Preservation of the Anterior Cruciate Ligament: Surgical Techniques
In the first part of this series, we (I) discussed the history of anterior cruciate ligament (ACL) preservation, (II) discussed how modern advances altered the risk-benefit ratio for ACL preservation, and (III) proposed our treatment algorithm for ACL injuries, which is based on tear location and tissue quality. In the second part of this series, we discuss (I) our proposed modification of the Sherman classification of the different tear types and (II) the surgical techniques and variations that can be used to treat these different tear types.
Complex Tear or Poor Tissue Quality: Reconstruction
In some cases, the tissue quality is poor, or the ligament has complex or multiple tears. Essentially, in these cases, there is nothing to preserve and a standard reconstruction approach is performed in these cases.
Conclusion
The uniform gold standard for all ACL tear types is currently primary reconstruction. However, several disadvantages of ACL reconstruction exist, while there are multiple advantages to the concept of ACL preservation. In this surgical technique article, we have discussed our tear type classification and the recommended surgical techniques for each. With this treatment algorithm, which is based on tear location and tissue quality, an optimal and minimally invasive treatment can be chosen for each individual patient. Future studies are needed to compare and contrast these treatments with the current gold standard of ACL reconstruction.
Am J Orthop. 2016;45(7):E406-E414. Copyright Frontline Medical Communications Inc. 2016. All rights reserved.
