Function of ACL / Surgical Indications - Chris Huber 10/10/2000

Authors

AMIS AA, Dawkins GP

Title

Functional anatomy of the anterior cruciate ligament. Fibre bundle actions related to ligament replacements and injuries

Reference

J Bone Joint Surg Br. 1991 Mar;73(2):260-7

Summary

3 bundles: anteromedial, intermediate, posterolateral. None isometric. AMB tightens in flexion, when PMB slackens, hence AMB inj. has more effect on AD and PLB inj. on Lachmann. Sequential bundle section showed PLB provides biggest contrib. to AP stability, with secondary restraints giving 22% 

Critique

Observational study in cadaveric knees. Role for clinical study to assess arthroscopic correlation

Authors

Jomha NM, Borton DC, Clingeleffer AJ, PINCZEWSKI LA

Title

Long-term osteoarthritic changes in anterior cruciate ligament reconstructed knees

Reference

Clin Orthop. 1999 Jan;(358):188-93

Summary

Leaving ACL recon 3/12 gave increased Xray and arthroscopic OA even if meniscus was orig. intact. 89% having acute recon with meniscus preserved had no XR OA at 7yrs, but 0/16 having late recon + menisectomy had normal XR at 7yrs, 7/16 having marked OA (p<0.01). At scope 93% had normal chondral surface at acute recon, but only 46% if chronic (p<0.001). Need for menisectomy increased from 31% (acute) to 67% (chronic) (p<0.025)

Critique

Prospective trial from major ACL unit in Australia

Authors

Indelicato PA, Bittar ES

Title

A perspective of lesions associated with ACL insufficiency of the knee. A review of 100 cases

Reference

Clin Orthop. 1985 Sep;(198):77-80

Summary

Incid of meniscal tear increased from 77% to 91% if ACL recon > 6/52 post inj or pt had further injury. Similarly, articular cartilage injury increased from 23% to 54% (p<0.002) 

Critique

2 separate pt groups, acute and chronic, rather than F.U. of same acutes