Surgery for anterior cruciate ligament deficiency: a historical perspective

Schindler, Oliver
January 2012
Knee Surgery, Sports Traumatology, Arthroscopy;Jan2012, Vol. 20 Issue 1, p5
Academic Journal
The anterior cruciate ligament (ACL) has entertained scientific minds since the Weber brothers provided biomechanical insight into the importance of the ACL in maintaining normal knee kinematics. Robert Adams described the first clinical case of ACL rupture in 1837 some 175 years to date, followed by Mayo-Robson of Leeds who performed the first ACL repair in 1895. At that time, most patients presented late and clinicians started to appreciate signs and symptoms and disabilities associated with such injuries. Hey Groves of Bristol provided the initial description of an ACL reconstruction with autologous tissue graft in 1917, almost as we know it today. His knowledge and achievements were, however, not uniformly appreciated during his life time. What followed was a period of startling ingenuity which created an amazing variety of different surgical procedures often based more on surgical fashion and the absence of a satisfactory alternative than any indication that continued refinements were leading to improved results. It is hence not surprising that real inventors were forgotten, good ideas discarded and untried surgical methods adopted with uncritical enthusiasm only to be set aside without further explanation. Over the past 100 years, surgeons have experimented with a variety of different graft sources including xenograft, and allografts, whilst autologous tissue has remained the most popular choice. Synthetic graft materials enjoyed temporary popularity in the 1980 and 1990s, in the misguided belief that artificial ligaments may be more durable and better equipped to withstand stresses and strains. Until the 1970s, ACL reconstructions were considered formidable procedures, often so complex and fraught with peril that they remained reserved for a chosen few, never gaining the level of popularity they are enjoying today. The increasing familiarity with arthroscopy, popularised through Jackson and Dandy, and enhancements in surgical technology firmly established ACL reconstruction as a common procedure within the realm of most surgeons' ability. More recently, the principle of anatomic ACL reconstruction, aiming at the functional restoration of native ACL dimensions and insertion sites, has been introduced, superseding the somewhat ill-advised concept of isometric graft placement. Double-bundle reconstruction is gaining in popularity, and combined extra- and intra-articular procedures are seeing a revival, but more accurate and reliable pre- and post-operative assessment tools are required to provide customised treatment options and appropriate evaluation and comparability of long-term results. Modern ACL surgery is united in the common goal of re-establishing joint homoeostasis with normal knee kinematics and function which may ultimately assist in reducing the prevalence of post-operative joint degeneration. This review hopes to provide an insight into the historical developments of ACL surgery and the various controversies surrounding its progress. Level of evidence V .


Related Articles

  • Republished research: Treatment for acute anterior cruciate ligament tear: five year outcome of randomised trial. Frobell, Richard B.; Roos, Harald P.; Roos, Ewa M.; Roemer, Frank W.; Ranstam, Jonas; Stefan Lohmander, L. // British Journal of Sports Medicine;Apr2013, Vol. 47 Issue 6, p373 

    Study question In young active adults with an acute anterior cruciate ligament (ACL) rupture, do patient reported or radiographic outcomes after five years differ between those treated with rehabilitation plus early ACL reconstruction and those treated with rehabilitation and optional delayed...

  • Nachbehandlungsschema und Return to Sports nach Kreuzbandplastik. Vavken, Patrick; Sadoghi, Patrick; Valderrabano, Victor; Pagenstert, Geert // Schweizerische Zeitschrift f�r Sportmedizin & Sporttraumatolog;2012, Vol. 2012 Issue 2, p83 

    ACL reconstruction is among the most extensively researched topics in orthopedic sports medicine and traumatology. However, while substantial amounts of research is done on surgical technique and graft fixation, one of the most crucial predictors of successful treatment is oftentimes neglected -...

  • Anterior cruciate ligament reconstruction with synthetic grafts. A review of literature.  // International Orthopaedics;Apr2010, Vol. 34 Issue 4, p465 

    Abstract Anterior cruciate ligament (ACL) rupture, one of the most common knee injuries in sports, results in anteroposterior laxity, which often leads to an unstable knee. Traditional ACL reconstruction is performed with autograft; disadvantages of this technique are donor site morbidity and a...

  • Incidence of the Remnant Femoral Attachment of the Ruptured ACL. Wittstein, Jocelyn; Kaseta, Maria; Sullivan, Robert; Garrett, William // Clinical Orthopaedics & Related Research;Oct2009, Vol. 467 Issue 10, p2691 

    Abstract  The presence of remnant tibial and femoral attachments of the ruptured ACL has been described in the literature but the femoral remnant has not been well described as a landmark for tunnel placement during reconstruction. We reviewed operative reports, pictures, and videotapes...

  • ACL graft re-rupture after double-bundle reconstruction: factors that influence the intra-articular pattern of injury. Van Eck, Carola F.; Kropf, Eric J.; Romanowski, James R.; Lesniak, Bryson P.; Tranovich, Michael J.; Van Dijk, C. Niek; Fu, Freddie H. // Knee Surgery, Sports Traumatology, Arthroscopy;Mar2011, Vol. 19 Issue 3, p340 

    Purpose: To determine the most common rupture patterns of previously reconstructed DB-ACL cases, seen at the time of revision surgery, and to determine the influence of age, gender, time between the initial ACL reconstruction and re-injury, tunnel angle and etiology of failure. Methods: Forty...

  • Surgical Management of Meniscal Tears.  // Bulletin of the NYU Hospital for Joint Diseases;2011, Vol. 69 Issue 1, p56 

    No abstract available.

  • Hamstrings anterior cruciate ligament reconstruction with and without platelet rich fibrin matrix. Del Torto, M.; Enea, D.; Panfoli, N.; Filardo, G.; Pace, N.; Chiusaroli, M. // Knee Surgery, Sports Traumatology, Arthroscopy;Dec2015, Vol. 23 Issue 12, p3614 

    Purpose: Anterior cruciate ligament (ACL) rupture is the most common complete ligamentous injury in the knee. Many studies explored ACL graft integration and maturation, but only a few assessed the application of platelet rich fibrin matrix (PRFM) as augmentation for ACL...

  • Morphological changes in femoral tunnels after anatomic anterior cruciate ligament reconstruction. Tachibana, Yuta; Mae, Tatsuo; Shino, Konsei; Kanamoto, Takashi; Sugamoto, Kazuomi; Yoshikawa, Hideki; Nakata, Ken // Knee Surgery, Sports Traumatology, Arthroscopy;Dec2015, Vol. 23 Issue 12, p3591 

    Purpose: Few studies investigated the enlargement inside the tunnel as well as the morphological change at the aperture after anterior cruciate ligament (ACL) reconstruction, whereas the tunnel enlargement has been well documented. The purposes were to evaluate the change in the...

  • Knee injuries in children and adolescents. Hoetzel, J.; Preiss, A.; Heitmann, M.; Frosch, K.-H. // European Journal of Trauma & Emergency Surgery;Feb2014, Vol. 40 Issue 1, p23 

    As more children and adolescents are involved in sporting activities, the number of injuries to immature knees rises. We will focus on three entities: ruptures of the anterior cruciate ligament, patellar dislocation, and meniscal injuries. There is a trend in recent literature toward early...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics