Special Focus Section
325
Foreword
ACL Reconstruction Patrick A. Smith, MD1 1 Columbia Orthopaedic Group, Department of Orthopaedic Surgery,
University of Missouri, Columbia, Missouri
I felt very honored when Dr. Jim Stannard and Dr. Greg Fanelli asked me to be the guest editor for a Journal of Knee Surgery special focus on anterior cruciate ligament (ACL) reconstruction. Despite all the great advances made over the past several years relative to surgical technology and arthroscopic ACL reconstructive techniques, as well as basic science research with navigation testing in cadavers and virtual computer modeling, we still do not have the ACL “solved.” There is still controversy and differing opinions on the best way to reconstruct this complicated structure that has really been at the forefront of sports medicine for the past 50 years. I knew right away the key to make this a special educational experience for readers of this issue was to cover contemporary options for ACL surgery, and also to provide “how to” for the different reconstructive procedures. So you can pick up valuable pearls on how to do your chosen ACL reconstruction technique better, or learn how to do a different approach if you are so inclined. The authors I recruited are colleagues all greatly respected and published in this field. They have taught me a lot in my career, and true to form I learned even more from reading their articles. I very much appreciate their willingness to help me with this important project, and I believe overall it is a comprehensive and current review for ACL surgery in 2014. Regarding the topics covered, Dr. Jim Lubowitz shares first a review of the evolution with ACL femoral tunnel placement beginning with the transtibial approach. Dr. Bernie Bach then shares his extensive successful experience with transtibial ACL reconstruction and his important surgical tips to avoid
vertical graft placement. Dr. Rick Wright then very nicely summarizes the rationale for the two-incision technique and its inherent advantages. Dr. Mike Stuart describes the history behind the “newest” option for ACL surgery with the allinside technique, including surgical detail for hamstring autograft reconstruction performed this way with the GraftLink technique. A personal interest of mine relates to the importance of extra-articular surgery in combination with primary ACL reconstruction. This certainly dates back to my training with Dr. Jack Hughston, but I believe associated medial ligament injury, as well as lateral and posterolateral injury, in many cases of ACL reconstruction tends to be undertreated. So, Greg Fanelli provides his approach—as well as outcomes— for dealing with combined ACL/posterolateral injury, including his allograft semitendinosis modification for a figure-ofeight type posterolateral reconstruction. Finally, Dr. Matt Bollier and I discuss the importance of the medial side and indications for repair and/or reconstruction in appropriate combined ACL/MCL injuries. We particularly highlight recognition of injury to the medial meniscotibial ligament, which can be overlooked, and its need for repair to optimize ultimate joint stability when associated with an ACL tear. In summary, I hope our readership learns something new —as I certainly did—from this focus on ACL surgery. I will conclude this foreword with one of my favorite quotations from my mentor Dr. Hughston about education: “if you are green you are growing, but if you are ripe, you are next to rotten.”
Address for correspondence Pat Smith, MD, Columbia Orthopaedic Group, Department of Orthopaedic Surgery, University of Missouri, 1 South Keene Street, Columbia, MO 65201 (e-mail: [email protected]).
Copyright © 2014 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel: +1(212) 584-4662.
DOI http://dx.doi.org/ 10.1055/s-0034-1390082. ISSN 1538-8506.
Downloaded by: Karolinska Institutet. Copyrighted material.
J Knee Surg 2014;27:325–326.
325
Foreword
ACL Reconstruction Patrick A. Smith, MD1 1 Columbia Orthopaedic Group, Department of Orthopaedic Surgery,
University of Missouri, Columbia, Missouri
I felt very honored when Dr. Jim Stannard and Dr. Greg Fanelli asked me to be the guest editor for a Journal of Knee Surgery special focus on anterior cruciate ligament (ACL) reconstruction. Despite all the great advances made over the past several years relative to surgical technology and arthroscopic ACL reconstructive techniques, as well as basic science research with navigation testing in cadavers and virtual computer modeling, we still do not have the ACL “solved.” There is still controversy and differing opinions on the best way to reconstruct this complicated structure that has really been at the forefront of sports medicine for the past 50 years. I knew right away the key to make this a special educational experience for readers of this issue was to cover contemporary options for ACL surgery, and also to provide “how to” for the different reconstructive procedures. So you can pick up valuable pearls on how to do your chosen ACL reconstruction technique better, or learn how to do a different approach if you are so inclined. The authors I recruited are colleagues all greatly respected and published in this field. They have taught me a lot in my career, and true to form I learned even more from reading their articles. I very much appreciate their willingness to help me with this important project, and I believe overall it is a comprehensive and current review for ACL surgery in 2014. Regarding the topics covered, Dr. Jim Lubowitz shares first a review of the evolution with ACL femoral tunnel placement beginning with the transtibial approach. Dr. Bernie Bach then shares his extensive successful experience with transtibial ACL reconstruction and his important surgical tips to avoid
vertical graft placement. Dr. Rick Wright then very nicely summarizes the rationale for the two-incision technique and its inherent advantages. Dr. Mike Stuart describes the history behind the “newest” option for ACL surgery with the allinside technique, including surgical detail for hamstring autograft reconstruction performed this way with the GraftLink technique. A personal interest of mine relates to the importance of extra-articular surgery in combination with primary ACL reconstruction. This certainly dates back to my training with Dr. Jack Hughston, but I believe associated medial ligament injury, as well as lateral and posterolateral injury, in many cases of ACL reconstruction tends to be undertreated. So, Greg Fanelli provides his approach—as well as outcomes— for dealing with combined ACL/posterolateral injury, including his allograft semitendinosis modification for a figure-ofeight type posterolateral reconstruction. Finally, Dr. Matt Bollier and I discuss the importance of the medial side and indications for repair and/or reconstruction in appropriate combined ACL/MCL injuries. We particularly highlight recognition of injury to the medial meniscotibial ligament, which can be overlooked, and its need for repair to optimize ultimate joint stability when associated with an ACL tear. In summary, I hope our readership learns something new —as I certainly did—from this focus on ACL surgery. I will conclude this foreword with one of my favorite quotations from my mentor Dr. Hughston about education: “if you are green you are growing, but if you are ripe, you are next to rotten.”
Address for correspondence Pat Smith, MD, Columbia Orthopaedic Group, Department of Orthopaedic Surgery, University of Missouri, 1 South Keene Street, Columbia, MO 65201 (e-mail: [email protected]).
Copyright © 2014 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel: +1(212) 584-4662.
DOI http://dx.doi.org/ 10.1055/s-0034-1390082. ISSN 1538-8506.
Downloaded by: Karolinska Institutet. Copyrighted material.
J Knee Surg 2014;27:325–326.
