Arthroscopic-assisted reconstruction of the anterior cruciate ligament

Arthroscopic-assisted Reconstruction of the Anterior Cruciate Ligament RUPTURE OF THE ANTERIOR CRUCIATE LIGAMENT can lead to degenerative arthritis of the knee. Persons who participate in sports that require jumping and pivoting are at a high risk for injury leading to repeated episodes of instability, and surgical reconstruction is usually undertaken. Although no procedure can exactly replicate the kinematic and anatomic properties of the anterior cruciate ligament, intra-articular reconstruction with a strong and isometric graft offers the best hone, of restoring anatomic and functional stability and preventing future degenerative changes.

Traditional intra-articular reconstruction is associated with substantial morbidity from the surgical dissection necessary to expose the torn anterior cruciate ligament and then implant the substitute. In most cases, this has meant severe pain, swelling, and difficulty initiating range-of-motion exercises in the immediate postoperative period, resulting in a hospital stay of three to five days.

Arthroscopic techniques have recently been used to reconstruct the anterior cruciate ligament by adding a small extracapsular incision along with routine arthroscopic portals. This procedure is often done on an outpatient basis, and usually only an overnight hospital stay is required. With diminished pain, range of motion can be regained early. The cosmetic advantage of arthroscopic-assisted reconstruction of the anterior cruciate ligament is obvious.

The arthroscopic procedure begins with the use of a motorized shaver and burr to remove remnants of the torn ligament and to enlarge the intercondylar notch of the femur to prevent impingement of the graft as the knee extends. A special aiming guide allows a tunnel to be drilled into the joint at the selected tibial attachment site. Work is carried out through this tunnel while viewing arthroscopically, and the femoral attachment site is selected. A strain gauge is used to measure any shortening or elongation between the selected points. If substantial strain is found, the femoral attachment site can be altered. Once an acceptable site is located, the bony tunnel for the anterior cruciate ligament graft is drilled from within the joint, using the tibial tunnel as a working portal. The selected graft (usually autogenous tissue) is then passed through the tibial tunnel, across the joint, and positioned in the closed femoral tunnnel. After the graft is securely fixed, immediate range of motion is allowed.

Regardless of the method of reconstruction, all biologic grafts used to reconstruct the anterior cruciate ligament undergo revascularization that requires protection of the graft from excessive activity for several months. Despite the improved cosmetic and perioperative advantages of arthroscopic reconstruction, the long-term outcome is similar to the results achieved by open methods.

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