← ACL Evidence Book

Full contents

Front Matter

What Healing, Stability, Success, Failure, and Return to Sport Mean in Research In preparation

Part I Basic Science, Epidemiology, and Prevention

1ACL Anatomy, Biomechanics, and Injury Mechanisms5 available
  1. 1.1
  2. 1.2
  3. 1.3
    Blood Supply of the Anterior Cruciate Ligament In preparation
  4. 1.4
    Innervation of the Anterior Cruciate Ligament In preparation
  5. 1.5
    Role of the Anterior Cruciate Ligament in Anterior Stability In preparation
  6. 1.6
    Role of the Anterior Cruciate Ligament in Rotational Stability In preparation
  7. 1.7
  8. 1.8
  9. 1.9
  10. 1.10
    Mechanisms of Contact Anterior Cruciate Ligament Injury In preparation
  11. 1.11
    Video Analysis of Anterior Cruciate Ligament Injuries In preparation
  12. 1.12
    Development of the Anterior Cruciate Ligament In preparation
  13. 1.13
    Histology of the Anterior Cruciate Ligament In preparation
  14. 1.14
    Age-Related Changes in the Anterior Cruciate Ligament In preparation
2Epidemiology, Disease Burden, and Risk Factors
  1. 2.1
    Injury Incidence, Sports Exposure, Surgical Volume, and Disease Burden In preparation
  2. 2.2
    Risk Factors and Sex-Related Factors in Noncontact Anterior Cruciate Ligament Injury In preparation
  3. 2.3
    Osseous and Anatomic Risk Factors: Intercondylar Notch, Posterior Tibial Slope, and Plateau Morphology In preparation
  4. 2.4
    Neuromuscular, Hormonal, and Training-Exposure Factors In preparation
3ACL Injury Prevention and Screening
  1. 3.1
    Neuromuscular Training Prevention Programs: FIFA 11+, PEP, and Other Programs In preparation
  2. 3.2
    Analysis of Anterior Cruciate Ligament Injury Prevention Programs in Female Athletes In preparation
  3. 3.3
    Screening and Risk Prediction: Landing Assessment, Motion Capture, and Predictive Ability In preparation
  4. 3.4
    Implementation, Adherence, and Real-World Effectiveness of Prevention Programs In preparation

Part II Diagnosis and Treatment Decision-Making

4Clinical Diagnosis, Imaging, and Injury Classification1 available
  1. 4.1
    Clinical Diagnosis and Differential Diagnosis of Anterior Cruciate Ligament Tears In preparation
  2. 4.2
  3. 4.3
    Imaging Recognition of Associated Injuries: Ramp Lesions, Lateral Meniscus Posterior Root Tears, and Segond Fractures In preparation
  4. 4.4
    Injury Classification: Complete vs. Partial Tears, Tear Location, and Acute vs. Chronic Injury In preparation
  5. 4.5
    Evaluation When Joint Laxity, Functional Instability, and Imaging Findings Are Discordant In preparation
5Acute Management and Nonoperative Treatment
  1. 5.1
    Acute Management: Hemarthrosis, Pain, Weight-Bearing, Range of Motion, and Bracing In preparation
  2. 5.2
    Candidates for Nonoperative Treatment and Assessment of Functional Compensation: Coper Screening and Its Limitations In preparation
  3. 5.3
    Rehabilitation Programs, Activity Modification, and Follow-up in Nonoperative Treatment In preparation
  4. 5.4
    Natural History and Spontaneous Healing After Anterior Cruciate Ligament Rupture In preparation
  5. 5.5
    The Cross Bracing Protocol: Protocol, Clinical Studies, and Limitations In preparation
  6. 5.6
    Persistent Instability, Secondary Injury, and Reassessment After Nonoperative Treatment In preparation
6Operative vs. Nonoperative Treatment Decisions and Surgical Timing1 available
  1. 6.1
    Comparative Evidence for Operative and Nonoperative Treatment: Complete Rupture, Activity Demands, and Associated Injuries In preparation
  2. 6.2
    Surgical Timing: Early Reconstruction, Optional Reconstruction After Rehabilitation, and Delayed Reconstruction In preparation
  3. 6.3
  4. 6.4
    Treatment Goals, Patient Preferences, and Shared Decision-Making In preparation

Part III Surgical Treatment and Associated Injuries

7Primary ACL Repair and Biological Augmentation
  1. 7.1
    Primary Repair: History, Tissue Conditions, and Modern Indications In preparation
  2. 7.2
    Arthroscopic Repair and Suture Augmentation In preparation
  3. 7.3
    Bridge-Enhanced Repair: BEAR and Related Studies In preparation
  4. 7.4
    Biological Augmentation: Evidence for PRP, Cell-Based, and Other Interventions In preparation
  5. 7.5
    Primary Repair vs. Reconstruction and Management After Failed Repair In preparation
8Anterior Cruciate Ligament Reconstruction: General Principles2 available
  1. 8.1
  2. 8.2
    Anatomic Reconstruction, Footprint Localization, and Bone Tunnels In preparation

    Femoral anatomic footprint and tibial tunnel positioning; anteromedial portal, transtibial, and outside-in femoral tunnel drilling; single-bundle and double-bundle reconstruction

  3. 8.2.1
  4. 8.3
    Reconstruction Techniques and Remnant Management In preparation

    Intercondylar notch anatomy and notchplasty; all-inside ACL reconstruction with hamstring tendon; selective single-bundle augmentation for partial tears; remnant preservation during reconstruction: technique, outcomes, and complications

  5. 8.4
    Graft Tensioning and Fixation In preparation

    Initial tension, fixation angle, and cyclic preconditioning; suspensory, interference, and other fixation methods; Endobutton femoral fixation

  6. 8.5
    Graft Remodeling and Graft–Tunnel Healing In preparation

    Remodeling, ligamentization, and bone-block and soft-tissue healing; relationship of intratunnel graft length to healing and fixation

  7. 8.6
    Anesthesia, Analgesia, and Perioperative Management In preparation

    Nerve blocks, multimodal analgesia, tourniquet, and tranexamic acid; preoperative health assessment, hemostasis, and early recovery; for infection and thromboprophylaxis, see Chapter 16

9ACL Graft Selection2 available
  1. 9.1
    Common Autografts Compared With the Native Anterior Cruciate Ligament In preparation
  2. 9.2
    Autograft Selection, Indications, and Trade-offs In preparation

    Bone–patellar tendon–bone, hamstring, and quadriceps tendon; all-soft-tissue central quadriceps tendon vs. graft with bone block; graft diameter, number of strands, and failure risk

  3. 9.2.1
  4. 9.3
    Allografts: Suitable Populations, Tissue Processing, and Failure Risk In preparation

    Allograft vs. autograft in young, active patients; tissue processing, recipient characteristics, and failure-related factors

  5. 9.4
    Current Status of Synthetic Grafts In preparation
  6. 9.5
    Autograft Harvest Techniques In preparation

    Hamstring, quadriceps tendon, and bone–patellar tendon–bone harvest

  7. 9.6
    Effects of Hamstring Tendon Harvest and Functional Recovery

    Donor-site symptoms and functional effects of the three autograft types; hamstring tendon regeneration after harvest and its clinical significance

10Anterolateral Augmentation and Management of Osseous Risk Factors
  1. 10.1
    Research on Indications for Anterolateral Augmentation: Pivot-Shift Grade, Age, Sports Demands, and Revision Settings In preparation
  2. 10.2
    Lateral Extra-articular Tenodesis (LET) In preparation
  3. 10.3
    Anterolateral Ligament Reconstruction (ALLR) In preparation
  4. 10.4
    Comparative Evidence and Complications of LET and ALLR In preparation
  5. 10.5
    Posterior Tibial Slope: Measurement Methods, Research Thresholds, and Slope-Reducing Osteotomy In preparation
  6. 10.6
    Coronal Lower-Limb Alignment and Corrective Osteotomy In preparation
11Associated Meniscal and Cartilage Injuries
  1. 11.1
    Distribution of Meniscal Injuries and Treatment Options: Preservation, Repair, Resection, and Deficiency In preparation
  2. 11.2
    Medial Meniscus Ramp Lesions In preparation
  3. 11.3
    Lateral Meniscus Posterior Root, Other Root, and Radial Tears In preparation
  4. 11.4
    Concomitant or Staged Meniscal Repair With ACL Reconstruction: Technique and Healing In preparation
  5. 11.5
    Bone Bruises: Associations With Intra-articular Injury, Pain, and Prognosis In preparation
  6. 11.6
    Management of Associated Cartilage and Osteochondral Lesions In preparation
  7. 11.7
    Effect of Concomitant Procedures on Rehabilitation Planning In preparation
12Associated Ligament and Multiligament Injuries
  1. 12.1
    Associated Medial Collateral Ligament and Posteromedial Injuries In preparation
  2. 12.2
    Associated Lateral Collateral Ligament and Posterolateral Corner Injuries In preparation
  3. 12.3
    Associated Posterior Cruciate Ligament Injury and Knee Dislocation In preparation
  4. 12.4
    Surgical Timing, Sequence, and Staging in Multiligament Injuries In preparation
  5. 12.5
    Rehabilitation and Outcomes After Multiligament Injuries In preparation
13Special Populations and Special Clinical Situations
  1. 13.1
    Overview of Diagnosis and Treatment of ACL Injuries in Skeletally Immature Athletes In preparation
  2. 13.2
    Operative and Nonoperative Treatment and Surgical Timing in Skeletally Immature Patients In preparation
  3. 13.3
    Physeal and Growth Protection: Transphyseal, All-Epiphyseal, and Extraphyseal Reconstruction In preparation
  4. 13.4
    Growth Disturbance and Other Complications of Pediatric Reconstruction In preparation
  5. 13.5
    Tibial Eminence (Spine) Avulsion Fractures In preparation
  6. 13.6
    Middle-Aged and Older Patients: Age, Activity Demands, and the Degenerative Knee In preparation
  7. 13.7
    Professional and Elite Athletes and Physically Demanding Occupations In preparation
  8. 13.8
    Indications for Unicompartmental Knee Arthroplasty Combined With Reconstruction in ACL-Deficient Patients In preparation
  9. 13.9
    Technique of ACL Reconstruction Combined With Unicompartmental Knee Arthroplasty In preparation

Part IV Rehabilitation and Return to Sport

14Preoperative Preparation and Postoperative Rehabilitation for ACL Reconstruction1 available
  1. 14.1
    Prehabilitation Before Anterior Cruciate Ligament Reconstruction In preparation
  2. 14.2
  3. 14.3
    Principles of Postoperative Rehabilitation, ACL Strain During Exercise, and Rate of Progression In preparation
  4. 14.4
    Arthrogenic Muscle Inhibition, Strength Recovery, and Training Load In preparation
  5. 14.5
    Comparative Evidence for Open- and Closed-Kinetic-Chain Exercise In preparation
  6. 14.6
    Blood Flow Restriction Training and Other Adjunctive Methods In preparation
  7. 14.7
    Proprioception and Neuromuscular Control In preparation
  8. 14.8
    Postoperative Functional Bracing: Evidence and Limitations In preparation
  9. 14.9
    Tailoring Rehabilitation to Graft Type, Concomitant Procedures, Repair, or Revision In preparation
15Return to Activity, Return to Sport, and Reinjury Prevention
  1. 15.1
    Return to Daily Activities, Work, Training, Competition, and Performance In preparation
  2. 15.2
    Return-to-Sport Testing: Isokinetic Strength, Hop Tests, Movement Quality, and Composite Decision-Making In preparation
  3. 15.3
    Psychological Recovery and Readiness: ACL-RSI, Fear of Reinjury, Fear-Avoidance, and Psychological Support In preparation
  4. 15.4
    Timing of Return to Sport, Sports Exposure, and Reinjury In preparation
  5. 15.5
    Reinjury Prevention Training and Load Management In preparation
  6. 15.6
    Return-to-Sport Rates, Return to Preinjury Level, and Reasons for Not Returning In preparation

Part V Complications, Revision, and Long-Term Outcomes

16Complications of Anterior Cruciate Ligament Reconstruction3 available
  1. 16.1
    Incidence, Risk Factors, and Clinical Presentation of Postoperative Infection In preparation
  2. 16.2
  3. 16.3
  4. 16.4
    Treatment of Postoperative Infection, Graft Management, and Functional Recovery In preparation
  5. 16.5
    Knee Stiffness, Extension Deficit, and Cyclops Lesions: Prevention and Treatment In preparation
  6. 16.6
    Anterior Knee Pain and Other Persistent Pain After Reconstruction In preparation
  7. 16.7
    Saphenous and Other Nerve Injuries, Numbness, and Neuropathic Pain In preparation
  8. 16.8
    Venous Thromboprophylaxis and Vascular Complications In preparation
  9. 16.9
    Fracture Complications After Reconstruction In preparation
  10. 16.10
    Fixation Device and Other Implant Complications In preparation
  11. 16.11
    Tunnel Widening After Reconstruction In preparation
  12. 16.12
    Bone Mineral Density Changes After Reconstruction and Their Clinical Significance In preparation
  13. 16.13
17Evaluation of Failed ACL Reconstruction and Revision
  1. 17.1
    Definition, Incidence, and Causes of Failure In preparation
  2. 17.2
    Pre-revision Evaluation: Prior Operative Records, Tunnel Imaging, Lower-Limb Alignment, and Associated Injuries In preparation
  3. 17.3
    Strategies and Techniques for Revision Anterior Cruciate Ligament Reconstruction In preparation
  4. 17.4
    Management of Femoral Tunnel Malposition and Tibial Tunnel Problems In preparation
  5. 17.5
    One-Stage vs. Two-Stage Revision and Tunnel Bone Grafting In preparation
  6. 17.6
    Graft Selection, Anterolateral Augmentation, and Other Additional Procedures in Revision In preparation
  7. 17.7
    Results and Limitations of the MARS Study and Other Revision Cohorts In preparation
  8. 17.8
    Rehabilitation, Return to Activity, and Re-failure After Revision In preparation
18Outcome Assessment and Predictors
  1. 18.1
    Standardized Rating Scales, Outcome Definitions, and Measurement Error In preparation
  2. 18.2
    Stability Outcomes After Reconstruction In preparation
  3. 18.3
    Health-Related Quality of Life After Reconstruction In preparation
  4. 18.4
    Age and Treatment Outcomes In preparation
  5. 18.5
    Sex, Preoperative Activity Level, and Treatment Outcomes In preparation
  6. 18.6
    BMI, Body Weight, and Treatment Outcomes In preparation
  7. 18.7
    Smoking and Other Health Factors and Treatment Outcomes In preparation
  8. 18.8
    Psychological Factors: Associations With and Ability to Predict Treatment Outcomes In preparation
  9. 18.9
    Cartilage Injury, Meniscal Tears, and IKDC, KOOS, and Marx Outcomes In preparation
  10. 18.10
    From Associated Factors to Prediction Models: Study Design, Confounding, Loss to Follow-up, and External Validation In preparation
19Long-Term Outcomes, Reinjury, and Post-traumatic Osteoarthritis
  1. 19.1
    Long-Term Stability, Function, and Activity Level After Nonoperative and Operative Treatment In preparation
  2. 19.2
    Graft Rerupture and Contralateral ACL Injury: Incidence, Risk Factors, and Follow-up In preparation
  3. 19.3
    Joint Degeneration and Post-traumatic Osteoarthritis After ACL Injury In preparation
  4. 19.4
    Knee Arthroplasty After ACL Injury or Reconstruction In preparation
  5. 19.5
    Long-Term Joint Health, Symptom Control, and Maintenance of Function In preparation

Back Matter

Terminology, Rating Scales and Licensing Sources, References and Search Records, Errata and Version Information In preparation