REVIEWS   

Minerva Ortopedica e Traumatologica 2016 September;67(3):137-49

Copyright © 2016 EDIZIONI MINERVA MEDICA

language: English

Anterior cruciate ligament augmentation

Sebastián IRARRÁZAVAL, Humza S. SHAIKH, Jonathan N. WATSON, Freddie H. FU

Department of Orthopedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

Partial tears of the anterior cruciate ligament (ACL) are a common but poorly understood injury. Partial tears comprise 10-35% of all ACL ruptures, with 38-50% of partial tears progressing to complete ACL tears. However, early treatment and diagnosis remains a challenge for orthopedic surgeons. Patient history, clinical examination, MRI, and arthroscopic assessment all provide clues, but none has proven definitive in the diagnosis of partial ACL tears. Nonetheless, a history of ACL injury mechanism, single bundle signal intensity on MRI, laxity on clinical examination, and arthroscopic evidence of a single bundle ACL tear should guide the surgeon towards an ACL augmentation procedure as the preferred treatment. Although well-designed studies are lacking, evidence suggests that when performed in a manner that replicates a patient’s native anatomy, the ACL augmentation technique yields better clinical outcomes than standard ACL reconstruction. Preservation of an intact ACL remnant leads to improved graft orientation, greater joint stability, improved position sense, improved vascularization, faster remodeling, and ultimately, a faster and safer rehabilitation for the patient. Thus, effort should be made to preserve such functional remnants while focusing the reconstruction on the damaged anatomy. In adhering to this concept of individualized anatomical ACL reconstruction, surgeons can provide optimum care tailored to each patient’s unique injury.