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Anterior cruciate-deficient knees: A review of the literature

Sports Medicine Unit, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina

Daniel M. Adair, MD

Sports Medicine Unit, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina

Injury to the anterior cruciate ligament may lead to functional instability, meniscal injury, and premature degenerative changes of the knee or, if treatment and rehabilitation are carried out carefully, to a functionally stable knee with no premature degenerative changes. Unfortunately, the complex anatomy of the three fiber bundles, consisting of multiple collagenous strands, which constitutes the anterior cruciate ligament com bined with variation of injuries to the ligament, with or without injury to other structures of the knee, makes any standardization of surgical treatment difficult. In this paper, we review the biomechanics of the knee, the anatomy and vascularization of the anterior cruciate ligament, the healing characteristics of ligamentous ma terial, and the types of surgical repair that have ap peared in recent articles. Those repairs can be divided into direct repair, extraarticular substitution and intraar ticular augmentation, freeze-dried fascia lata allografts, and temporary supportive prosthesis such as carbon fiber. Essential to the success of any surgical repair of the anterior cruciate-deficient knee is a prolonged, care fully organized rehabilitation program that allows ade quate healing and strengthening of the ligament before it is used normally again. The patient's clear under standing of the importance of a prolonged rehabilitation is best established before the surgical procedure is done.

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