Anterior Cruciate Ligament Reconstruction: A Practical Surgical Guide

487 Pages·2014·33.791 MB·English

by  Rainer Siebold, David Dejour, Stefano Zaffagnini (eds.)

Rainer Siebold
David Dejour
Stefano Zaffagnini
Editors
Anterior Cruciate
Ligament
Reconstruction
A Practical
Surgical Guide
123
Anterior Cruciate Ligament
Reconstruction

Rainer Siebold (cid:129) David Dejour

Stefano Zaffagnini
Editors
Anterior Cruciate
Ligament
Reconstruction
A Practical Surgical Guide
Editors
Rainer Siebold David Dejour
HKF: Center for Specialised Lyon Ortho Clinic
Hip-Knee-Foot Surgery Lyon
ATOS Hospital Heidelberg France
Heidelberg
Germany Stefano Zaffagnini
Istituti Ortopedico Rizzoli Clinica
Institute for Anatomy and Cell Ortopedica Traumatologica III
Biology Bologna
Ruprecht-Karls Italy
University Heidelberg
Heidelberg
Germany
ESSKA ASBL
Centre Médical
Fondation Norbert Metz
76, rue d’Eich
1460 Luxembourg
Luxembourg
ISBN 978-3-642-45348-9 ISBN 978-3-642-45349-6 (eBook)
DOI 10.1007/978-3-642-45349-6
Springer Heidelberg New York Dordrecht London
Library of Congress Control Number: 2014936633
© ESSKA 2014
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Foreword
The importance of this high-quality work may affect positively health profes-
sionals, orthopaedic sports medicine and rehabilitation education. This
expectation seems natural and reasonable enough since the authors are also
outstanding surgeons. The agenda was built and accomplished by a skillful
and laborious team, providing guidance on the best current practice rules of
the exciting developments related to anterior cruciate ligament (ACL)
reconstruction.
ESSKA would like to gratefully and sincerely thank the authors for their
commitment with this book. ESSKA intends to leverage education in the fi eld
of orthopaedic sports medicine and degenerative joints in Europe and all
around the world. Hopefully it will be in good service for ACL injured
patients and for improving people’s quality of life.
T he state of the art on ACL reconstruction provided here facilitates the
access to recent insights concerning some hot topics in a friendly, compre-
hensive, clear and practical way. Nonetheless, this subject is continuously
developing, and this publication brings new knowledge such as how to accu-
rately measure knee laxity before and after reconstruction, prevention of
early osteoarthritis, bone morphometrics and lower limb mechanics that can
either precipitate ACL tears or prevent them. Therefore, it should be able to
impel your extraordinary learning skills and strong motivation. Join the
authors and ESSKA in their education mission.
Enjoy your reading, and I am sure you will fi nd the challenge rewarding.
João Espregueira-Mendes
ESSKA President
Clínica Espregueira-Mendes F.C. Porto Stadium
– FIFA Medical Centre of Excellence
v

Pref ace
The anterior cruciate ligament (ACL) plays the central role for knee stability,
proprioception and protection of internal knee structures.
R upture often results in giving way, pain and function loss. The risk of
secondary meniscal or cartilage injury is high, and chronic instability often
ends in early osteoarthritis.
As most patients are young and active it is widely accepted to reconstruct the
torn ACL. Also older patients are not willing to compromise their activities and
ask for reconstruction.
Thus more and more ACL reconstructions are performed every year.
F or many patients today’s synonym for a successful surgery is “fast return
to play”. Especially active patients have very high expectations in our sur-
gery. The highest rerupture rate occurs in patients younger than 20 years (risk
10 %), when returning within 7–9 months (risk 15 %) and when returning to
strenuous stop-and-go sports, e.g. soccer (risk 20 %). Only approximately
50 % of our patients are able to return to their previous level of sports. It is
our responsibility to make patients and coaches aware of these facts.
Of course surgeons are fascinated by technical details, and thousands of
articles on bone tunnel positioning, grafts and surgical steps were published.
However, today we have to realize that modern science needs cooperation
and exchange of knowledge between surgeons and scientists. Central areas of
today’s research are ACL anatomy, biomechanics, ACL reconstruction, reha-
bilitation and prevention of injury and re-injury. All disciplines are of similar
importance – and – everywhere there is plenty of room for us to improve.
T his illustrative guide book written by world known experts presents the
latest exciting news on ACL. Spectacular fi ndings on the fl at ACL anatomy
are demonstrated. Remnant preservation is discussed along with the classical
ACL reconstruction. Bony ACL refi xation and reconstruction in kids is
explained as is the concept of double bundle. Several chapters deal with the
diffi cult topic of ACL revision and the combination of ACL reconstruction
with high tibial osteotomy. Finally there are two chapters on rehabilitation
and prevention of (re)-injury.
On behalf of all editors we thank everybody who contributed to the book,
and hope that it will be a valuable addendum to your practise.
Heidelberg, Germany Rainer Siebold
May 2014
vii

Contents
Part I Anatomy
1 Ribbonlike Anatomy of the Anterior Cruciate
Ligament from Its Femoral Insertion to the Midsubstance . . . 3
Robert Śmigielski, Urszula Zdanowicz,
Michał Drwięga, Bogdan Ciszek, and Rainer Siebold
2 Anatomic and Histological Analysis of the Midsubstance
and Fanlike Extension Fibers of the ACL . . . . . . . . . . . . . . . . . . 11
Tomoyuki Mochizuki, Akimoto Nimura, Kazunori Yasuda,
Takeshi Muneta, and Keiichi Akita
3 Tibial C-Shaped Insertion of the Anterior Cruciate
Ligament Without Posterolateral Bundle . . . . . . . . . . . . . . . . . . 19
Rainer Siebold, Peter Schuhmacher, Axel Brehmer,
Francis Fernadez, Robert Śmigielski, and Joachim Kirsch
4 Variations of the Tibial Insertion of the Anterior Cruciate
Ligament: An Anatomical Study . . . . . . . . . . . . . . . . . . . . . . . . . 29
Robert Śmigielski, Urszula Zdanowicz, Michał Drwięga,
Bogdan Ciszek, Christian Fink, and Rainer Siebold
5 Arthroscopic Appearance of the “C”–Shaped
Insertion of the Anterior Cruciate Ligament . . . . . . . . . . . . . . . 33
Rainer Siebold and Robert Śmigielski
Part II Biomechanics
6 Biomechanics of the Knee with Intact
Anterior Cruciate Ligament . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Milos Dordevic and Michael T. Hirschmann
7 Injury Mechanisms of ACL Tear . . . . . . . . . . . . . . . . . . . . . . . . . 49
Milos Dordevic and Michael T. Hirschmann
8 Biomechanics of the Knee After Complete and Partial
ACL Tear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Milos Dordevic and Michael T. Hirschmann
ix