Anatomic Double-Bundle ACL Reconstruction - Freddie Fu

Anatomic Double-Bundle ACL Reconstruction - Freddie Fu -...

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Anatomic Double-Bundle ACL Reconstruction Patient Information Handout / Frequently Asked Questions Freddie H. Fu, MD, DSc (Hon), DPs (Hon) Sam G. Tejwani, MD Rebecca Singleton, PA-C University of Pittsburgh, Department of Orthopaedic Surgery What is the ACL and what does it do? ± The ACL, or Anterior Cruciate Ligament, connects the femur to the tibia in the center of the knee joint. It is made up of two functional bundles of tissue, the anteromedial (AM) and posterolateral (PL) bundles. [1] ± The AM bundle of the ACL primarily controls anterior (forward) movement of the tibia underneath the femur. ± The PL bundle of the ACL plays a significant role in rotational stability in the knee, such as in pivoting, twisting and jumping. [9,10] ± The ACL is critical to the stability of the knee during daily activities and sports that require twisting, pivoting, balancing, running and jumping. ± Fetal research has demonstrated that humans are born with a double-bundle ACL. ± Cadaver research has shown the two bundles are still present at the end of our lives. Anatomy of ACL ACL Anatomy ACL Anatomy Fetus 22 weeks Fetus 22 weeks PL AM AM AM PL PL Fetus 16 weeks Fetus 16 weeks Chhabra et al, JBJS 2006 40 total specimens examined 40 total specimens examined NOTES:
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± Cadaver studies have also demonstrated that the AM bundle is approximately twice as long as the PL bundle, and that the two bundles have a similar cross- sectional diameter. ± The AM and PL bundles have a complex relationship with each other. When the knee is straight they are parallel with each other. As the knee is flexed, they cross each other. ± In normal knees both bundles of the ACL can be seen during arthroscopic surgery: 2
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± We can also see both bundles of the normal ACL clearly on MRI scan: Are ACL tears common? ± ACL tears are very common. Over 100,000 ACL tears occur each year in the United States. The highest incidence is in individuals 15 to 25 years old who participate in pivoting sports, but ACL tears can occur at all ages. [18] How is an ACL tear diagnosed? ± Tear of the ACL can be diagnosed by a history of traumatic event to the knee joint and physical examination. MRI scan can confirm the diagnosis: 3
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± At the time of arthroscopic surgery, severe stretch-out or complete tear of the AM and PL bundles of the ACL can be seen, as pictured below: Can the ACL be repaired or does it have to be reconstructed? In general, the fibers of the ACL cannot be sewn back together again or repaired. This is due to severe stretch-out and irreversible damage sustained at the time of injury. Therefore, the damaged ligament must be removed and a reconstructed with a new one. I just tore my ACL—when will I be ready for surgery?
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This note was uploaded on 11/16/2011 for the course CHEM 104 taught by Professor Yang during the Fall '04 term at University of California, Berkeley.

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Anatomic Double-Bundle ACL Reconstruction - Freddie Fu -...

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