Best Practice for the Management of Anterior Cruciate Ligament Injuries
Francis, Ioan Parri
Cardiff Metropolitan University
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Rupture of the anterior cruciate ligament (ACL) impairs the stability of the knee, resulting in difficulty with athletic performance and increased risk of early degenerative joint disease. The purpose of this study was to investigate the various treatment methods available to orthopaedic surgeons when managing ACL injury. This was performed by reviewing contemporary medical literature, with the supplementation of specifically designed questionnaires distributed to selected surgeons affiliated with the British Association for Surgery of the Knee. From available data the study attempted to identifr best practice for primary isolated ACL reconstruction in general terms. Although conseryative treatment was considered, the main focus of the study examined the various surgical techniques available when reconstructing the ACl deficient knee. In addition, mechanisms of initial ACL injury, optimal timing for ACL surgery, causes of graft failure, and performance evaluation systems were discussed. From the distributed questionnaires, a response rate of 71% was generated. Results from within the recent medical literature recognised that confusion continues to exist as to whether the patellar tendon or hamstring tendon graft should be utilised. From the surgeons' responses, it was clear that the hamstring tendon was considered the preferred choice of graft. A relationship was also seen between the medical literature and the surgeons' experiences regarding the causes of graft failure following ACL surgery. The most important potential causes were identified as the surgical technique, failure of graft incorporation, and failune during trauma. Both sources of data highlighted the uncertainty regarding the optimal timing for surgery following ACL injury. The majority of surgeons felt that surgery should take place within the first month. However, confusion persists within the current medical literature with a variation of surgical periods speciñed. Although uncertainty regarding the 'best' graft persists, it was found that both the patellar tendon and hamstring tendon produce satisfactory results.
BSc (Hons) Sport P.E. and Recreation
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