a common knee injury, with a reported estimate of 200,000 ACL injuries annually in the United States. Annual ACL reconstruction rates have been reported to be increasing in the United States, with recent estimates ranging from 60,000 to 175,000. Functional bracing often plays an important role in postoperative management of ACL reconstructions and in nonoperative management of ACL-deficient knees.…

Proprioception and Anterior Cruciate Ligament Reconstruction

Introduction Most rehabilitation programs for patients who have undergone anterior cruciate ligament (ACL) reconstruction include exercises and drills that are directed toward improving neuromuscular function and coordination. They are often loosely referred to as proprioceptive training exercises. This chapter explores the basis for the incorporation of such exercises into rehabilitation following ACL reconstruction. The human ACL has been shown to contain mechanoreceptors, including Golgi tendon organs,…

The Stability-Conservative Anterior Cruciate Ligament Reconstruction Rehabilitation Protocol

Introduction The primary goal of anterior cruciate ligament reconstruction (ACLR) is to restore stability without sacrificing mobility or strength. The primary purpose of ACLR rehabilitation is to restore mobility and strength without sacrificing stability. It is the central hypothesis of this chapter that overly aggressive rehabilitation is both unnecessary and potentially compromises knee stability. The stability-conservative rehabilitation protocol can best be summarized as follows: Avoid graft…

Principles of Anterior Cruciate Ligament Rehabilitation

Introduction Rehabilitation with anterior cruciate ligament (ACL) reconstruction has evolved considerably since the 1970s, when intra-articular ACL reconstructions were first being performed. We have evolved from using casts on the leg for 6 weeks after surgery to no immobilization at all, from restricting weight bearing to encouraging weight bearing, from limiting range of motion to fostering stability to emphasizing exercises to achieve full knee extension and…

Anterior Cruciate Ligament Strain Behavior During Rehabilitation Exercises

This chapter describes the devices, methods, and approaches used to measure anterior cruciate ligament (ACL) strain in vivo, and provides insight into the strain behavior of the normal ACL during various rehabilitation activities. The effectiveness of functional knee bracing on the ACL and the strain behavior of the bone–patellar tendon–bone (BPTB) graft after the reconstruction of the ACL are also reviewed. Description of the Devices, Methods, and…

Indications for Anterior Cruciate Ligament Reconstruction in Anterior Cruciate Ligament– Deficient Patients Undergoing Unicondylar Knee Arthroplasty

Introduction and Pathophysiology Anterior cruciate ligament (ACL) rupture is commonly associated with osteoarthritis (OA) of the knee. There are two pathologies to ACL rupture in knee OA. ACL rupture can be secondary to primary OA, or it can be the primary problem (e.g., traumatic rupture) leading to secondary OA. In the first case, knee OA appears to be the initiating disease. Typically OA starts as anteromedial…

Ganglion Cyst

Introduction Knee joint intra-articular ganglion cysts may originate from the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), menisci or meniscal tears, popliteus tendon, alar folds, or areas of chondral fracture in descending order of frequency. Although the term ganglion cyst is widely accepted, it needs to be differentiated from synovial cysts and mucoid degeneration. Most ligament cysts (75.4%) in the knee joint are known to…