By Rainer Siebold, David Dejour, Stefano Zaffagnini
This functional and educational guidebook, written via overseas specialists in anterior cruciate ligament (ACL) reconstruction, covers all tough features of ACL rupture within the acute and persistent surroundings. It covers the newest, remarkable anatomical findings, therapy of partial ACL tears, a variety of options for unmarried- and double-bundle ACL reconstruction, and intricate ACL revision surgical procedure. very important surgical steps are in actual fact defined with assistance from instructive, fine quality images. vital assistance, tips, and pitfalls are highlighted and intra- and postoperative problems, rehabilitation, and prevention of re-rupture are mentioned. All authors are famous and skilled ACL surgeons.
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Extra info for Anterior Cruciate Ligament Reconstruction: A Practical Surgical Guide
Sasaki et al.  concluded from their femoral dissections that whereas the indirect insertion plays a role as a dynamic anchorage of soft tissue to bone allowing certain shear movements, the strength of anchoring is weaker than the direct insertion. Mochizuki et al.  concluded that it is very difficult to reconstruct the fanlike indirect extension fibers by a bone tunnel; however, the midsubstance fibers of the ACL can be reconstructed. From our dissections we conclude that it would be ideal to reconstruct the “functional” direct insertion of the ACL (see Chap.
Our findings reconfirmed reports of Smigielski et al.  (see Chap. 4). We found the ACL midsubstance fibers to insert in a narrow C-shaped way from along the medial tibial spine toward the anterior aspect of the anterior root of the lateral meniscus around a central and posterolateral area. The latter was the place of the bony insertion of the anterior root of the lateral meniscus. It was covered by fat and overpassed by the flat ACL anteriorly. As described for the femoral ACL insertion , the tibial insertion could macroscopically be divided into a “direct” and “indirect” part.
T. Hirschmann 42 a Ultimate Load 400 Linear Slope 300 Load (N) Fig. 3 (a) Structural properties of femur– ACL–tibia complex (FATC), showing the variables of load–elongation curve. (b) Mechanical properties of ACL substance are calculated from its structural properties and morphological characteristics (Modified from Takeda et al. ) Energy Absorbed 200 0 Ultimate Elongation Toe Region 100 0 2 4 6 8 10 Elongation (mm) b Ultimate Stress 80 Tangent Modulus Stress (MPa) 60 40 Ultimate Strain 20 0 0 2 4 6 8 10 Strain (%) Inactivity Normal Activity Increased Activity Tissue Adaption loads acting on the ACL.