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According to the proponents of the central femoral footprint position for the ACL graft, the use of this position will give improved kinematics based on cadaveric ‘time- zero’ studies, and, on that basis, better results and less meniscal / chondral failure and less long term osteoarthritis. In personal communication these surgeons acknowledge an increased re-rupture rate. They have suggested that this is a consequence of better femoral tunnel placement meaning that the ACL graft will ‘work properly’ and thus be stressed hence increased re-rupture rates. In their view this is the price of better long-term outlook for those in whom the graft survives as they have a ‘better knee’.
In response to the higher failure rate and these recent anatomical and biomechanical studies that show the important fibres of the ACL are not located centrally but are eccentrically place in the AM bundle position all authors of this review have moved their femoral tunnel back to the AM position. All of us use a transportal technique to ensure that we can hit the desired AM femoral tunnel position that is within the footprint thus the ACL graft remains ‘anatomical’. The transportal technique also enables independent tibial tunnel drilling so the ACL graft can match the crescenteric insertion of the native ACL and this avoids the short oblique posterior tibial tunnel that is required to hit the femoral footprint with a trantibial technique
To suggest the central footprint position alone is ‘anatomical’ is incorrect and implies other options are ‘sub-optimal’. Other tunnel positions within the footprint are, of course, still ‘anatomical’.
Biomechanical studies have now shown this technique will enable reproducible knee kinematics with a more isometric graft replicating the direct fibers of the native ACL.
Recent clinical studies presented in this review show a lower failure rate than with the center femoral footprint ACL reconstruction.
It is hoped this surgical technique will result in decreased meniscal and chondral damage and minimize the risk of graft failure. Further long term clinical studies are required to determine whether this is the case.
06 Anisometry profiles of anteromedial (AM), posterolateral (PL), central and conventional single bundle fibers as a function of flexion
CURRENT CONCEPTS
SPORTS MEDICINE INJECTIONS
Injections are a current practice not
only in sports medicine but in the practice of general orthopaedics.
Right at this moment, thousands are being made worldwide. Injections
are used in a variety of joints and anatomical structures, with different drugs, and to treat different pathologies. Complications are rarely known as few are reported.
To understand more about the use
of injections in sports medicine, the ISAKOS Orthopaedic Sports Committee has developed a brief survey to gather information that can give a better knowledge about this massive practice. The results will contribute to the goal of establishing a consensus about the use of injections, and provide guidelines for surgeons and patients for scientific use.
To complete the survey, please visit www.isakos.com.
ISAKOS NEWSLETTER 2015: Volume II 31