Acl History PDF

Knee Surg Sports Traumatol Arthrosc
DOI 10.1007/s00167-011-1756-x
KNEE
Surgery for anterior cruciate ligament deficiency:

a historical perspective
Oliver S. Schindler
Received: 27 September 2011 / Accepted: 26 October 2011

Springer-Verlag 2011
Abstract The anterior cruciate ligament (ACL) has often so complex and fraught with peril that they remained
entertained scientific minds since the Weber brothers pro- reserved for a chosen few, never gaining the level of pop-
vided biomechanical insight into the importance of the ACL ularity they are enjoying today. The increasing familiarity
in maintaining normal knee kinematics. Robert Adams with arthroscopy, popularised through Jackson and Dandy,
described the first clinical case of ACL rupture in 1837 and enhancements in surgical technology firmly established
some 175 years to date, followed by Mayo-Robson of ACL reconstruction as a common procedure within the
Leeds who performed the first ACL repair in 1895. At that realm of most surgeons’ ability. More recently, the principle
time, most patients presented late and clinicians started to of anatomic ACL reconstruction, aiming at the functional
appreciate signs and symptoms and disabilities associated restoration of native ACL dimensions and insertion sites,
with such injuries. Hey Groves of Bristol provided the has been introduced, superseding the somewhat ill-advised
initial description of an ACL reconstruction with autolo- concept of isometric graft placement. Double-bundle
gous tissue graft in 1917, almost as we know it today. His reconstruction is gaining in popularity, and combined extra-
knowledge and achievements were, however, not uniformly and intra-articular procedures are seeing a revival, but more
appreciated during his life time. What followed was a per- accurate and reliable pre- and post-operative assessment
iod of startling ingenuity which created an amazing variety tools are required to provide customised treatment options
of different surgical procedures often based more on sur- and appropriate evaluation and comparability of long-term
gical fashion and the absence of a satisfactory alternative results. Modern ACL surgery is united in the common goal
than any indication that continued refinements were leading of re-establishing joint homoeostasis with normal knee
to improved results. It is hence not surprising that real kinematics and function which may ultimately assist in
inventors were forgotten, good ideas discarded and untried reducing the prevalence of post-operative joint degenera-
surgical methods adopted with uncritical enthusiasm only to tion. This review hopes to provide an insight into the his-
be set aside without further explanation. Over the past torical developments of ACL surgery and the various
100 years, surgeons have experimented with a variety of controversies surrounding its progress.
different graft sources including xenograft, and allografts, Level of evidence V.
whilst autologous tissue has remained the most popular
choice. Synthetic graft materials enjoyed temporary popu- Keywords Anterior cruciate ligament ACL History
larity in the 1980 and 1990s, in the misguided belief that ACL reconstruction ACL deficiency
artificial ligaments may be more durable and better equip-
ped to withstand stresses and strains. Until the 1970s, ACL
reconstructions were considered formidable procedures, Anatomy and basic science: from ancient history
to the twentieth century
O. S. Schindler (&)
The history of ACL surgery is also the history of the dis-
St Mary’s Hospital, Clifton, PO Box 1616,
Bristol BS40 5WG, UK covery of the ligament’s function, the recognition of its
e-mail: schindler@doctors.net.uk injury pattern and the development of reliable methods in
123
Fig. 1 Illustration from

‘Mechanics of the human
walking apparatus’ by the
Weber brother’s published in
1836 clearly showing the
appearance of the ACL in
extension and flexion. The
Weber brothers were the first to
describe the existence of two
distinct ACL fibre bundles and
their respective tension pattern
(with kind permission of
Springer Science, Berlin) [297]
assessing and diagnosing ACL injury. Hippocrates of the Autopsy of the knee revealed that the knee had become
Greek island of Kos (460–370 BC) although unaware of the septic and that the ACL had torn off the tibia with a portion
cruciate ligaments as such, was the first to suggest that knee of bone still attached to the ligament (Fig. 2). Many more
instability following trauma may be attributable to torn
internal ligaments [116]. Galen of Pergamon in Greece
(131–201 BC) is credited for providing the cruciate liga-
ments with their name, when, based on their appearance of
crossing over, he coined the term ‘ligamenta genu cruciata’
[92]. Over the following 2000 years, the cruciate ligaments
occupied a Cinderella status by receiving little attention in
scientific circles. In 1836 Wilhelm Weber (1804–1891)
Professor of Physics in Göttingen and Eduard Weber
(1806–1871) Professor of Anatomy and Physiology in
Leipzig were also able to show that sectioning of the anterior
cruciate ligament resulted in abnormal anterior–posterior
movement of the tibia, thereby providing an early descrip-
tion of the anterior drawer sign [297]. They also described
the exact anatomic position of the cruciate ligament complex
and demonstrated that the anterior cruciate ligament consists
of two distinct fibre bundles which are tensioned at different
times during knee motion (Fig. 1) In 1858 Karl Langer,
anatomist at the University of Vienna (1819–1887), not only
confirmed earlier findings by the Weber brothers, but pro-
vided the first detailed description of cruciate kinematics and
the ligaments torsional behaviour pattern [171].
The first description of a clinical case of ACL injury in
the English literature was provided by the Irish surgeon
Robert Adams of Dublin (1791–1875) [2]. In December of
1837, he observed the case of a drunken 25-year-old man Fig. 2 Earliest recorded drawing of a cruciate ligament tear (avulsion
who injured his knee wrestling and died 24 days later. injury), observed by Robert Adams [2]
123
Fig. 3 Sliding frame designed

by Bonnet in 1853 as part of his
conservative treatment approach
to prevent stiffness and enable
early mobilisation following
internal derangement of the
knee [24]
ACL ruptures are likely to have occurred before then, but and a further 10 months using a semi-rigid brace made of a
failure to recognise clinical signs and the absence of reli- ‘‘finely fitting laced stocking, made of Saxony broad cloth,
able assessment tools prevented their discovery. and a broad flat steel spring was sewed to the back of it’’,
In 1845, Amedeé Bonnet (1809–1858) Professor of Sur- neither patient regained entirely normal knee function.
gery at the Lyon University published his Traité des maladies Stark is often quoted as the first clinician to describe cases
des articulations [23]. He described three essential signs of ACL deficiency in the English literature. Wagner how-
indicative of acute ACL rupture, ‘‘In patients who have not ever pointed out, that the excessive hyperextension and
suffered a fracture, a snapping noise, haemarthrosis, and loss
of function are characteristic of ligamentous injury in the
knee’’, and thought that the pain that accompanied ACL
rupture was due to the stretching of its nerve supply. Through
cadaver experiments, Bonnet became aware that the anterior
cruciate ligament (ACL) was more likely to tear close to its
femoral insertion. He also described the subluxation phe-
nomenon, which later became known as the pivot-shift.
Although a surgeon, Bonnet advocated conservative man-
agement for ligamentous injuries with application of cold
packs in the acute stage. Through his own experiments, he
was aware of the detrimental effects prolonged immobili-
sation has on articular cartilage and hence encouraged early
motion exercises using a sliding frame [24] (Fig. 3). For
patients who continued to suffer from instability, he sug-
gested wearing of a long-leg hinged brace not dissimilar in
principle to modern stabilising braces used following injury
or surgery (Fig. 4). His ideas and suggestions on the treat-
ment of acute ligamentous injuries were far ahead of his time
but received little recognition in the English speaking world,
as most of his work remained un-translated.
James Stark, a general practitioner from Edinburgh
(1811–1890), observed two cases of cruciate ligament tears
in 1839 and 1841, respectively, describing some of the
typical signs of ligament rupture ‘‘… and felt something
gave way with a snap in the left knee; when raised, she
found she had lost all command over the leg’’ [274]. Stark
believed that damage to the cruciates would render the
Fig. 4 Early design of a knee brace/walking apparatus introduced by
knee ‘‘utterly useless’’. He treated both of his patients Bonnet to enable patients with chronic knee instability to ambulate
conservatively, but despite 3 months of immobilisation, [24]
123
instability seen in Stark’s patients most probably suggests Notwithstanding Dittel’s observation that ACL tears may
that both suffered combined ACL and PCL injuries. occur in isolation following unidirectional force applied to
In 1875, the Greek Georgios C. Noulis (1849–1915) the tibia in postero-anterior direction, he was the first
gave a detailed description of what is now known as the clinician to become aware of the strong association
Lachman test, when he wrote, ‘‘… fix the thigh with one between injuries of ACL, medial collateral ligament and
hand; with the other hand hold the lower leg just below the medial meniscus.
knee with the thumb in front and the fingers behind; then, Three years later in 1879, the French surgeon Paul
try to shift the tibia forward and backward … when only Segond of Paris (1851–1912) provided a detailed descrip-
the anterior cruciate ligament is transected, this forward tion of signs and symptoms accompanying the rupture of
movement is seen when the knee is barely flexed’’ [219]. cruciate ligaments, including ‘‘strong articular pain, fre-
Stirling Ritchey of Washington DC rediscovered the test in quent accompanying pop, rapid joint effusion and abnor-
1960, but it was not until 1976 when Joseph Torg, in mal anterior-posterior movement of the knee on clinical
appreciation of his mentor John Lachman of Philadelphia examinations’’ [259]. Segond also described the so-called
(1956–1989), described it as the ‘Lachman test’ and pop- Segond fracture, a small bony avulsion on the lateral tibial
ularised its value in assessing ACL function [246, 285]. plateau which if present is commonly combined with an
Clinicians, curious as to how cruciate damage occurs, ACL tear. He commented that ‘‘This lesion is pathogno-
were hoping to find answers through cadaver experiments monic of torsion of the knee in internal rotation and slight
[23, 60, 120]. In 1876, Leopold Dittel of Vienna flexion of the lower leg and is associated with rupture of
(1815–1898) published on the examination results of a the anterior cruciate ligament’’. To fully appreciate Seg-
number of knee specimens which he had previously ond’s discovery, one should bear in mind that he was
exposed to extremes of motions [60]. Like Bonnet and unable to rely on radiographs, as Röntgen rays had not been
later Hönigschmied, he observed that the ACL most discovered.
commonly tore close to its femoral insertion, but occa- Between 1853 and 1917, physiologists and anatomists
sionally avulsed with a fragment of bone off the tibia, such as Hermann von Meyer (1815–1892) and Hermann
leaving the ligament essentially intact [23, 120] (Fig. 5). Zuppinger of Zürich, and Hans Straßer of Bern (1852–1927),
Fig. 5 Illustration of two

cadaver specimens drawn
following Dittel’s experiments
published in 1876. The left
illustration is showing the ACL
(c) being torn off its femoral
insertion whilst on the right a
combined injury to ACL (c),
MCL (e) and medial meniscus
(e) can be depicted [60]
123
further advanced our knowledge on the function of the cru- had hence gained a sophisticated understanding of the
ciates and their interplay with other internal and external functional behaviour of the cruciate ligaments.
knee structures [204, 277, 313]. These scientists recognised
the importance of the functional unit of ACL and PCL,
known as the ‘four-bar-linkage’, in providing normal rolling, Direct repair of the torn ACL: 1895–1990
gliding and sliding motion of femur on tibia, and that any
disturbance of this unit (e.g. ACL tear) would invariably In the ninetieth century when morbidity and mortality
disrupt this mechanism and create un-physiological move- associated with surgery was still high and antimicrobial
ment patterns. agents to combat sepsis not yet discovered, surgeons
In 1911 Rudolf Fick of Leipzig (1866–1939) described showed general reluctance to offer surgery for a condition
in detail the tension pattern of the two ACL bundles and as obscure as ligament disruption. This era was described
recognised that parts of the ACL were tensioned at all by Edgar Bick of New York as a time ‘‘when the [knee]
times, a finding that later led to the creation of the concept joint was considered a matter beyond the pale of the
of graft isometry [79]. In 1927 Bruno Pfab of Graz was ordinary rules of surgery’’ [17]. Injuries to ligaments often
able to demonstrate the blood supply to the cruciates [237]. remained unrecognised and symptoms of knee instability
In the following decades, further studies on the functional rarely attributed to a torn ACL [1]. In 1915 Richard Warren
anatomy of the ACL were produced by Otto Brantigan and of London (1876–1957) well aware of the ignorance of
Allan Voshell of Baltimore in 1941, LeRoy Abbott of San some of his colleagues wrote in his ‘Textbook of Surgery’,
Francisco (1890–1965) in 1944, Fakhry Girgis of New ‘‘Such cases are likely to be regarded as bad sprains, but
York in 1975, and Lyle Norwood and Mervyn Cross of when the abnormal mobility persists the joint should be
Columbus in 1979, defining the ACL as the primary explored and the ligaments sutured with chromic gut’’
anterior stabiliser and secondary rotatory stabiliser of the [295].
knee [1, 28, 99, 218] (Fig. 6). Although William Battle of St. Thomas in London
In the early 1970s, Victor Frankel of New York, Frank (1855–1936) was the first to publish the successful results
Noyes of Cincinnati and Jack Kennedy of London, Ontario of a single case of open ACL repair with a silk suture in
provided further insight into injury pattern and biome- 1900, it was in fact Sir Arthur Mayo-Robson of Leeds
chanics of ACL failure by assessing the effect of a number (1853–1933, Fig. 7) who had performed a similar surgical
of variables including age, and stress and strain upon the procedure on a 41-year-old miner 5 years earlier [14, 200].
physical ligament properties [84, 149, 151, 220]. By the Here too the ligaments were torn off the femoral side and
end of the twentieth century, the orthopaedic community secured via catgut ligatures. The patient was discharged after
Fig. 6 Schematic drawing

representing changes in the
shape and tension of the ACL
components in extension and
flexion according to Girgis 1975
(With kind permission of
Lippincott Williams & Wilkins,
Philadelphia) [99]
123
Ernest Hey Groves of Bristol (1872–1944) who in 1920

commented that ‘‘… in all my cases the ligaments have
been so destroyed … that direct suture would have been
utterly impossible’’ [114].
Georg Perthes of Tübingen (1869–1927), better known
for his description of femoral head necrosis in children, was
aware of the difficulties in connecting the torn ACL fibres
with sutures, since he realised that the ACL almost always
tore off its femoral attachment leaving not enough proximal
ligament to facilitate repair [236]. He devised a new tech-
nique whereby a suture loop of aluminium-bronze wire was
connected to the distal ligament remnant and both ends of
the wire pulled through separate drill holes entering the
femoral foot print of the ACL and exiting at the outer aspect
of the femoral metaphysis (Fig. 8). The ligament was pulled
tight and the wire twisted over the bony bridge to achieve
secure fixation. He reported excellent results with this
technique at 1–4 years in three patients. Animal studies
provided further evidence on the suitability of his tech-
nique, by confirming complete reconstitution in all cases
following Perthes’ repair [238]. Perthes, however, was
concerned that most of his colleagues only considered ACL
Fig. 7 Sir Arthur Mayo-Robson (1853–1933) of the Leeds General repair once it became clear that conservative management
Infirmary performed the first repair of a torn ACL in 1895 (with kind had failed and patients suffered from ongoing instability
permission of BMJ Publishing Group Ltd, London) [315]
[236]. He believed that the level of knee laxity and asso-
ciated symptoms of swelling and discomfort are likely to
3 weeks with a plaster of Paris, which was removed after a
month. When reviewed 6 years later, the patient considered
his leg ‘‘perfectly strong’’ and Mayo-Robson remarked, ‘‘He
walks well without a limp and can run. No abnormal
mobility whatever present. Extension to the straight line is
perfectly free. Flexion is somewhat limited’’.
By 1913 Hubert Goetjes of Cologne was able to trace a
total of 23 cases of ACL rupture in the available scientific
literature [102]. In his comprehensive paper, he elegantly
summarised all knowledge on the function, biomechanics
and treatment of cruciate ligaments of his day. He reported
in detail on each single case and added a further 7 from his
own hospital. Goetjes concluded that suture repair should
be recommended in all acute and chronic cases if associ-
ated with abnormal knee function. He was also the first
surgeon to suggest examination under anaesthesia of the
knee when the clinical diagnosis was uncertain.
The results of ACL repair, however, remained unpre-
dictable, due to difficulties encountered in trying to obtain
reliable suture fixation of the often tethered and shredded
ligament remnants. Hence surgeons like Sir Robert Jones
of Liverpool (1857–1933) continued to advocate conser-
vative management [144, 145]. He expressed disbelief that
suture repair would yield advantage over plaster immobi-
Fig. 8 Perthes’ technique of ACL repair using transcortical wire
lisation when he remarked that ‘‘… stitching the ligaments
suture. Please note the longitudinal division of the patella, according
is absolutely futile. Natural cicatricial tissue … is the only to Robert Jones, to gain access to the joint (with kind permission of
reliable means of repair’’. Jones’s view was echoed by Hüthig Jehle Rehn, Heidelberg) [236]
123
increase with time and therefore suggested that patients be satisfactorily reconstructed at a later date if the patient
should be examined as soon as pain and swelling have has sufficient disability. On the other hand, after successful
subsided and that surgical repair should follow in all cases repair of an acute rupture I have no hesitation in recom-
where rupture of the cruciate ligament is strongly suspected. mending return to active athletics, including football’’. It
Erwin Payr of Leipzig (1861–1946) took a different becomes clear that O’Donoghue did ‘‘not recommend
approach to repairing the ACL from Perthes [233]. Aware routine reconstruction’’ but instead proposed that in an
of the insufficient length of the proximal ligament remnant ‘‘acute injury, cruciate repair should be done routinely’’
he designed a procedure that was essentially a partial ACL and that ‘‘the time of the repair is vastly more important
reconstruction. A fascia loop was threaded through a than the severity of the injury’’. Through emphasising the
semicircular tunnel, positioned at the femoral origin of the need for early intervention following ligament injury if
ACL, and sewn against the tibial ACL stump (Fig. 9). In return to sport activities is desirable, O’Donoghue gave
1938 Ivar Palmer published his thesis ‘On the Injuries to ACL surgery an unexpected boost in the USA.
the Ligaments of the Knee Joint’, a detailed study on Suture repair continued to be practised way into the
anatomy, biomechanics, pathology, and treatment [232]. early 1980s and supported by good clinical results pub-
He advocated operating ‘‘at an early stage when it is gen- lished by David MacIntosh of Toronto and John Marshall
erally possible to restore anatomic conditions’’. Palmer of New York [186, 193]. Both devised a variation on the
used the Perthes’ technique and emphasised the importance Perthes technique with sutures being passed behind the
of repairing both bundles separately. lateral femoral condyle in a so-called ‘over-the top’ repair.
Don O’Donoghue of Oklahoma (1901–1992), a key In 1976 John Feagin of the Keller Army Hospital in West
figure in Orthopaedic Sports Medicine, popularised ACL Point, New York presented his 5-year results of 32 army
repair in the United States in the 1950 and 1960s [225, cadets who had undergone direct ACL repair [77].
226]. O’Donoghue had already gained experience with the Although initially 84% did well and returned to sporting
reconstruction of neglected ACL-deficient knees in 29 activities, at 5 years almost all patients suffered some
athletes using a modified Hey Groves technique [227]. degree of instability, two-thirds experienced pain and 17 of
Although his results were acceptable, he felt that ‘‘the rate the 32 had sustained a re-injury during the follow-up per-
of success is not sufficiently high to warrant the attitude iod. Feagin concluded that ‘‘long-term follow-up evalua-
that acute ruptures of the anterior cruciate need not be tions do not justify the hope … that anatomic repositioning
repaired under the misapprehension that the ligament can of the residual ligament would result in healing’’. His views
Fig. 9 Payr’s technique to

repair the proximally torn ACL
with a trans-osseous fascia lata
loop (with kind permission of
123
were shared by Werner Müller of Bale who believed that

‘‘success in these cases may well have been due to exten-
sive adhesions among the intra-articular folds, greatly
reducing joint play and restraining anterior translation
while still permitting recovery of knee motion in flexion–
extension’’ [214]. Damaging long-term results published
by Engebretsen and associates in the 1990s sealed the fate
of primary suture repair, which was all but abandoned by
the end of the century [73].
Pioneers of ACL reconstruction: 1914–1920
Clinicians eventually realised that a number of patients

developed ongoing instability due to chronic knee laxity.
These patients required a different solution other than repair
which subsequently led to the concept of replacing the ACL
with some form of graft material [166, 292]. The clinical
indications for ACL reconstruction were later defined by
O’Donoghue as ‘‘… anterior cruciate instability sufficiently
severe to interfere with a person’s normal everyday living’’
[227]. John Insall, however, recognised that ‘‘… the ability
to perform at some level, in some kind of sport is highly
desirable and must be recognised as a true indication for Fig. 10 Photograph of Ernest William Hey Groves (1872–1944) of
Bristol in the year 1916 (with kind permission of John Wiley & Sons,
ligament reconstruction’’, whilst bearing in mind that
Hoboken) [115]
‘‘surgery is not indicated to cure a physical sign without
symptom nor should the end result be judged solely on the
basis of the stability examination alone’’ [129]. entire fascia lata which he detached from its tibial insertion
In 1913 Paul Wagner of Leipzig wrote a thesis on the and ‘‘threaded through new canals bored in femur and
‘Isolated rupture of cruciate ligaments’ [292]. He suggested tibia’’ where it was sown onto the periosteum (Fig. 11).
the use of fascia for the reconstruction of the ACL in cases Leaving the tendon attached to the muscle belly was
where the ligament is so badly damaged that suture repair believed to maintain tendon blood supply and nutrition.
has become impossible, but did not refer to any clinical Hey Groves was clearly aware that proper knee joint
experience. Erich Hesse, surgical assistant to Ivan Grekov function could only be re-established if the reconstructed
(1867–1934) in St. Petersburg, reported in 1914 on what is ligament graft is placed in the exact anatomic position of
believed to be the first attempt of an anatomic recon- the original ACL ‘‘in contradistinction to a mere passage of
struction of the cruciate ligaments performed on a 40-year- new ligaments across the joint’’ [114]. He also recognised
old man who had fallen from the 3rd floor dislocating his the importance of graft obliquity, as ‘‘any new ligament
knee [111]. The operation was performed by Grekov, who which is used to replace them should be given this oblique
used a free fascia graft which he routed through drill holes direction, even in an exaggerated degree, because an
in the femur and stitched against the ligament remnants on anterior ligament will be efficient in preventing anterior
the tibia. The functional results were thought to be tibial displacement in proportion to its obliquity’’. The
‘‘exceptionally good with no side to side laxity’’. mechanical principle behind Hey Groves’s notion of graft
The first complete reconstruction of the ACL was per- obliquity, however, remained unrecognised for almost a
formed 3 years later by Ernest William Hey Groves at the century, until Loh and colleagues from Pittsburgh pub-
General Hospital in Bristol [113] (Fig. 10). He was dis- lished their biomechanical study on tunnel placement in
enchanted with the standard of treatment of ACL injuries 2002 [179]. They discovered that increased graft obliq-
of his day when he wrote in 1917, ‘‘while the frequency uity achieved through a low femoral tunnel placement
and importance of this injury is becoming more widely within the notch, provided for improved rotational sta-
known, there have not been any corresponding advances in bility of the knee compared to a graft placed in a more
the method of treatment. A rigid plaster or leather cast to be vertical position. Their findings were later confirmed in
worn for a year, followed by a hinged apparatus represents clinical studies and subsequently became accepted
the generally accepted method’’. Hey Groves utilised the practice [257].
123
criticising the incomplete nature of the construct, ‘‘as it

does not attempt to strengthen in any way the internal
lateral ligament, so that the new fascial strip has to bear the
entire strain of abduction of the knee as well as of anterior
sliding and internal rotation’’ [268, 269]. Smith’s report
would suggest that he had encountered a more complex
injury pattern also involving the MCL which would later
become known as antero-medial instability. He therefore
proposed a modification to the Hey Groves technique
suggesting the use of only a section (strip) of the fascia lata
(1 00 wide and 1000 long) which should be detached
proximally from its muscle belly (Fig. 12). The tendon is
then routed through femoral and tibial tunnels and looped
through a superficial drill hole around the medial femoral
epicondyle, to provide additional reinforcement to the
MCL. Smith also described using massage and electrical
stimulation to decrease quadriceps atrophy.
For other reasons than Smiths’s, Hey Groves had also
became disenchanted with his original technique using
proximally based fascia, as it provided a relatively short
graft and weakened the knee by depriving it of one of its
main lateral supporting structures. In his second publica-
tion on ACL surgery in 1920, Hey Groves presented results
of 14 cases of ACL reconstruction using a modification of
his original technique [114]. Of his 14 cases, ‘‘None were
made worse, 4 showed no benefit, 4 benefitted to some
degree, 4 were cured and 2 were only operated 6 months
ago’’ but ‘‘promise to be successful’’. Hey Groves appeared
rather self-critical and his refreshing honesty in conveying
his results deserves credit and has to be considered unusual
for his time. He continued using the revised technique for
the remainder of his career and documented each case
Fig. 11 Original Hey Groves ACL reconstruction technique of 1917 thoroughly and often added artistic drawings (Fig. 13). Hey
(With kind permission of The Lancet) [113] Groves and Smith had laid down the basic principles of
anatomic ACL reconstruction and although the surgical
Hey Groves was also the first clinician who described community followed various pathways in the coming years
antero-lateral subluxation of the tibia in the ACL-deficient it eventually started to appreciate their achievements and
knee when he commented that ‘‘In active exercise, when ingenuity.
the foot is put forward and the weight of the body pressed Despite the excellent work of these early pioneers
on the leg, then the tibia slips forward; sometimes this however, the debate over the following 50 years was less
forward slipping of the tibia occurs abruptly with a jerk over primary ligament repair versus reconstruction, but
…’’ [114]. His description leaves little doubt that Hey whether any procedure should be performed at all [199].
Groves, like Bonnet 70 years earlier, had identified the Conservative management of ACL-deficient knees was
pivot shift phenomenon, which indicated that the anterior fostered by the improvements in orthotics and physiother-
half of the ilio-tibial band had become an extensor rather apy. Timbrell Fisher of London (1888–1967) strongly
than flexor and hence was unable to prevent subluxation of believed in the benefits of conservative management and in
the lateral tibial plateau when the knee was close to his view ‘‘operations should be reserved for cases who
extension. This phenomenon was later used by Galway & suffer grave functional disability, which persist in spite of
MacIntosh to devise the ‘pivot-shift-test’, a sensitive increasing the power of the quadriceps, and other thigh
diagnostic assessment tool to identify ACL incompetence muscles, or the wearing of a well-planned and accurately
[94]. fitting mechanical support’’ [80].
In 1918, Alwyn Smith of Cardiff (1884–1931) reported Amedeé Bonnet had already experimented with off-set
on nine cases treated with Hey Groves’ technique, hinges for knee orthoses in the early 1850s [24]. Staudinger
123
Fig. 12 Smith of Cardiff re-

routed a distally based strip of
fascia, through lateral femoral
condyle and medial tibial
plateau and attached it onto the
medial femoral epicondyle,
thereby combining
reconstruction of the ACL with
MCL augmentation (with kind
permission of John Wiley &
Sons, Hoboken) [268]
Fig. 14 Knee brace introduced by Staudinger in 1931 using a

‘parallelogram hinge’ to accommodate the changes in the centre of
rotation during knee flexion (with kind permission of Ferdinand Enke,
Fig. 13 Original drawing by Hey Groves in 1937 showing the
Stuttgart) [276]
revised technique of using proximally detached pedicled fascia lata as
described in 1920. Tibial tubercle osteotomy was performed for
enhanced exposure and the graft secured with an ivory nail (author’s
archive)
123
of Frankfurt, aware of the disadvantages of traditional ACL reconstruction) without having seen a perfect result,
hinged knee braces, introduced his ‘‘parallelogram hinge but several have been much improved’’ [146]. Both
brace’’ in 1931 [276] (Fig. 14). The mechanism, which was authors, however, were mindful that such surgery should
based on a design by Schede & Habermann used in leg not be performed indiscriminately when they concluded
prosthesis, tried to emulate the changes of instant centre of that ‘‘the operations are usually grave and require the
rotation and thereby accommodating the natural rolling and highest craftsmanship, and should never be undertaken
gliding motion of femur on tibia [255, 276]. In 1945 without a sense of grave responsibility’’.
Thomas DeLorme of Chicago introduced the concept of With changes in life style especially towards the second
muscle strengthening through heavy resistance exercise half of the twentieth century, patients expectations rose and
and reported that ‘‘most dramatic results have been as evidence emerged on the relatively high failure rate of
obtained in cases of instability of the knee’’ [59]. conservative management, reconstructive surgery gradu-
Critics of ACL surgery were not only mindful of the ally gained wider acceptance. A major impetus towards a
extensile exposure necessary to facilitate surgery, but more pro-active approach in the treatment of ACL injuries
believed that it was essentially wrong to allow the dynamic was provided by Frank Noyes of Cincinnati in 1983 fol-
play of forces in the knee, which had lost stability, to lowing his publication on ‘the rule of thirds’ in patients
depend on a relatively fragile, isolated graft, running freely treated non-operatively [221]. He concluded that ‘‘one-
through the joint (Fig. 15). Constantine MacGuire of New third of the patients with this injury will compensate
York believed that reconstruction ‘‘could not give any adequately and be able to pursue recreational activities,
benefit other than that derived from the period of immo- one-third will be able to compensate but will have to give
bilisation following operation’’ [184]. Such objections, up significant activities, and one-third will do poorly and
however, did not dampen the overall enthusiasm, con- will probably require future reconstructive surgery’’.
firmed by an ever increasing number of publications on the
topic, focussing on modifications of surgical technique and
graft selection [13, 45, 68, 103, 137]. The mood was ech- ACL graft materials
oed by LeRoy Abbott who in 1944 wrote ‘‘The application
of a splint or plaster cast until such time as the lesion is Fascia lata (ilio-tibial band): 1914–1990
judged to have healed, satisfies the attendant, if not always
the patient. Rest and fixation, although sound in princi- Fascia lata remained a popular choice of graft for the best
ple,… often prove disastrous in those patients in whom the part of the twentieth century. In 1927 Charles F Eikenbary
supporting ligaments of the knee have been severely of Seattle (1877–1933) followed Grekov to become only the
damaged’’ [1]. Even Sir Robert Jones, one of the great second surgeon to use a free tissue graft to reconstruct the
promoters of conservative management, conceded in the entire ACL [68]. The procedure was ‘‘suggested as an
1923 edition of Jones & Lovett’s ‘Orthopaedic Surgery’ improvement over the Hey Groves or the Putti method’’ and
that ‘‘the writers have examined several of these cases (of utilised a medial para-patellar approach thereby avoiding
patellar tendon detachment or splitting which was standard
at the time [68, 114, 243]. Drill holes were placed through
the anterior surface of femur and tibia to simplify graft
introduction (Fig. 16). First clinical results of free tissue
grafts for ACL reconstruction were provided by Wilhelm
Jaroschy of Prague (1886–1938) in 1929 [138]. He reported
on two successful cases where grafts remained competent
and joint stability was maintained 9 months after surgery,
thereby diminishing concerns of impaired biological via-
bility thought to be associated with free tissue grafts.
William Cubbins and James Callahan of Chicago
became the key promoters of the Hey Groves procedure in
the United States. Both published extensively on their
technique of simultaneous ACL and PCL reconstruction
during the 1930s [45, 46]. In 1978 John Insall (1930–2000)
Fig. 15 Intra-operative photograph taken from Janik’s treatise on presented the ‘bone block ilio-tibial band transfer’, a pro-
cruciate ligament injuries published in 1955, which highlights the
cedure based on Jeffrey Minkoff’s and James Nicholas’s
extensive exposure used at the time to perform ACL reconstruction
with fascia lata (with kind permission of Walter De Gruyter, Berlin) ‘ilio-tibial band pull-through’ (ITPT) technique, first used
[137] at Lennox Hill Hospital in 1971 [128, 129, 217] (Fig. 17).
123
Fig. 16 One of the first ACL

reconstruction using a free
tissue graft through a medial
para-patellar approach as
designed by Charles Eikenbary
in 1927 (with kind permission
of Elsevier, Philadelphia) [68]
Fig. 17 John Insall’s ‘bone block ilio-tibial band transfer’ first published in 1981 (with kind permission of Elsevier, Oxford) [129]
Insall detached the central portion of the fascia lata with its ‘‘impossible to duplicate the original anatomy exactly with
osseous insertion from Gerdy’s tubercle, re-routed the graft any form of graft’’ [128].
over-the-top of the postero-lateral femoral condyle through
the joint and secured the bone block with a screw just Meniscus: 1917–1990
below the tibial plateau. At a minimum of 2 years follow-
up, Insall reported that ‘‘although the results of the post- Even at the beginning of the twentieth century, surgeons
operative anterior drawer test are disappointing if one were already aware of the strong association between
hopes to restore the knee to normal, the improvement in the rupture of the ACL and meniscal damage. The treatment of
patients’ functional capacity is quite dramatic … and most choice for a torn meniscus was its removal and since it was
of these patients were engaging in strenuous sports without known that meniscal tissue consisted of avascular fibro-
brace protection.’’ Insall conceded however that ‘‘normal cartilage nourished by synovial fluid, it appealed to many
stability rarely if ever is restored’’ as he believed it to be as an almost ideal and readily available substitute for the
123
ACL. In 1917 Hölzel, assistant to Max zur Verth of studies, Lange was able to confirm mucoid and cystic
Hamburg (1874–1941), reported on a patient with cruciate degeneration of meniscal implants and concluded that ‘‘a
deficiency, who was seen on a hospital ship during the war degenerative meniscus appears to be too poor to be con-
[119]. Zur Verth replaced the ACL with the torn lateral sidered for reconstruction, whilst a healthy meniscus would
meniscus, which he left attached distally, and sutured appear to be too good’’ [93, 169].
against the ligament remnants proximally. He commented Knowledge of the importance of the meniscus, the
that ‘‘As far as the replacement of the ligaments are con- consequences of its removal and reports on clinical failures
cerned free fascia lata graft would have been available. gradually prompted a shift in opinion [294]. This was led
Instead it was preferred to use the remaining aspect of the by publications of Jack Hughston of Columbus, Georgia
meniscus which was well anchored on the tibia. This (1917–2004) in 1962 who recognised the contribution of
spared the trouble of trying to attach the fascia to the tibia the meniscus to knee stability and those of Peter Walker of
which is not a very simple task’’. From his account, it New York in 1975, who defined the role of the meniscus in
would appear that zur Verth had already used the technique the force transmission across the joint [76, 123, 124, 188,
of grafting the torn ACL with fascia lata before Hey 258, 293]. Meniscus was finally abandoned as grafting
Groves but without formally publishing on it. material by the end of 1980s.
In 1927 Pfab was able to confirm through experiments
on sheep, that healing and integration of meniscal tissue Extensor retinaculum and patellar tendon: 1927—today
occurred when used in replacing the ACL [238]. Meniscus
was seen as a suitable ACL replacement graft until the late Mitchell Langworthy of Spokane, Washington (1891–1929)
1970s and promoted by a number of well-known Ortho- is reported to have been the first surgeon to replace the ACL
paedic Surgeons on both sides of the Atlantic [40, 131, using part of the ligamentum patellae [68]. Langworthy
177]. Their view is reflected by Bengt Tillberg of Linkö- never published on his method and suffered an untimely
ping in Sweden who, after having performed the surgery on death when he became the victim of a bullet from an unhappy
43 patients concluded that ‘‘The use of a meniscus for the patient in his private practice in 1929.
reconstruction of either cruciate ligament is considered to In 1928 Ernst Gold of Vienna presented the case of a
be simple, safe and effective’’ [284]. 27-year-old lady hampered with knee instability, who had
Although Max Lange of Munich (1899–1975) had torn her ACL skiing 2 years earlier [103]. Gold used a
experimented with meniscal tissue graft in the early 1930s, distally based strip of extensor retinaculum and medial
he remained critical upon its use. He upheld the view that border of the patellar tendon, brought into the joint through
meniscal tissue was ‘‘functionally unsuitable to replace a a tibial tunnel, and secured against the anterior–superior
ligament’’ as it was primarily designed to withstand com- aspect of the PCL with interrupted locking sutures
pression rather than tension and shear [169]. In histological (Fig. 18). At 7 months, the patient resumed normal
Fig. 18 ACL reconstruction

according to Gold, using medial
patellar retinaculum and tendon
attached to the posterior cruciate
ligament (with kind permission
of Springer Science, Berlin)
[103]
123
activities including cross country walking with little pain. simpler and more physiological than those previously
Clinically her knee was stable and bending beyond 90. In described’’ [141] (Fig. 20). He used the central third of the
1932 Max zur Verth reported on the treatment of chronic patellar tendon which he left attached distally. The proxi-
ACL-deficient knees with a pedicled section of patellar mal part of the tendon was removed from the patella
tendon [314]. Zur Verth never presented his clinical results, together with a small block of bone. He then passed the
but Arnold Wittek of Graz (1871–1956), who had adopted graft ‘‘beneath the fat pad’’ into a femoral tunnel ‘‘placed in
the ‘zur Verth’ technique, presented 16 successfully oper- the intercondylar notch just posterior to the margin of the
ated cases in 1935 [303]. Just like Gold, he did not strive articular cartilage’’. To overcome the problem of insufficient
for true anatomic reconstruction as he attached the proxi- graft length associated with a pedicled patellar tendon graft,
mal end of the graft to the PCL. Jones had to move the attachment of the anterior cruciate
In 1936 the American surgeon Willis C. Campbell of ligament forward within the roof of the intercondylar notch.
Memphis (1880–1941), who coined the term ‘giving way’ in This resulted in an extremely non-anatomical and vertical
summarising the distressing signs of knee instability, pub- graft position and contradicted Jones’ earlier claims that his
lished the first of two articles in which he described the use procedure may be ‘‘more physiological’’.
of extensor retinaculum containing ‘‘very strong tendinous Modern biomechanical understandings and the principle
tissue from the medial border of the quadriceps and patellar of the ‘four-bar-linkage’, however, suggested that anterior
tendons’’ [32] (Fig. 19). This strip was threaded through positioning of the femoral tunnel away from its anatomic
tibial and femoral tunnels drilled in accordance to Hey foot print would, as shown by Müller, increase tension
Groves and sutured against the periosteum of the distal forces within the ligament graft in proportion with knee
femur. Campbell, like Dittel before him, noticed that ACL flexion and hence was likely to cause graft attenuation or
injuries are commonly associated with injury to the medial failure long-term [27, 203, 213] (Fig. 21). In addition,
meniscus and medial collateral ligament, a situation he Wirth and Artmann of Munich studied 100 knee specimens
called ‘terrible triad’, thereby predating O’Donoghue’s and found that distally based patellar tendon grafts were
description of the ‘unhappy triad’ [32, 33, 60, 225]. Camp- simply not long enough with only 13% reaching the ana-
bell was mindful that isolated reconstruction of the ACL in tomical insertion site of the native ACL on the femur
such cases might not provide the desired level of knee sta- [300]. Although Jones claimed generally good results at
bility and hence promoted combined reconstruction of ACL 2 years with none of his patients ‘‘regarded the knee as
and MCL, just as Smith had done several years before him. unstable’’, 50% of patients nevertheless presented a posi-
In 1963 Kenneth Jones of Little Rock, Arkansas, sug- tive anterior drawer sign. When Jones reviewed 83 of his
gested a new surgical technique which he ‘‘considered patients in 1980, almost 30% were lacking confidence and
Fig. 19 Illustrations taken form Willis Campbell’s publication on knee ligament repair published in 1936. He became the first American to use
extensor fascia and part of the patellar tendon to reconstruct the ACL (with kind permission of Elsevier, Philadelphia) [32]
123
Fig. 20 Illustrations of the original ‘Jones Procedure’ as described by Kenneth Jones in 1963. Of note is the non-anatomical femoral tunnel
placement through the inferior part of the femoral trochlea (with kind permission of the Journal of Bone & Joint Surgery, Boston) [141]
Fig. 21 Werner Müller’s model

of the ‘Four-bar-linkage’, first
developed by Zuppinger of
Vienna and later refined by
Strasser and Menschik,
demonstrating the detrimental
effect of anterior mal-
positioning of femoral tunnel in
relation to the anatomical foot-
print of the native ACL (with
kind permission of Springer,
Berlin) [213]
suffered residual symptoms [143]. Despite its shortcom- into the joint. This allowed Brückner to position a blind
ings, Jones’s technique gained widespread popularity par- ending femoral tunnel closer to the anatomic foot print of
ticularly in the United States and reconstruction of the the ACL in the intercondylar notch creating a more phys-
ACL with patellar tendon graft became known as the iological reconstruction and improved graft isometry. The
‘Jones procedure’. graft was pulled tight into the femoral tunnel and with the
In 1966 Helmut Brückner of Rostock, Germany knee positioned at about 40 of flexion, and secured with
described the use of the medial 1/3 of the patellar tendon wire sutures tightened over a small metal button. As an
which he left attached distally, whilst the proximal part was alternative technique Brückner recommended the use of a
lifted off the patella together with a thin sliver of bone [30] free central strip of bone-patellar tendon-bone graft (B-PT-
(Fig. 22). To overcome problems of insufficient graft B) taken from the contra-lateral knee in cases where the
length, which had forced Jones to compromise on the ipsi-lateral patellar tendon was compromised through pre-
femoral tunnel position, Brückner re-routed the patellar vious surgery. By 1969 he had performed 35 reconstruc-
tendon graft through a tibial tunnel, thereby essentially tions, 90% of which regained normal stability and 25%
shortening the distance between graft attachment and entry experienced minor discomfort after strenuous activities
123
Fig. 22 ACL reconstruction utilising the pedicled medial section of a patellar tendon graft as devised by Brückner in 1966 (with kind permission
of Springer Science, Berlin) [30]
[239]. The Brückner technique remained relatively ‘Quadriceps tendon substitution’ technique published in
unknown at first but received wider attention through Enjar 1979 [193]. They utilised the distally attached central third
Eriksson of Stockholm, who in 1976 presented a series of of the patellar ligament, the pre-patellar expansion and part
72 patients, of whom 80% were stable at 1 year [74]. of the quadriceps tendon as a single graft, which they
Emerging evidence on changes of patellar kinematics pulled through a tibial tunnel and looped ‘over-the-top’ of
resulting in an increased tendency to patellar subluxation the lateral femoral condyle (Fig. 23).
and subsequent degeneration brought an end to utilising the In 1976 Kurt Franke of Berlin presented his experience
medial 1/3 of the patellar tendon in favour of a central strip of 130 ACL reconstructions using a free graft of the central
[196, 301]. third of the patellar tendon as previously described by
William Clancy of Madison, Wisconsin became a major Brückner [30, 83]. This was the first publication on clinical
proponent of patellar tendon for ACL reconstruction in the long-term results with a free bone-patellar-tendon-bone
United States [37]. Unaware of Brückner’s original work, (B-PT-B) graft in a large patient cohort, providing good
Clancy initially described an almost identical technique functional outcome in combination with a reliable and
using a pedicled patellar tendon graft. Although he reported reproducible technique. Following Franke’s publication,
encouraging clinical results with this technique, he even- B-PT-B was to become one of the most popular graft
tually converted to using a free tendon graft [38]. John sources and was further popularised through the work of
Marshall and associates chose a different approach to Eriksson in Europe and Clancy in the United States
overcome problems of insufficient graft length with their [38, 74].
Fig. 23 Quadriceps tendon

substitution technique devised
by Marshall and associates in
1979. The graft was placed in
the ‘over-the-top’ position close
to the proximal aspect of the
foot-print of the ACL (red area)
Elsevier, Oxford) [129]
123
Quadriceps tendon: 1984—today hamstring tendons [66]. He was not concerned with ana-
tomic reconstruction, since he used a single femoral tunnel
With time however, it became apparent that harvesting drilled through the medial femoral condyle and two tibial
autogenous patellar tendon graft was not an entirely benign tunnels placed in the anterior aspect of the tibial spines. No
procedure but associated with postoperative problems such as clinical cases using his technique were ever reported.
patellar fracture [264], patellar tendon rupture [195], flexion In 1934 Riccardo Galeazzi (1866–1952) of Milan pio-
contracture, patellar tendonitis and anterior knee pain [3, 222, neered anatomic ACL reconstruction with semitendinosus
230, 253]. Mindful of the potential morbidity associated with tendon which he left distally attached to the pes anerinus
patellar tendon harvest some surgeons started experimenting [91]. Using a three incision technique, he threaded the
with using a central section of the quadriceps tendon. In 1984 tendon through 5-mm tunnels, placed according to Hey
Walter Blauth of Kiel became the first to publish on the use of Groves’ original description (Fig. 25). Patients were im-
quadriceps tendon for chronic ACL deficiency [21]. The graft mobilised in a cast for 4 weeks and remained partially
was harvested with a triangular-shaped bone block distally weight bearing for 6 weeks. All three patients in his series
whilst the proximal part was divided into two strands thereby fared well even though follow-up was very short. Despite
facilitating a double-bundle reconstruction. Blauth positioned being forward thinking, Galeazzi’s surgical ingenuity
one bundle trans-femorally and the other ‘over-the-top’ of the remained obscured by language barriers as most of his
lateral femoral condyle (Fig. 24). Between 1982 and 1984, he work was published in lesser known Italian journals.
operated on 53 patients with apparently good results. In the Harry Macey (1905–1951) staff surgeon at the Mayo
United States John Fulkerson of Farmington, Connecticut Clinic in Rochester, unaware of Galeazzi’s earlier publi-
became the key promoter of quadriceps tendon which he cation, presented a similar but simplified ‘two-incision’
considered to be superior to any other graft source [90]. technique for the use of semitendinosus tendon [183]. The
Quadriceps tendon, however, never gained the same level of knee was exposed via an S-shaped lateral para-patellar
popularity as patellar tendon or hamstrings despite experi- approach whilst the hamstring tendon was severed through
mental studies confirming their excellent mechanical prop- a small stab incision at its musculo-tendinous junction
erties as a tendon graft [275]. Today the use of quadriceps (Fig. 26). He did not report on any clinical cases. A vari-
graft continues to occupy a fringe position and remains a ation on Macey’s technique was offered by James
suitable alternative in the revision setting or when other graft McMaster of Pittsburgh in 1974 [201]. He reported on
sources are compromised [54, 96, 271]. using pedicled gracilis instead of semitendinosus tendon,
which he fixed to the lateral condyle with a staple.
Hamstring tendons: 1927—today In 1950 Kurt Lindemann of Heidelberg (1901–1966)
developed the concept of ‘dynamic reconstruction’ by
In 1927 Alexander Edwards of Glasgow suggested an attempting to take advantage of the stabilising effect of the
operation he had performed on a cadaver whereby both muscle–tendon unit, a principle first explored by Hey
cruciate ligaments were replaced with the proximally based Groves in 1917 [113, 176]. Lindemann utilised proximally
Fig. 24 Double-bundle ACL

reconstruction using quadriceps
tendon graft according to
Blauth. Of note are the
preservation of the ACL stump
and the press-fit fixation of the
graft via bone block in the tibial
tunnel (with kind permission of
123
Fig. 25 Riccardo Galeazzi

became the first surgeon to
publish on the clinical use of
hamstrings in the reconstruction
of the ACL in 1934. A distally
based semitendinosus tendon
was threaded through near
anatomically placed bony
tunnels in tibia and femur [91]
Fig. 27 The Lindemann ‘dynamic reconstruction’ technique intro-

duced in 1950, was believed to reduce knee instability through the
Fig. 26 Harry Macey introduced his two-incision technique using
actively stabilising effect of the gracilis muscle/tendon unit (with kind
pedunculated semitendinosus tendon in 1939. He utilised a small stab
permission of Springer Science, Berlin) [291]
incision to cut off the tendon at the musculo-tendinous junction (with
kind permission of Elsevier, Philadelphia) [183]
when the hamstrings are contracted’’. Augustine, however,
based gracilis tendon, passed through an opening in the expressed doubts that any reconstructive effort of a chronic
postero-lateral capsule into the inter-condylar notch, and cruciate ligament rupture would result ‘‘in return to a
threaded through a tibial tunnel positioned at the foot print normal state’’ and that such knees are ‘‘possible of
of the ACL (Fig. 27). At an average follow-up of 2 years, improvement but not cure’’. His views were echoed by
all 6 patients, originally affected by isolated ACL defi- other investigators including O’Donoghue and Insall and
ciency, regained normal knee function and were able to summed-up by Kenneth Jones in 1963, who commented
return to work. that ‘‘Anatomical normalcy of the structure is, by the nat-
Robert Augustine of Madisonville, Kentucky suggested ure of the situation, beyond expectation’’ [128, 141, 227].
an almost identical technique to the one proposed by Nevertheless, dynamic reconstructions gained relative
Lindemann 6 years earlier but instead of gracilis chose a success for some time, as surgeons believed that with intact
pedicled semitendinosus graft [13]. Like Lindemann, he proprioceptors and attachment to active muscle, tension in
believed in the dynamic effect of the operation to ‘‘stabilise the transfer would be maintained and anterior subluxation
the tibial plateau on the femur in conjunction with the PCL of the tibia prevented [65, 283].
123
Merle d’Aubigné of Paris (1900–1989) described his encouraged early mobilisation thereafter. The idea of early
techniques and results of ACL reconstruction with distally mobilisation was later expanded upon by Donald Shel-
based semitendinosus tendon graft in 1957 [52]. He was bourne of Indianapolis, who, in 1992, created his concept
followed by Max Lange, who had used the original Hey of ‘‘accelerated rehabilitation’’ [260, 261].
Groves technique since the 1940s and was one of the first Reports on the use of human allografts in other areas of
surgeons to publish clinical long-term follow-up results Orthopaedics were able to confirm their mechanical, bio-
[93, 169]. Out of 50 isolated ACL tears, he reported logical and functional comparability to autologous tissue
excellent outcomes in 82% following early reconstruction grafts [130, 234, 298]. In 1984 Konsei Shino of Osaka
and in 62% when surgery was delayed. Although Lange studied the mechanical properties of both allografts and
was satisfied with his results achieved with fascia, he autografts in a dog model without finding any significant
changed over to using hamstrings as the operation required differences [262]. Two years later, his group became one of
less exposure and soft tissue dissection and therefore the first to publish clinical results of 31 patients who had
reduced the surgical trauma to the patient [170]. In the received allogenic reconstruction of the ACL utilising
United States, Kenneth Cho of Washington DC also mainly anterior tibial and calcaneal tendon grafts [263].
adopted distally attached semitendinosus as graft source After a minimum follow-up of 2 years, all but one patient
and in 1975 reported overall good results and no residual had been able to return to full sporting activities. Further
anterior drawer sign in 5 out of 7 patients [36]. Cho publications by Richard Levitt and associates of Miami
believed that ‘‘the preservation of the tendon sheath and who reported excellent results in 85% of cases at 4 years
its intact distal insertion may help to retain some of the with patellar and Achilles tendon allografts and Jacques
vascularity, rendering it more compatible with the intra- Defrere & Anne Franckart of Liege who had similar results
synovial environment’’. in their group of 70 patients at 4.5 years with patellar
In 1982 Brant Lipscomb of Nashville started using both grafts, paved the way for allografts to achieve relative
semitendinosus and gracilis tendon as a double-strand left popularity particularly in the United States [55, 174].
attached to the pes anserinus [178]. Six years later, fol- Unfortunately, the increased risk of viral disease trans-
lowing on from Lipscomb’s experience, Marc Friedman of mission (e.g. HIV, Hepatitis C) associated with allografts
Los Angeles pioneered the use of an arthroscopically in the 1990s created a significant setback for this technol-
assisted four-strand hamstring autograft technique, which, ogy. Sterilisation methods were developed to reduce this
despite several smaller modifications, set the standard for risk, but radiation in particular affected the collage struc-
ACL reconstruction with hamstrings for the next 25 years ture and with it the mechanical properties of the graft [244,
[86]. Long-term follow-up studies have since confirmed 270]. Allograft reconstruction has only recently regained
almost equivalent results regarding knee function and some of its ground through the introduction of improved
prevalence of osteoarthritis, independent of the choice of ‘graft-friendly’ sterilisation techniques, although it is still
graft tissue [118, 247]. not possible to definitively eliminate the risk of viral
disease transmission [209, 245]. Today allograft tissue
Allografts: 1929—today remains an attractive and reliable alternative to autograft in
the primary and revision setting despite the rather consid-
Allograft reconstruction of the ACL was an attractive erable cost implications [107].
proposition as it avoids the need of graft harvest and
associated donor site morbidity and prevents weakening of Synthetics: 1903—today
external ligament and tendon structures which contribute to
overall joint stability. Eugene Bircher of Arau in Switzer- The use of synthetic materials has intrigued surgeons for
land (1882–1956), better known for his pioneering work on over 100 years. It was hoped that readily available ‘off-the-
arthroscopy, conveyed his experience with kangaroo ten- shelf’ synthetic grafts could be developed which are
don as an augment as well as a sole graft in 1929 and was stronger than soft tissue equivalents, and simplify the
followed by Micheli from Italy who published his results operation by avoiding graft harvest and associated donor
4 years later [18, 19, 206]. Kangaroo tendon, however, site morbidity. Themistokles Gluck of Berlin (1853–1940),
remained a rare choice, and like other xenografts, never pioneer of joint arthroplasty, successfully bridged tendon
gained any real popularity. Bircher was also one of the first defects with plaited catgut in 1881, but did not take his
clinicians to promote a more progressive rehabilitation discovery further [100]. Fritz Lange of Munich
regime following surgery, just like Bonnet had done for the (1864–1952) suggested silk sutures as prosthetic ligaments
conservative management in the previous century [18, 24]. to stabilise ‘wobbly’ knees in 1903 [165]. Lange had
He used a sliding frame during the initial 10-day period already used silk as early as 1895 for the treatment of
instead of the then traditional plaster of Paris, and paralytic feet and in 1907 reported on 4 cases of ACL
123
deficiency, which he stabilised by using ‘‘artificial liga- fascia in ACL reconstruction [167, 168]. Lange was
ments made of silk’’ in conjunction with the tendons of mindful that joint stability could not be achieved by silk
semitendinosus and semimembranosus placed extra-artic- alone, which he saw merely as a foreign body scaffold
ularly [166] (Fig. 28). The silk was slowly surrounded by providing initial strength whilst inducing a process of lig-
fibrous tissue, and Lange praised the ‘‘wonderful ability of ament healing and re-growth. Karl Ludloff of Frankfurt
the silk to produce fibrous tissue under functional stress’’, a (1864–1945) had followed a similar approach when in
finding confirmed through histological investigations by 1927 he used a strip of fascia wrapped around a thick
Max Borst a few years earlier [25]. central silk suture to replace the ACL in a 23-year-old
Alwyn Smith of Cardiff was critical of silk after a farmer who had come off his motorbike [182] (Fig. 29). He
patient suffered with synovitis which only settled once was meticulous in trying to place both tunnels at the centre
Smith had removed all silk from the joint [268]. A similar of the anatomical foot prints of the ACL and kept tunnel
experience prompted Max Herz in 1906 to declare that diameters small enough to obtain a tight fitting graft.
‘‘The silk ligaments were too beautiful an idea; the Ludloff refrained from any form of graft fixation as he
attempts to copy something from nature had failed’’ [110]. believed that the graft should be allowed to establish
Although both Herz and Smith realised that silk cannot equilibrium of tension. Like Bircher, Ludloff encouraged
survive when used in isolation within the intra-articular early mobilisation from day 14 and walking from day 25
environment, they failed to appreciate the fibrogenic onwards. The patient was reviewed at 5 months, after
potential of silk when placed in direct proximity to colla- having gone back to his duties as a farmer, presenting
gen rich tissue. Fritz Lange’s grandson Max (1899–1975), minimal loss of flexion and a negative anterior drawer sign.
who also became Professor of Orthopaedics in Munich, Edred Corner of St Thomas in London (1873–1950)
achieved clinical success by utilising silk augmented with presented the case of a 29-year-old man, who injured his
Fig. 29 The first ACL augmentation device as presented by Ludloff

Fig. 28 Fritz Lange’s early attempt to reconstruct the torn ACL with in 1927. The fascia lata graft is wrapped around a thick silk suture and
silk sutures placed trans-femorally (with kind permission of Georg placed through tight fitting bony tunnels without additional fixation
Thieme, Stuttgart) [168] (with kind permission of Hüthig Jehle Rehn, Heidelberg) [182]
123
knee playing football and subsequently complained ‘‘of stability. The production of the Dacron ligament device
pain, and weakness in the knee joint, which gives way was finally discontinued in 1994.
suddenly, letting him down’’ [43]. Corner employed a In 1973 Proplast, a porous Teflon graft claiming to
novel technique by passing a loop of silver wire through offer enhanced fibrogenic properties, became one of the
the lateral condyle which was interlaced with a similar loop first synthetic graft materials to receive FDA approval, but
brought through the tibia to form a new ACL (Fig. 30). clinical performance was disappointing [305]. David Jen-
Post operatively the patient was advised to wear an appa- kins of Cardiff began to use flexible carbon fibres to
ratus ‘‘to limit his knee movement’’. The latter broke and reconstruct the ACL in the mid-1980s [140]. The carbon
with it the wire loops, but no information was disclosed was thought to act as a temporary scaffold, encouraging the
upon the patient’s fate. ingrowth of fibroblastic tissue and the production of new
The second half of the twentieth century saw a myriad collagen. More often than not however, fragmentation of
of different synthetic ligament graft materials appear. In carbon occurred creating unsightly staining of the syno-
1949 Rüther of Germany reported disappointing results vium and foreign body reaction. Not unsurprisingly in the
following the implantation of a synthetic ACL made of hands of most investigators, carbon fibre ACL recon-
Supramid, a polyamide derivative [252]. Olav Rostrup of struction provided for rather inconsistent and often unre-
Edmonton, Alberta started using synthetic grafts in humans liable results especially when used in isolation [251].
in 1959 after having successfully implanted Teflon grafts Angus Strover of South Africa demonstrated more prom-
into dogs knees [72, 249]. He saw synthetics primarily as ising results with collagen-coated carbon fibre which he
augmentation devices to support fascia or tendon and felt published in 1985 [279]. He noticed that when placing
that Teflon or Dacron were ‘‘not the ideal material’’ and ‘‘carbon fibres either within the remnants of the original
hence did ‘‘not recommend its wide-scale or indiscriminate ligament or within a sheath of fascia and maintained in the
use’’. Stryker nevertheless made Dacron as a ligament retro-synovial situation, no carbon debris appears within
replacement device commercially available in the 1980s. the joint cavity, and a normal-looking cruciate ligament
Richard Wilk of Burlington and John Richmond of Boston results’’.
reviewed 50 patients following ACL reconstruction with Awareness of the potential biological and biomechanical
the Stryker Dacron ligament in 1993 and recorded a shortcomings of using a single type of synthetic material
significant deterioration of ligament failure rate from 20% prompted attempts to combine materials of favourable
at 2 years to 37.5% at 5 years [299]. Wolfgang Maletius characteristics. Strover and associates developed the ABC
and Jan Gillquist of Sweden reported their 9-year follow-up (Activated Biological Composite) ligament in the mid-
results in 55 patients in 1997 [189]. By that time, 44% of 1980s, which combined the advantages of polyester in
grafts had failed, 83% had developed radiographic signs of terms of durability, based on the success of Dacron vas-
osteoarthritis and only 14% presented with acceptable cular grafts, and those of carbon in terms of its fibrogenic
Fig. 30 Corner’s attempt of

ACL reconstruction with
interlaced silver wire in 1914
(With kind permission of John
Wiley & Sons, Hoboken) [43]
123
potential [280]. Carbon and polyester were interwoven in a Munich examined the mechanical properties of 51 different
type of plaited arrangement, positioned through a tibial commercially available polymer ligaments under physio-
tunnel distally and over-the-top proximally and secured logical conditions and found only one type to meet basic
with bollards placed through prefabricated ligament loops. testing requirements [241, 242]. It was eventually conceded
The ABC ligament enjoyed a period of relative success in that in vivo functional stresses applied on the knee exceed the
the 1980 and 1990s but like all other synthetic grafts biomechanical properties of the new ligaments in the long
eventually became obsolete. term [22, 136]. Improved results with intra-articular recon-
In the late 1970s, Jack Kennedy of London, Ontario struction using autologous grafts finally saw the end of
introduced a ligament augmentation device made of poly- synthetics in ACL reconstruction, a trend Ejnar Eriksson of
propylene, which became known as the ‘Kennedy-LAD’ Stockholm had already anticipated in 1976 by saying syn-
[150] (Fig. 31). The concept arose from observations that thetics are ‘‘like shoestrings, they eventually break’’ [75].
biological grafts are affected by temporary degeneration
and loss of strength before being fully incorporated and
that the LAD would protect the biological graft during this Extra-articular ACL reconstruction: 1913—today
vulnerable phase. Kennedy created the notion of load
sharing, as he was hoping the LAD would reduce stresses The complexities of intra-articular reconstructions were
and strains on the natural graft and prevent early graft often fraught with peril and clinicians were eager to find
failure [153]. Lars Engebretsen and associates of Trond- ways to simplify stabilising procedures for ACL deficien-
heim in Norway commenced a large randomised controlled cies without opening the joint. This idea was fostered by
study in 1990 to assess the merits of the LAD compared to Henry Milch of New York (1895–1964) who in the early
acute repair and reconstruction with autologous B-PT-B 1930s promoted the principle that ‘‘a torn ACL left little if
[73]. He enrolled 150 patients into the three treatment arms any disability whilst the medial or tibial collateral ligament
and produced follow-up results of up to 16 years. Both is of the utmost importance in the stability of the knee’’
acute repair and repair with the LAD provided for failure [207, 208].
rates of up to 30%, and the authors hence discouraged any
form of repair other than autograft reconstruction [64]. The
Kennedy-LAD together with the Leeds-Keio and the
LARS ligament became nevertheless one of the very few
synthetic grafts which gained more widespread popularity
and which have remained in use as augmentation devices
up to this day.
Various other synthetic ACL grafts, including Gore-
Tex, PDS, Eulit, and Polyflex, were introduced during
the same period [136] (Fig. 32). Clinicians, however,
became over-optimistic regarding the clinical long-term
performance of most of these materials, as their in vitro
behaviour showed fatigue resistance on cyclic loading
beyond the limit of human endurance [250]. The hope of
finding a reliable and durable off the shelf ACL replacement
was soon dampened by a flood of reports on an increasing
amount of fatigue failures, including graft re-rupture,
chronic synovitis, tunnel widening through osteolysis, for-
eign body reaction, and poor incorporation of the synthetics
into host bone [127, 265, 304]. In 1981 Wolfgang Plitz of
Fig. 32 Synthetic anterior cruciate ligament stent in situ according to

Fig. 31 Ligament Augmentation device (PROLAD) with fixation James in 1979 (With kind permission of Lippincott Williams &
lugs (Courtesy of Prof. W. Plitz, Munich) Wilkins, Philadelphia) [136]
123
The first account of an extra-articular procedure was

published in 1907 by Fritz Lange who successfully placed
silk sutures across the joint space in an attempt to treat
knee instabilities (see chapter 4.7) [166]. Encouraging
results of free tissue transfer obtained between 1910 and
1913 by Martin Kirschner of Königsberg (1879–1942) and
John Davis of Baltimore (1842–1946) persuaded the
Swedish surgeon Knut Giertz (1876–1950) in 1913 in
attempting to stabilise the knee of a 13-year-old girl who
had lost her cruciates as a result of septic arthritis during
childhood [53, 97, 154, 155]. He succeeded by augmenting
both collateral ligaments with sections of fascia lata and
the child regained good function albeit with slight restric-
tions in motion.
In 1918 Hermann Matti of Bern (1879–1941) published
his paper entitled ‘Replacement of the torn anterior cruciate
with extra-articular free fascia graft’, where he describes
the application of an obliquely placed doubled-up fascia
strip running from the posterior aspect of the medial fem-
oral condyle towards the antero-medial aspect of the tibia
[197]. For PCL insufficiencies, he simply reversed the
alignment of the fascial strip. A number of similar proce-
dures focussing on strengthening of the MCL and antero-
medial capsule were introduced over the next 20 years,
based on the general believe, that rupture of the ACL
would commonly occur in conjunction with injury to the
medial structures [20] (Fig. 33).
Granville Bennett of Boston described an almost iden- Fig. 33 Various types extra-articular reconstructions introduced
tical procedure to Matti, whereby the medial ligament was between 1920 and 1940 aimed at stabilising the medial capsule and
tightened and reinforced with a free strip of fascia woven collateral ligament thereby primarily addressing antero-medial insta-
along the medial joint line [16]. In 1936 David and bility (with kind permission of Elsevier, Philadelphia) [20]
Bordman Bosworth of New York presented three suc-
cessful clinical cases of extra-articular joint reinforcement and fastened to itself at the entry point into the femur, thus
using strips of fascia arranged in a fan shape across the forming a complete loop (Fig. 34). Strickler believed such a
joint space [26]. In the same year, Page Mauk of Rich- single loop could service both ACL and PCL insufficiencies.
mond, Virginia proposed sub-periosteal advancement of The principle of this idea was rediscovered and modified in
the distal MCL attachment to cure recurrent instability the 1980s by a number of surgeons who believed that intra- or
whilst Emil Hauser of Chicago (1897–1981) utilised part of extra-articular reconstruction performed in isolation were
patellar and quadriceps tendon which he left attached to the more likely to fail longer term [37, 311].
patella and secured in a criss-cross fashion onto the antero- Arthur Jacob Helfet of Cape Town (1907–1989) pro-
medial capsule [108, 198]. In 1973 Dolanc of Basel vided further impetus for what became a period which
advocated opening wedge tibial osteotomy above the distal inspired surgeons particularly in the United States to
MCL attachment to treat knee instabilities with concomi- explore extra-articular stabilisation procedures [109]. In
tant axial mal-alignment [61]. This idea was further 1963 Helfet published his treatise on the management of
developed by Roland Jakob of Berne and Henri Dejour and internal derangement of the knee in which he conveyed his
Phillipe Neyret of Lyon who saw a particular indication for theory on the function of the ACL. ‘‘If we consider that the
osteotomy in cases of residual instability following soft cruciate ligaments act as check-straps which prevent
tissue procedures or in established knee instability where anteroposterior movement of the tibia on the femur and that
osteoarthosis had already developed [58, 135]. resulting instability after rupture of these ligaments is due
In 1937 Frank Strickler of Louisville championed lateral to the absence of these check-straps, then the only logical
extra-articular substitution which he combined with intra- course of treatment is anatomic replacement. On the other
articular reconstruction [278]. A long strip of fascia was hand, if the cruciate ligaments are guide ropes which keep
routed through the joint and across the antero-lateral capsule the tibia in its normal helicoid track on the medial condyle
123
strip which he positioned underneath the lateral collateral

ligament, threaded through a bony tunnel slightly posterior to
the lateral femoral epicondyle, folded back and sutured
against its origin at Gerdy’s tubercle. By 1975, he had
operated on 328 isolated ACL ruptures of which he rated
87% as good [173]. Lemaire was aware that, although his
procedure was ill-equipped to control the anterior drawer, it
controlled some of the rotational instability associated with
ACL deficiency, which in clinical practice appeared to be
enough to allow patients to resume sporting activities.
In 1968 Donald Slocum and Robert Larson of Eugene,
Oregon introduced the notion of rotatory laxity, citing, as
the usual cause, an injury to the ACL and the medial lig-
ament complex [266]. This was thought by many to be
insufficiently addressed by ACL reconstruction alone and
demanded extra-articular reinforcements either in combi-
nation as ‘belt-and-braces’ or as independent procedures
[37, 41, 311]. Initially, the emphasis was placed on anterior
medial rotatory instability [41, 125, 228]. This produced a
myriad of extra-articular procedures most notably the ‘pes
anserinus transfer’ of Slocum and Larson and the ‘five-in-
one repair’ of Nicholas, which were designed to hold the
tibia in an internally rotated position [215, 267]. Anatom-
ical studies by Kennedy and Fowler, and the establishment
of the ‘pivot shift phenomenon’ as pathognomonic for ACL
deficiency, prompted Hughston to incorporate these find-
Fig. 34 Combined intra- and extra-articular reconstruction with ings into his ‘anterior lateral rotatory instability’ theory
fascia loop as suggested by Strickler in 1937 which was designed [94, 126, 149]. A subsequent move towards laterally based
to cater for both ACL and PCL deficiencies (with kind permission of procedures limiting primarily antero-lateral subluxation of
Lippincott Williams & Wilkins, Philadelphia) [278]
the tibia followed and was led by MacIntosh, who devised
his ‘lateral substitution reconstruction’ in the mid-1970s
of the femur, it is possible to replace this function by extra- [185, 186]. This was essentially a variation on the Lemaire
articular tendon transplant’’ [109]. Helfet made a case for technique, avoiding the use of a bony tunnel and instead
the latter and his views were echoed by Arthur Ellison of threading the fascia through the lateral intermuscular sep-
Williamstown, Massachusetts (1926–2010), who consid- tum (Fig. 35). Depending on the level and type of knee
ered the ACL to be ‘‘located virtually at the axis or pivot of laxity, this procedure could be used either on its own or in
the knee and as such it is at the hub of the wheel’’ [71]. addition to an intra-articular stabilisation. If significant
This, so Ellison believed, ‘‘places it in a superb location to laxity was present, MacIntosh suggested to combine extra
guide rotational movement but at a very disadvantageous with intra-articular reconstruction. In this technique, which
position to restrict rotation’’. He saw distinct advantages in was not too dissimilar to what Strickler’s had described 40
stabilising the knee on the outside rather than to reconstruct years earlier, he routed the pedicled facia sling ‘over-the-
the ACL, based on his thinking that ‘‘it is easier to control top’ of the condyle, through the intercondylar notch and
rotation of a wheel at its rim than at its hub’’. Subsequently into a tibial tunnel exiting close to Gerdy’s tubercle [133].
extra-articular procedures became fashionable and enjoyed Various other extra-articular substitution procedures
a period of popularity until the late 1990s. became popular around the same time, most of which
Marcel Lemaire of Paris (1918–2006) started using a addressed antero-lateral instability, trying to control the
lateral extra-articular augmentation in 1960 which became pivot-shift phenomenon by using methods of capsular
particularly popular in Europe and Canada [172]. His pro- tightening, various tendon and fascial slings to re-route the
cedure was based on the then accepted wisdom ‘‘that the role ilio-tibial tract and repositioning of ligament attachments
of the ligament was to control external rotation’’, and that [42, 62, 71, 216]. Those included most notably the ones
‘‘people thought that ruptures of the anterior cruciate hap- described by Albert Trillat of Lyon (1972), Arthur Ellison
pened through a combination of valgus-flexion-external [69], Michael Jäger & Carl-Joachim Wirth of Munich
rotation’’. Lemaire used a distally attached central fascia lata (1976), Ronald Losee of Ennis, Montana (1978), and
123
Fig. 35 David MacIntosh of

Toronto (on far left) performing
his extra-articular fascia lata
tenodesis. The procedure was
popular with surgeons during
the 1980 and 1990s and was
used in isolation or in
combination with intra-articular
reconstructions (photograph
courtesy of David Dandy;
Illustration with kind
permission of Elsevier, Oxford)
[129]
Werner Müller [70, 133, 181, 213, 286, 287] (Fig. 36). Although most extra-articular procedures diminished or
Conscious of the notion of isometry and the failure of most obliterated pivot shift and Lachman manoeuvres, they
extra-articular procedures to provide stability throughout a provided for temporary stability only, as the repairs even-
full range of motion, James Andrews of Columbus, Geor- tually stretched-out [62]. Extra-articular reconstructions
gia devised his ‘‘mini reconstruction’’ in 1983 [10]. He gradually fell out of favour when reports emerged about
formed an anterior and posterior bundle of the ITB which their unpredictability to satisfactorily decrease tibial sub-
he tenodesed against the lateral femoral epicondyle so that luxation [82, 152, 212, 296]. In a landmark paper, Jack
the anterior part would be tight in flexion and the posterior Kennedy reported in 1978 on 52 patients following extra-
in extension. In 1981 Jakob described the ‘reverse pivot articuar stabilisation with only 47% achieving good to
shift sign’ introducing the concept of postero-lateral rota- excellent results [152]. This was echoed in the same year by
tory instability [134]. By this time, clinicians had created a Russell Warren and John Marshall of the Hospital of Spe-
classification of all variations of straight and rotatory knee cial Surgery in New York, who, after reviewing the results
instabilities, appropriate tests to define them, and a plethora of 86 patients, concluded that ‘‘as a general rule, extra-
of surgical remedies to treat them [56, 129, 213]. articular surgery without attention to the cruciate ligaments
Fig. 36 Lateral extra-articular

reconstruction through re-
routing of the ilio-tibial band
according to Jäger and Wirth
(left) and Ellison (right) (with
kind permission of Thieme,
Stuttgart) [133]
123
will often result in failure’’ [296]. In their biomechanical

study in 1993, Andrew Amis and Brigitte Scammell of
London found no basis for combining intra with extra-
articular reconstruction in isolated ACL deficiency, where
the main aim was to control anterior drawer [7]. This
however, so they conceded, ‘‘does not affect the role of
extra-articular procedures in controlling complex rotatory
instabilities, such as those resulting from combined injuries
of the ACL and peripheral structures affecting pivot shift
more than anterior drawer’’. Their findings were echoed by
clinical reports suggesting that intra-articular reconstruction
of the ACL would be sufficient in the treatment of knee
instability following isolated ACL tear and extra-articular
procedures added little to the overall functional out-come
[9, 222, 281]. Although this view was not shared uniformly,
most additional extra-articular procedures had vanished by
the end of 1990s [37, 63, 311].
The last few years have seen a renewed interest in
combined ACL reconstruction with extra-articular aug-
mentation, based on the notion that the additional repair will
not only protect the ACL graft from excessive loads espe-
cially during the healing process, but also improve lateral Fig. 37 Maurillio Marcacci’s combined extra and intra-articular
rotational control [190, 309]. The advantage of inhibiting reconstruction using double-strand hamstring graft (with kind
permission of SAGE Publications, London) [190]
pivot shift appears particularly desirable due to emerging
evidence that residual rotatory mobility might be associated
with an increase in post-surgical osteoarthritis [147]. In plastic deformation (a status whereby structural changes
2009 Marcacci and associates from Bologna presented make it impossible for the ligament to return to its original
11-year follow-up results of 54 patients who received length). Reproducing the ACL bundles and their tension
double-stranded hamstring ACL reconstruction and lateral pattern with a single tubular graft composed of parallel
augmentation, a technique not dissimilar to MacIntosh’s fibres posed difficulties to most surgeons, as they were
‘over-the-top’ repair [191, 192]. Over 90% presented with unsure where to place the ideal tibial and femoral tunnels
good to excellent IKDC scores and 97% had less 5 mm within the functionally important fan-shaped foot prints of
antero-posterior movement on arthrometer testing (Fig. 37). the native ACL. Orientation was usually accomplished
Although it is generally conceded that most cases of ACL through bony landmarks such as the lateral intercondylar
deficiency are suitable for isolated ACL reconstruction, ridge or ‘resident’s ridge’, first described by William
those with ‘‘associated ligamentous lesions of a subclinical Clancy Jr., which is located immediately anterior to the
nature’’ as quoted by Hughston, which often fail if standard ACL attachment [78]. It is often mistaken as the ‘over-the-
reconstruction techniques are applied, might be suitable top position’ by inexperienced surgeons in training, and
candidates for combined procedures. To achieve this reli- likely to lead to gross anterior graft misplacement, which is
ably, more specific quantitative assessment tools to define one of the most common causes of graft failure in ACL
thresholds of laxity are necessary, in order to tailor the most reconstruction [139].
appropriate treatment option to the individual [310]. In 1974 Artmann and Wirth were able to define isometric
points within the ACL origins, thus showing little or no
change in distance of linear separation as the knee was
The concepts of isometric and anatomic reconstruction flexed and extended [12] (Fig. 38). In their experiments, the
femoral tunnel was best placed within the postero-superior
The biomechanical concept of graft isometry was devel- portion of the anatomic foot print, close to the ‘over-the-
oped in the 1960s and was based on the notion that the top’ position, whilst the position of the tibial tunnel
ideal anterior cruciate ligament graft should be isometric, appeared to be less critical. Based on their results, Artmann
either in part or in the mechanical summation of its parts and Wirth concluded that reconstruction of the ACL should
[44, 163, 224]. Isometric placement of the ACL hence aim to primarily replace the antero-medial bundle. Their
referred to the concept that a full range of knee motion can findings were later confirmed through experimental studies
be achieved without causing ligament elongation and conducted by other investigators [202, 224, 235].
123
Fig. 38 Illustration taken from

Artmann & Wirth experimental
study on the definition of
isometric attachment points of
the ACL. Changes in distance
between the common origin on
the tibia and various attachment
points on the lateral wall of the
inter-condylar notch are
demonstrated (with kind
permission of Springer Science,
Berlin) [12]
To achieve greater surgical precision and reliable graft

placement, improved surgical equipment was required. The
first specific femoral drill guide was presented by Ivar
Palmer of Stockholm (1897–1985) in 1938 but received
little attention [232] (Fig. 39). More refined guiding
instruments were introduced in the 1960 and 1970s by Soli
Lam of London, Enjar Eriksson of Stockholm and George
Hewson of Tuscon [75, 112, 163]. Dale Daniel
(1939–1995) and Richard Watkins of San Diego, best
known for their creation of the KT-1000 Knee Ligament
Arthrometer, developed the tension Isometer in 1986 [50,
51] (Fig. 40). This was to become the first commercially
available instrument to define points of equidistance for
isometric graft placement and to provide improved preci-
sion in obtaining tension and displacement measurements
prior to graft fixation. Enthusiasm for using tension iso-
meters however started to wane towards the end of the 1990s
when it became apparent that they lacked accuracy com-
pared to off-set guides which allowed for the positioning of
the femoral tunnel at a set distance from the posterior
condyle, hence providing more reliable and reproducible
tunnel placements [81, 256] (Fig. 41). Advances in surgical
equipment proved crucial in improving surgical accuracy Fig. 39 Photograph of Ivar Palmers original femoral tunnel prepa-
and gave clinicians the necessary tools to achieve repro- ration equipment which included the first aiming and drill guide as
seen on the left (with kind permission of Acta Orthopaedica
ducible results making ACL reconstruction a more reliable Scandinavica, Stockholm) [232]
operation which even the average orthopaedic surgeon
could tackle. at an isometric point within the notch but posterior to it
By the 1990s, surgeons started to recognise that the goal [85]. Pierre Chambat of Lyon believed that these fibres
to achieve isometry within a single or double tubular graft should not be ignored as they display ‘‘favourable non-
proved an elusive one, and which, if achievable, would isometry’’, contributing to the rotational stability to the
create un-physiological conditions, as none of the identi- knee near extension [34]. In 1988 Friederich and O’Brien
fiable native ACL bundles are isometric in their own right conceived the notion of ‘functional isometry’ as they
[6, 162]. Through biomechanical investigations it became recognised that ‘‘only a limited number of fibres can
apparent that the majority of ACL fibres are not positioned directly interconnect isometric points’’ [85]. Whilst the
123
described the so called ’transition line’, which he believed

should represent the anterior border for ACL graft place-
ment, as any fibres positioned anterior to it would be
exposed to un-physiological elongation during knee flexion
[214, personal communication] (Fig. 42).
Over time it became apparent that any non-anatomical
single-bundle technique was unable to fully restore normal
knee kinematics or reproduce normal ligament function
and was hence thought to be responsible for the relatively
disappointing clinical results and the high prevalence of
arthritis long term [147, 180, 306]. The beginning of the
twenty-first century saw a movement away from the con-
cept of isometry towards ACL reconstruction focussing
more on physiological and anatomical principles, led by
Kazunori Yasuda of Sapporo and Freddie Fu of Pittsburgh
[307, 312]. Thus it was realised that any reconstructive
effort must restore any injured anatomic structure to its
normal functional position and tension. This philosophy,
however, was not new as Hey Groves, Palmer, Wirth and
Hughston had already recommended anatomic reconstruc-
tion in the treatment of these injuries previously.
In 1997 the group of Freddie Fu of Pittsburgh examined
the in situ force distribution between the anteromedial
Fig. 40 Illustration of patent application for a system for establishing
anterior cruciate ligament graft orientation and isometry, designed by
(AM) and posterolateral (PL) bundles of the ligament in
Daniel in 1986 (US patent No. 4.712.542) [51] response to applied anterior tibial loads and revealed that
the magnitude of forces in the PL bundle was significantly
affected by the flexion angle whilst forces in the AM
bundle remained relatively constant [89, 254]. This study
was the first to suggest that in order for an ACL graft to
reproduce in situ forces of the native ACL, reconstruction
technique would have to focus on the role of both bundles.
This prompted Fu to explore possible merits of anatomic
ACL reconstruction [312]. He has since developed the
‘anatomic double bundle concept’ which aims to more
closely replicate the native ACL anatomy, in its dimen-
sions, insertion and fibre arrangement [88, 210, 308]
(Fig. 43). The ‘anatomic double bundle concept’ can be
achieved through single or double-bundle reconstruction.
The reconstructive procedure is customised, based on the
patient’s individual anatomy and the precise mapping of
the ACL bundle insertion sites, which are known to show
significant variability [87, 160, 288]. Despite the enthusi-
Fig. 41 Illustration of patent application for an endoscopic femoral
off-set drill guide designed by Schmiedling in 1991 (US patent No. asm for this new technology, Jon Karlsson and associates
5.320.626) [256] have emphasised the importance of differentiating between
anatomic and double-bundle reconstruction, as the latter
most isometric fibres are the first to become taut, the ‘‘is merely a step closer to reproducing the native anatomy
remaining non-isometric fibres are strategically arranged to … [and] can still be done non-anatomically’’ [148].
allow for their progressive recruitment as increased bio-
mechanical demands arise during extension. Müller tried to
solve this conundrum by suggesting a compromise between Double-bundle ACL reconstruction
isometric and anatomic graft placement and conceived the
notion of ‘‘anatometry’’ in the early 1980s [213, 214]. Karl Ludloff, aware of the tension pattern displayed by the
Instead of working with a fixed point of isometry, Müller antero-medial and postero-lateral bundles of the ACL,
123
Fig. 42 ‘‘Anatometric’’ double-bundle reconstruction according to Müller. The AM bundle is placed in a 4 mm trough at the isometric point
(open circle) and none of the remaining fibres attach anterior to the transition line (line) (with kind permission of Springer Science, Berlin) [214]
Fig. 43 ‘Anatomic double-

bundle concept’ according to Fu
and associates. Three
dimensional laser scan image
highlighting the femoral
insertion sites of AM (blue) and
PL (yellow) ACL bundles.
Circles indicate best graft
placement in anatomic single-
bundle (a) or double-bundle
(b) reconstruction (with kind
permission of Elsevier,
Philadelphia; images courtesy
of Freddie Fu and Carola van
Eck, Pittsburgh) [288]
recognised that ‘‘reconstitution of relatively normal function reconstruction with split patellar tendon [214]. The free
would require the new cruciate ligament to consist of two tendon graft emerged from a single tibial tunnel, with one
separate bundles’’ [182]. Palmer had already performed leg being placed intra-osseously, whilst the other was
double-bundle ACL repairs in the 1930s claiming good positioned over-the-top of the femoral condyle (see
results, but his technique failed to find wider acceptance [232]. Fig. 42). Up to this point, traditional single-bundle recon-
Karl Viernstein and Werner Keyl of Munich pioneered struction techniques had aimed to replace the antero-medial
double-bundle ACL reconstruction with a proximally bundle, thereby predominately restoring antero-posterior
detached semidendinosus and gracilis graft in 1973 [289]. laxity. The addition of a postero-lateral bundle was hoped
In the description of their technique, the tendons were to address any remaining elements of rotational laxity.
routed through a single tibial tunnel into two separate The first publication on a double-bundle ACL recon-
femoral tunnels and sutured against each other at the exit struction in the English literature was provided by William
(Fig. 44). Viernstein and Keyl noted that by placing the Mott of Jackson, Wyoming in 1983. He created double
femoral tunnels close to the anatomic foot prints of the tunnels in both tibia and femur through which he placed a
native ACL bundles, they were able to emulate the natural free semitendinosus graft, a technique he called the
twisting between the two graft bundles during flexion. In ‘‘semitendinosus anatomic reconstruction’’ or STAR pro-
1990 Müller introduced his ‘‘anatometric’’ double-bundle cedure [211]. He was followed by Walter Blauth of Kiel,
123
Fig. 45 Antero-posterior radiograph of a double-bundle ACL recon-

struction according to Rosenberg’s original technique utilising
Endobuttons for proximal graft fixation (author’s case)
Modern double-bundle reconstruction aims to re-estab-

Fig. 44 Inaugural double-bundle ACL reconstruction method
devised by Viernstein & Keyl of the Staatlich Orthopädische Klinik
lish positioning of the ACL bundles at their respective
in Munich-Harlaching in the early 1970s (with kind permission of anatomical foot prints and according to clinical and bio-
Urban & Fischer, Munich) [289] mechanical studies more closely resembles physiological
knee kinematics with respect to translation and rotation
who had started using a free quadriceps tendon graft to [8, 157, 187, 210, 282, 306] (Fig. 46). It is hoped that
reconstruct both the anteromedial and posterolateral bundle improvements in kinematics might translate into a reduc-
in 1981 and was able to publish promising results 3 years tion in the prevalence of osteoarthritis in the long term. Eije
later [21] (see Fig. 24). In 1990 Jean-Louis Meystre of Kondo and associates of Saporro and Paolo Aglietti and
Lausanne reported 77% good to excellent results with his associates of Florence were able to show improved out-
technique of semitendinosus double tibial and single fem- come results in terms of stability and function with double-
oral tunnel reconstruction [205]. An arthroscopically bundle compared to single-bundle reconstruction [4, 156].
assisted technique for double-bundle ACL reconstruction So far however, it has remained unclear whether the
was first introduced by Tom Rosenberg in 1994, who used increased surgical complexity and trauma associated with
single tibial and double femoral tunnels [248] (Fig. 45). this technique might outweigh proposed long-term benefits
More recently, selective bundle augmentation in cases of [101].
partial ACL ruptures has apparently been performed with
considerable success [31, 223, 272]. In 1999 Bradley
Edwards and associates of New Orleans presented the ACL graft fixation methods
results of an in vitro study comparing single bundle with 3
different double-bundle techniques (dual tibial/dual femo- Over the best part of the twentieth century, fixation of the
ral, dual tibial/single femoral, single tibial/dual femoral) ACL graft consisted by and large of simple suturing of the
[67]. With the exception of the dual tibial and dual femoral protruding parts of the graft to the periosteum at the tunnel
tunnel reconstruction, ‘‘all of the [other] procedures placed exits. Fred Albee of New York (1876–1945) believed that
greater strain on the reconstructive tissues than was the principle reason for failures following ACL recon-
observed on the native ACL, after approximately 30 struction was the inappropriateness of graft fixation which
degrees of flexion’’. he thought would allow for ‘‘laxity to increase with the
123
Fig. 46 Anatomic landmarks

used in modern double-bundle
ACL reconstructions, to
position AM and PL graft
bundles at their respective,
native insertion sites (with kind
permission of Elsevier,
Philadelphia; intra-operative
image courtesy of Freddie Fu,
Pittsburg) [78]
passage of time’’ [5]. In 1943 he suggested securing free tunnel thereby stopping the tendon from slipping through
fascia graft with small bone wedges harvested from the [30, 239] (Fig. 49). Hans Pässler of Heidelberg did much to
anterior tibia and driven alongside the tendon into the introduce press fit graft fixation to a wider audience. He
tunnel. Although his technique was flawed through posi- adopted Brückner’s original idea and converted it for the
tioning tunnels centrally within the joint, his idea of graft use of soft-tissue grafts by knotting hamstring grafts at the
fixation anticipated the principles behind interference end [231].
screws by many decades (Fig. 47). Broader awareness that In 1927 Arnold Wittek introduced, what is believed to
the ‘‘mechanically weak link of the reconstructed graft is be the first intra-articular screw fixation of an ACL liga-
located at the fixation site’’, as suggested by Masahiro ment graft when he utilised a torn medial meniscus to
Kurosaka of Kobe, Japan however did not emerge until the replace the ACL [302] (Fig. 50). In 1970, Kenneth Jones,
1980s and gave rise to the development of a plethora of who was using distally attached patellar tendon, described
ligament fixation devices [161, 194] (Fig. 48). a method for fixation of the femoral bone block by means
Brückner, whilst still using the then traditional suture of a 2.4 mm Kirschner wire ‘‘drilled across the femoral
fixation on the femoral side, left a slightly oversized tri- tunnel and into the opposite femoral condyle’’ [142]. He
angular bone block attached to the inferior part of a free was aiming to traverse the base of the femoral tunnel and
patellar tendon graft which he press-fitted into the tibial thereby stopping the graft from being dislodged. In his
Fig. 47 ACL reconstruction

according to Albee in 1943:
Bone wedges taken from the
proximal tibia were driven
alongside the tendon graft to
facilitate interference fixation
Elsevier, Philadelphia) [5]
123
Fig. 48 Drawing depicting various methods of graft fixation at tibia and femur (with kind permission of Elsevier, Philadelphia) [194]
Fig. 49 Brückner’s tibial

‘press-fit’ technique of free
bone-patellar tendon-bone graft
ACL reconstruction (with kind
permission of Springer Science,
Berlin) [239]
opinion, it was not essential that the wire went directly in 1983, who utilised standard 6.5 mm AO cancellous
through the bone plug itself. This technique received wider screws of 30 mm in length which he passed from outside-in
attention with the introduction of the Transfix device for alongside the bone blocks of B-PT-B grafts [164] (Fig. 51).
the suspension of hamstring grafts designed by Eugene The screw produced an ‘‘interference fit, whereby it actu-
Wolf of San Francisco and Donald Grafton of Naples in ally engages both the side of the bone block and the screw
1998 [39, 105]. hole in a more or less cogwheel fashion’’. Interference
Aperture fixation with interference screws was origi- screws gained wider attention through Kurosaka’s work on
nally described by Kenneth Lambert of Jackson, Wyoming the fixation strength of various fixation methods, which he
123
Fig. 50 Screw fixation of a

meniscal ACL graft performed
by Wittek of Graz in 1927 (with
kind permission of Springer
Science, Berlin) [302]
which, due to its relatively ‘smooth’ thread and spherical

head safeguarded against tendon damage and was hence
universally suitable for B-PT-B and soft tissue graft fixa-
tion [240]. In 1994 Ben Graf, Joseph Sklar, Tom Rosen-
berg and Michael Ferragamo introduced the Endobutton,
a ligament suspensory device that works as a tissue anchor
by locking itself against the cortex of the femoral condyle
[35, 104, 248] (Fig. 52). The Endobutton was primarily
designed for the femoral fixation of hamstring grafts, but
was later re-adapted to accommodate other graft materials
Fig. 51 Interference screw fixation of patellar tendon graft with AO

screws according to Kenneth Lambert. The cancellous screw engages
both the wall of the drill hole and the bone plug of the graft (with kind
permission of Lippincott Williams & Wilkins, Philadelphia) [164]
published in 1987 whilst working at the Cleveland Clinic in

Ohio [161]. The study compared staples with ‘‘tying
sutures over buttons’’ and interference screws and revealed
that specially designed large diameter cancellous screws
provided the strongest fixation. This commenced a period
of relative popularity of metal interference screws, which
became the fixation method of choice for patellar tendon
grafts. Within a few years, interference screws made of
biodegradable materials such as PLA (polylactic acid),
PGA (polyglycolic acid) and TCP (tri-calcium phosphate)
or any combination thereof also became available [273]. Fig. 52 The Endobutton, a ligament suspensory device designed by
In 1992 Leo Pinzcewski & Gregory Roger of Sydney Graf, Sklar, Rosenberg and Ferragamo, was first introduced in 1994
invented the RCI screw, a cannulated interference screw, (with kind permission of Elsevier, Philadelphia) [35]
123
including BPTB, and has become one of the most popular [48, 49] (Fig. 54). He reported the use of a carbon fibre
fixation methods in ligament surgery altogether. Although prosthesis supplemented with a MacIntosh lateral extra-
critics have highlighted theoretical biomechanical disad- articular substitution in 8 patients with good results at
vantages of suspensory fixation compared to aperture 1 year. Dandy later admitted that the good results might
fixation including windscreen wiper and bungee effect, have been due to the extra-articular reconstruction rather
clinical results between the various fixation methods than the carbon fibre ACL replacement, which often dis-
however have not highlighted significant differences [117]. integrated with time [49].
Arthroscopic ACL reconstruction in those days was a
complex and challenging procedure as neither sophisti-
Arthroscopic ACL reconstruction: 1980—today cated instrumentation nor camera and monitor units pro-
viding for appropriate magnification were available. In
In the early parts of the twentieth century, ACL surgery addition, the close proximity between the surgeon’s eye
was still considered by most surgeons a formidable pro- and the rod lens system created a constant danger of de-
cedure. This is reflected in the treatise on ‘Internal sterilisation, nota bene accurate placement depended on
Derangements of the Knee-Joint’ by Timbrell Fisher, who hand-eye coordination monitored by arthroscopic visual-
in 1933 appealed for prudence when considering ACL isation of the tunnel entry points [49]. Studies comparing
reconstruction as ‘‘we must bear in mind that an operation, open with arthroscopic techniques finally confirmed the
which may appear easy, when performed by a master of benefits associated with arthroscopically performed ACL
technical methods, may present extreme difficulty to the reconstruction in terms of lessened post-operative mor-
average surgeon’’ [80]. In the 1950s, prior to the advent of bidity, improved cosmesis, increased speed of recovery and
operative arthroscopy, Willy König of Hannover and Li enhanced range of motion [29]. Initially, the procedure
from Russia had already performed trans-articular recon- required a two-incision technique [57]. One incision was
struction of the ACL without opening of the joint, by either needed to facilitate graft harvest and tibial tunnel prepa-
relying on anatomical land marks or on radiographic con- ration, whilst a second incision placed over the outside of
trol and guidance for positioning of femoral and tibial the femur was required to position a ‘rear-entry-guide’
tunnels [158, 175] (Fig. 53). The increasing familiarity around the posterior aspect of the lateral condyle for out-
with knee arthroscopy popularised by Robert Jackson of side-in drilling of the femoral tunnel. The introduction of
Toronto, Canada (1932–2010) and David Dandy of Cam- arthroscopic drill and off-set guides allowed for femoral
bridge, England in the 1970s together with improvements tunnel preparation either through the tibial tunnel (trans-
in arthroscopic instrumentation allowed surgeons to con- tibial) or through the medial portal, making a second
sider more and more intricate operative procedures to be incision unnecessary.
performed via keyhole [47, 132]. David Dandy performed By the end of the 1990s, most surgeons had adopted the
the first arthroscopically assisted ACL reconstruction at single-incision technique for arthroscopic ACL recon-
Newmarket General Hospital on the 24th April 1980 struction [106]. However, criticism emerged about
Fig. 53 Trans-articular ACL

reconstruction as devised by
Willy König in 1955, using
anatomical land-marks without
formal joint arthrotomy (with
kind permission of Springer
Science, Berlin) [158]
123
Fig. 54 Arthroscopic ACL

reconstruction using a
composite carbon fibre graft
performed by David Dandy in
1980 (photographs courtesy of
David Dandy, Cambridge)
potential disadvantages of femoral tunnel placement using required opening of the joint. The treatment of the ACL-
single-incision, trans-tibial techniques, especially in cases of deficient knee has seen many changes since Adams
single-bundle reconstruction [15, 88, 229]. In a study pub- described the first a clinical case of ACL rupture 175 years
lished in 2001, Markus Arnold and associates of Nijmegen in ago. Arthroscopic ACL reconstruction has since become a
Holland found it impossible to position the femoral tunnel at standard procedure for almost every knee surgeon, but we
the anatomical foot print when using a single-incision tech- are in danger of becoming complacent. It is essential that
nique due to restrictions in drill-guide placement [11]. In we all continually review our own results and carefully
1993 Stephen Howell of Davis, California developed a spe- assess the values and merits of new techniques and tech-
cific drill guide (Howell 65 tibial guide) used in conjunc- nologies in order to offer our patients the best treatments
tion with radiographic control to overcome such problems available. We should however not forget Jack Hughston’s
believing that the tibial tunnel holds the key in correctly advice that there is no knee injury which could not be made
positioning the femoral tunnel [121, 122]. Although refine- worse by inappropriate surgical management.
ments in surgical technique might safeguard against notch It is intriguing to review the pioneering work of Hey-
impingement, single-incision ACL reconstruction remains Groves and Smith as it anticipated many of the modern
more likely to result in a vertically orientated, non-anatomic ideas on graft obliquity and anatomic reconstruction, and in
graft, unable to effectively control rotation [15, 159]. Thus many respects, the surgical philosophy of ACL recon-
prompting some researchers to re-consider the benefits of a struction has come full circle. Many advancing ideas were
revised two-incision technique [95, 98]. dismissed, or forgotten only to be re-discovered, often
without giving credit to the original inventors. We should
hence not lose sight of the achievements of our surgical
Conclusion forefathers and be encouraged to become familiarised with
the historical developments as it may assist us in the pursuit
The number of injuries to the ACL has risen exponentially, of, what Ivar Palmer called, the restoration of the physio-
since the days when only a fall from a horse could send the logical joint.
cavalry officer into early retirement due to an unstable
Acknowledgments The author would like to convey his admiration
knee. High-speed travel and an ever increasing enthusiasm and gratitude to Wolfgang Plitz of Munich and David James Dandy of
for sports are to be blamed for this development. From a Cambridge, for their friendship and for providing invaluable advice
healthy scepticism towards surgery in the nineteenth cen- and support. Furthermore special gratitude is extended to David
tury to an ever increasing plethora of operative solutions, Young of Melbourne, Peter Myers of Brisbane, and Leo Pinczewski
of Sydney, for their patience in conveying the craft of ACL recon-
simplified by a myriad of surgical aids and implements, we struction, to Freddie Fu and Carola van Eck of Pittsburgh, and Werner
have come a long way, and many of us may not even Müller of Bale for their kindness and co-operation and to Jon Kar-
remember the challenging days when ACL surgery lsson of Möndal for his encouragement and advice in preparing the
123
manuscript. Last but not least appreciation is given to all the pub- the anterior cruciate ligament with the quadriceps tendon].
lishers who have kindly permitted the reproduction of all historical Unfallheilkunde 87:45–51
illustrations. 22. Blazina ME (1978) Biomechanical discussion on the polyflex
ligament in late reconstruction of injured ligaments of the knee.
In: Schulitz KP, Krahl H, Stein WH (eds) Late reconstruction of
injured ligaments of the knee. Springer, Berlin, pp 22–32
References 23. Bonnet A (1845) Traité des maladies des articulations [Treatise
on joint diseases]. Baillière, Paris
1. Abbott LC, Saunders JB, Bost FC, Andersen CE (1944) Injuries 24. Bonnet A (1853) Traité de therapautique des maladies articul-
to the ligaments of the knee joint. J Bone Jt Surg 26:503–521 aires [Treatise on the treatment of joint diseases]. Baillière, Paris
2. Adams R (1847) Abnormal conditions of the knee joint. In: 25. Borst M (1903) Über die Heilungsvorgänge nach Sehnenplastik
Todd RB (ed) Cyclopaedia of anatomy and physiology, vol III. [On the healing process following tendon plasty]. Beitr Path
Sherwood Gilbert & Piper, London, pp 48–78 Anat 34:41–103
3. Aglietti P, Buzzi R, D’Andria S, Zaccherotti G (1993) Patel- 26. Bosworth DM, Bosworth BM (1936) Use of fascia lata to sta-
lofemoral problems after intraarticular anterior cruciate ligament bilize the knee in cases of ruptured crucial ligaments. J Bone Jt
reconstruction. Clin Orthop Relat Res 288:195–204 Surg 18:178–179
4. Aglietti P, Giron F, Losco M, Cuomo P, Ciardullo A, Mondanelli N 27. Bradley J, Fitzpatrick D, Daniel D, Shercliff T, O’Connor J
(2009) Comparison between single-and double-bundle anterior (1988) Orientation of the cruciate ligament in the sagittal plane a
cruciate ligament reconstruction: a prospective, randomized, sin- method of predicting its length-change with flexion. J Bone Jt
gle-blinded clinical trial. Am J Sports Med 38:25–34 Surg 70-B:94–99
5. Albee FH (1943) A new operation for the repair of the cruciate 28. Brantigan O, Voshell A (1941) The mechanics of the ligaments
ligaments. Am J Surg 60:349–353 and menisci of the knee joints. J Bone Jt Surg 23:44–66
6. Amis AA, Dawkins GPC (1991) Functional anatomy of the 29. Bray RC, Dandy DJ (1987) Comparison of arthroscopic and
anterior cruciate ligament: fibre bundle actions related to liga- open techniques in carbon fibre reconstruction of the anterior
ment replacement and injuries. J Bone Jt Surg 73-B:260–266 cruciate ligament: long-term follow-up after 5 years. Arthros-
7. Amis AA, Scammell BE (1993) Biomechanics of intra-articular copy 3:106–110
and extra-articular reconstruction of the anterior cruciate liga- 30. Brückner H (1966) Eine neue Methode der Kreuzbandplastik [A
ment. J Bone Jt Surg 75-B:812–817 new method for plastic surgery of cruciate ligaments]. Chirurg
8. Amis AA, Bull AM, Lie DT (2005) Biomechanics of rotational 37:413–414
instability and anatomic anterior cruciate ligament reconstruc- 31. Buda R, Ferruzzi A, Vannini F, Zambelli L, Di Caprio F (2006)
tion. Oper Tech Orthop 15:29–35 Augmentation technique with semitendinosus and gracilis
9. Anderson AF, Snyder RB, Lipscombe AB Jr (2001) Anterior tendons in chronic partial lesions of the ACL: clinical and
cruciate ligament reconstruction. A prospective randomized arthrometric analysis. Knee Surg Sports Traumatol Arthrosc
study of three surgical methods. Am J Sports Med 29:272–279 14:1101–1107
10. Andrews JR, Sanders RA (1983) A ‘‘mini-reconstruction’’ 32. Campbell WC (1936) Repair of the ligaments of the knee.
technique in treating anterolateral rotatory instability (ALRI). Report of a new operation for repair of the anterior cruciate
Clin Orthop Relat Res 172:93–96 ligament. Surg Gynecol Obstet 62:964–968
11. Arnold MP, Kooloos J, Kampen A (2001) Single-incision 33. Campbell WC (1939) Reconstruction of ligaments of the knee.
technique misses the anatomical femoral anterior cruciate liga- Am J Surg 43:473–480
ment insertion: a cadaver study. Knee Surg Sports Traumatol 34. Chambat P, Selva O (1999) Reconstruction du ligament croisè
Arthrosc 9:194–199 anterieure par autogreffe au tendon rotulien. Forage du tunnel
12. Artmann M, Wirth CJ (1974) Untersuchung über den funk- femoral de dehors en dedans. In: Sociéte Française d’Arthro-
tionsgerechten Verlauf der vorderen Kreuzbandplastik [Investi- scopie (ed) Arthroscopy. Elsevier, Paris, pp 141–145
gation of the appropriate functional replacement of the anterior 35. Chen L, Cooley V, Rosenberg T (2003) ACL reconstruction
cruciate ligament]. Z Orthop Ihre Grenzgeb 112:160–165 with hamstring tendon. Orthop Clin N Am 34:9–18
13. Augustine R (1956) The unstable knee. Am J Surg 92:380–388 36. Cho KO (1975) Reconstruction of the anterior cruciate ligament
14. Battle WH (1900) A case after open section of the knee-joint for by semitendinosus tenodesis. J Bone Jt Surg 57-A:608–612
irreducible traumatic dislocation. Trans Clin Soc Lond 37. Clancy WG Jr, Nelson DA, Reider B, Narechania RG (1982)
33:232–233 Anterior cruciate ligament reconstruction using one-third of the
15. Behrendt S, Richer J (2010) Anterior cruciate ligament recon- patellar ligament, augmented by extra-articular tendon transfers.
struction: drilling a femoral posterolateral tunnel cannot be J Bone Jt Surg 64-A:352–359
accomplished using an over-the-top step-off drill guide. Knee 38. Clancy WG Jr (1985) Intra-articular reconstruction of the
Surg Sports Traumatol Arthrosc 18:1252–1256 anterior cruciate ligament. Orthop Clin N Am 16:181–189
16. Bennet GE (1926) The use of fascia for the reinforcement of 39. Clark R, Olsen RE, Larson BJ, Goble EM, Farrer RP (1998)
relaxed joints. Arch Surg 13:655–666 Crosspin femoral fixation: a new technique for hamstring ante-
17. Bick EM (1933) History and source book of orthopaedic sur- rior cruciate ligament reconstruction of the knee. Arthroscopy
gery. The Hospital for Joint Diseases, New York 14:258–267
18. Bircher E (1929) Die Binnenverletzungen des Kniegelenkes 40. Collins HR, Hughston JC, Dehaven KE, Bergfeld JA, Evarts
[Internal derangement of the knee joint]. Benno Schwabe & Co, CM (1974) The meniscus as a cruciate ligament substitute. Am J
Basel Sports Med 2:11–21
19. Bircher E (1930) Über Kreuzbandverletzungen [On cruciate 41. Collins HR (1978) Medial instability of the knee. In: McColl-
ligament injuries]. Zentralbl Chir 57:2207 ister Evarts C (ed) Symposium on reconstructive surgery of the
20. Blair HC (1942) A simple operation for the stabilisation of the knee, Rochester, New York, May 1976. Mosby, Saint Louis,
knee joint. Surg Gynecol Obstet 74:855–859 pp 180–186
21. Blauth W (1984) Die zweizügelige Ersatzplastik des vorderen 42. Collins HR (1980) Anterolateral rotatory instability of the knee.
Kreuzband der Quadricepssehne [2-strip substitution-plasty of In: Funk FJ Jr (ed) Symposium on the athlete’s knee, surgical
123
repair and reconstruction. Hilton Head, South Carolina June in the anterior cruciate ligament deficient knee. Am J Sports
1978. Mosby, Saint Louis, pp 184–194 Med 18:262–266
43. Corner E (1914) The exploration of the knee-joint: with some 64. Drogset O, Grøntvedt T, Robak OR, Mølster A, Viset AT,
illustrative cases. Br J Surg 2:191–204 Engebretsen L (2006) A sixteen-year follow-up of three opera-
44. Cowan DJ (1963) Reconstruction of the anterior cruciate liga- tive techniques for the treatment of acute ruptures of the anterior
ment by the method of Kenneth Jones. Proc R Soc Med cruciate ligament. J Bone Jt Surg 88-A:944–952
58:336–338 65. DuToit GT (1967) Knee joint cruciate ligament substitution, the
45. Cubbins WR, Conley AH, Callahan JJ, Scuderi CS (1932) A Lindemann (Heidelberg) operation. S Afr J Surg 5:25–30
new method of operating for the repair of ruptured cruciate 66. Edwards AH (1926) Operative repair of cruciate ligaments in
ligaments of the knee joint. Surg Gynecol Obstet 54:299–306 severe trauma of knee. Br J Surg 13:432–438
46. Cubbins WR, Callahan JJ, Scuderi CS (1939) Cruciate liga- 67. Edwards TB, Guanche CA, Petrie SG, Thomas KA (1999)
ments: a resumé of operative attacks and results obtained. Am J In vitro comparison of elongation of the anterior cruciate liga-
Surg 43:481–485 ment and single- and dual-tunnel anterior cruciate ligament
47. Dandy DJ, Jackson RW (1975) The impact of arthroscopy on the reconstructions. Orthopedics 22:577–584
management of disorders of the knee. J Bone Jt Surg 68. Eikenbary CF (1927) A suggested method for the repair of
57-A:346–348 crucial ligaments of the knee. Surg Gynecol Obstet 45:93–94
48. Dandy DJ, Flanagan JP, Steenmeyer V (1982) Arthroscopy and 69. Ellison AE (1975) A modified procedure for the extra-articular
the management of the ruptured anterior cruciate ligament. Clin replacement of the anterior cruciate ligament. In: Presented at
Orthop Relat Res 167:43–49 the annual meeting of the American Orthopaedic Society for
49. Dandy DJ (2011) Personal communication Sports Medicine, New Orleans, pp 28–30
50. Daniel DM, Malcom LL, Losse G, Stone ML, Sachs R, Burks R 70. Ellison AE (1979) Distal iliotibial band transfer for anterolateral
(1985) Instrumented measurement of anterior laxity of the knee. rotatory instability of the knee. J Bone Jt Surg 61-A:330–337
J Bone Jt Surg 67-A:720–726 71. Ellison AE (1980) Anterolateral rotatory instability. In: Funk FJ
51. Daniel DM (1987) United States Patent No. 4712542, System Jr (ed) Symposium on the athlete’s knee, surgical repair and
for establishing ligament graft orientation and isometry, 15 reconstruction. Hilton Head, South Carolina June 1978. Mosby,
December 1987 Saint Louis, pp 178–183
52. d’Aubigné M (1957) Les lesions de l’appareil ligamentaire du 72. Emery MA, Rostrup C (1960) Repair of the anterior cruciate
genou (55 cas opérés) [Lesions of the ligaments of the knee (55 ligament with 8 mm tube Teflon in dogs. Can J Surg 4:11–115
surgical cases)]. In: Reconstruction surgery and traumatology, 73. Engebretsen L, Benum P, Fasting O, Molster A, Strand T (1990)
vol. 4. Karger, Basel, pp 156–180 A prospective, randomized study of three surgical techniques for
53. Davis JS (1911) The transplantation of free flaps of fascia. An treatment of acute ruptures of the anterior cruciate ligament. Am
experimental study. Ann Surg 54:734–738 J Sports Med 18:585–590
54. DeAngelis JP, Fulkerson JP (2007) Quadriceps tendon: a reli- 74. Eriksson E (1976) Reconstruction of the anterior cruciate liga-
able alternative for reconstruction of the anterior cruciate ligament. Orthop Clin N Am 7:167–179
ment. Clin Sports Med 26:587–596 75. Eriksson E (1976b) Sports injuries of the knee ligaments. Their
55. DeFrère J, Franckart A (1994) Freeze-dried fascia-lata allografts diagnosis, treatment, rehabilitation and prevention. In: Paper pre-
in the reconstruction of anterior cruciate ligament defects. A two sented at the 23rd annual meeting of the American College of Sports
to seven year follow-up. Clin Orthop Relat Res 303:56–66 Medicine in Anaheim, California. Med Sci Sports 8:133–144
56. DeHaven KE (1978) Classification and diagnosis of knee 76. Fairbank TJ (1948) Knee joint changes after menisectomy.
instabilities. In: McCollister Evarts C (ed) Symposium on J Bone Jt Surg 30-B:664–670
reconstructive surgery of the knee, Rochester, New York, May 77. Feagin JA, Curl WW (1976) Isolated tear of the anterior cruciate
1976. Mosby, Saint Louis, pp 171–179 ligament: 5-year follow-up study. Am J Sports Med 4:95–100
57. DeHaven KE (1983) Arthroscopy in the diagnosis and man- 78. Ferretti M, Ekdahl M, Shen W, Fu FH (2007) Osseous land-
agement of the anterior cruciate ligament deficient knee. Clin marks of the femoral attachment of the anterior cruciate liga-
Orthop Relat Res 172:52–56 ment: an anatomic study. Arthroscopy 23:1218–1225
58. Dejour H, Neyret P, Bonnin M (1992) Monopodal weight- 79. Fick R (1911) Handbuch der Anatomie und Mechanik der
bearing radiography of the chronically unstable knee. In: Jakob Gelenke. 3 Teil: Spezielle Gelenk- und Muskelmechanik. Gus-
RP, Stäubli H-J (eds) The knee and the cruciate ligaments. tav Fischer, Jena
Springer, Berlin, pp 568–576 80. Fisher AGT (1933) Internal derangements of the knee-joint. HK
59. DeLorme TL (1945) Restoration of muscle power by heavy- Lewis & Co, London
resistance exercise. J Bone Jt Surg 27:645–666 81. Flandry F, Terry GC, Montgomery RD, Kester MA, Madsen N
60. Dittel L (1876) Über intraartikuläre Verletzungen am Knie [On (1992) Accuracy of clinical isometry and preload testing during
intra-articular injuries of the knee]. Wiener Med Jahrbücher anterior cruciate ligament reconstruction. Clin Orthop Relat Res
1876:319–334 279:214–222
61. Dolanc B (1973) Die Behandlung des instabilen Kniegelen- 82. Fox JM, Blazina ME, DelPizzo W, Ivey FM, Broukhim B
kes mit Achsenfehlstellung durch die interligamentäre Anh- (1980) Extra-articular stabilization of the knee-joint for anterior
ebe-Tibiaosteotomie. [Treatment of the unstable knee joint instability. Clin Orthop Relat Res 147:56–61
with axial deviation by intraligamentous elevation osteotomy 83. Franke K (1976) Clinical experience in 130 cruciate ligament
of the tibia (author’s transl)]. Arch Orthop Unfall-Chir reconstructions. Orthop Clin N Am 7:191–193
76:280–289 84. Frankel VH, Burstein AH, Brooks DB (1971) Biomechanics of
62. Draganich LF, Reider B, Miller PR (1989) An in vitro study of internal derangement of the knee: pathomechanics as deter-
the Müller anterolateral femorotibial ligament tenodesis in the mined by analysis of the instant centers of motion. J Bone Jt
anterior cruciate ligament deficient knee. Am J Sports Med Surg 53:945–962
17:357–362 85. Friederich NF, O’Brien WR (1992) Functional anatomy of the
63. Draganich LF, Reider B, Ling M, Samuelson M (1990) An in cruciate ligaments. In: Jakob RP, Stäubli H-J (eds) The knee and
vitro study of an intraarticular and extraarticular reconstruction the cruciate ligaments. Springer, Berlin, pp 79–91
123
86. Friedman MJ (1988) Arthroscopic semitendinosus (gracilis) 109. Helfet AJ (1963) The management of internal derangements of
reconstruction for anterior cruciate ligament deficiency. Tech the knee. Lippincott, Philadelphia
Orthop 2:74–80 110. Herz M (1906) Die chirurgische Behandlung paralytischer
87. Fu FH, Jordan SS (2007) The lateral intercondylar ridge: a key Schlottergelenke—Seitenligamente oder Arthrodese? [The sur-
to anatomic anterior cruciate ligament reconstruction. J Bone Jt gical treatment of paralytic flail knees: silk ligaments or
Surg 89-A:2103–2104 arthrodesis?] Munch Med Wschr 51:2527–2529
88. Fu FH, Karlsson J (2010) A long journey to be anatomic. Knee 111. Hesse E (1914) Über den Ersatz der Kreuzbänder des Kniege-
Surg Sports Traumatol Arthrosc 18:1151–1153 lenkes durch freie Fascientransplantation [On the replacement of
89. Fu FH (2011) Personal communication the cruciate ligaments with transplanted free fascia grafts]. Verh
90. Fulkerson J, Langeland R (1995) An alternative cruciate Dtsch Ges Chir 43:188–189
reconstruction graft: the central quadriceps tendon. Arthroscopy 112. Hewson GF (1983) Drill guides for improving accuracy and in
11:252–254 anterior cruciate ligament repair and reconstruction. Clin Orthop
91. Galeazzi R (1934) La ricostituzione dei ligamenti crociati del Relat Res 172:119–124
ginocchio [Reconstitution of the cruciate ligaments]. Atti e 113. Hey Groves EW (1917) Operation for the repair of crucial lig-
Memorie della Società Lombarda di Chirurgica 13:302–317 aments. Lancet 190:674–675
92. Galen C (1968) On the usefulness of parts of the body (trans: 114. Hey Groves EW (1920) The crucial ligaments of the knee joint:
May MT). Cornell University Press, New York their function, rupture and operative treatment of the same. Br J
93. Galli H (1963) Kniebandverletzungen [Knee ligament injuries]. Surg 7:505–515
Munch Med Wschr 105:1066–1072 115. Hey Groves EW (1941) Brit J Surg 24:165–167
94. Galway RB, Beaupre A, MacIntosh DL (1972) Pivot shift: a 116. Hippocrates (1928) On wounds in the head. In: the surgery
clinical sign of symptomatic anterior cruciate insufficiency. In: fractures joints (trans: Whittington ET). The Loeb classical
Proceedings of the Canadian Orthopaedic Association, Jasper, library, vol. III. William Heinemann, London & Harvard Uni-
Alberta 6–10 June 1971. J Bone and Joint Surg 54-B:763–764 versity Press, Cambridge, MA
95. Garofalo R, Mouhsine E, Chambat P, Siegrist O (2006) Ana- 117. Hoher J, Livesay GA, Ma CB, Withrow JD, Fu FH, Woo SL
tomic anterior cruciate ligament reconstruction: the two-incision (1999) Hamstring graft motion in the femoral bone tunnel when
technique. Knee Surg Sports Traumatol Arthrosc 14:510–516 using titanium button/polyester tape fixation. Knee Surg Sports
96. Garofalo R, Djahangiri A, Siegrist O (2006) Revision anterior Traumatol Arthrosc 7:215–219
cruciate ligament reconstruction with quadriceps tendon-patellar 118. Holm I, Oiestad BE, Risberg MA, Aune AK (2010) No differ-
bone autograft. Arthroscopy 22:205–214 ence in knee function or prevalence of osteoarthritis after
97. Giertz KH (1913) Über freie Transplantation der fascia lata als reconstruction of the anterior cruciate ligament with 4-strand
Ersatz für Sehnen und Bänder [On the replacement of tendons hamstring autograft versus patellar tendon-bone autograft: a
and ligaments through transplantation of free fascia lata]. Dtsch randomized study with 10-year follow-up. Am J Sports Med
Z Chir 125:480–496 38:448–454
98. Gill TJ, Steadman JR (2002) Anterior cruciate ligament recon- 119. Hölzel W (1917) Fall von Zerreisung beider Kreuzbänder des
struction the two-incision technique. Orthop Clin N Am linken Kniegelenkes, geheilt durch Ersatz aus dem luxierten
33:727–735 äußeren Meniskus [Rupture of both cruciate ligaments, cured by
99. Girgis FG, Marshall JL, Al-Monajem ARS (1975) The cruciate replacement with the lateral meniscus]. Munch Med Wschr
ligaments of the knee joint. Anatomical, functional and experi- 64:928–929
mental analysis. Clin Orthop Relat Res 106:216–231 120. Hönigschmied J (1893) Leichenexperimente über die Zerreis-
100. Gluck T (1881) Ueber Muskel- und Sehnenplastik. Arch Klin sung der Bänder im Kniegelenk [Cadaver experiments on the
Chir 26:61–66 disruption of knee-joint ligaments]. Dtsch Z Chir 36:587–620
101. Gobbi A, Mahajan V, Karnatzikos G, Nakamura N (2011) 121. Howell SM (1993) United States Patent No. 5300077, methods
Single- versus double-bundle ACL reconstruction: is there any and instruments for ACL reconstruction, 23 Feb 1993
difference in stability and function at 3-year followup? Clin 122. Howell SM (1998) Principles for placing the tibial tunnel and
Orthop Relat Res (in press) avoiding roof impingement during reconstruction of a torn
102. Goetjes HP (1913) Über Verletzungen der Ligamenta cruciata anterior cruciate ligament. Knee Surg Sports Tramatol Arthrosc
des Kniegelenks [On injuries of the cruciate ligaments of the 6(Suppl 1):S49–S55
knee joint]. Dtsch Z Chir 123:221–289 123. Huckell JR (1965) Is meniscectomy a benign procedure?
103. Gold E (1928) Vollständiger plastischer Ersatz des vorderen A long-term follow-up study. Can J Surg 8:254–260
Kreuzbandes und funktionell-anatomische Wiederherstellung 124. Hughston JC (1962) Acute knee injuries in athletes. Clin Orthop
desselben [Complete functional/anatomical reconstruction of the Relat Res 23:114–133
anterior cruciate ligament]. Dtsch Z Chir 213:120–126 125. Hughston JC, Eilers AF (1971) The role of the posterior oblique
104. Graf BK, Rosenberg TD, Sklar JH, Ferragamo MC (1994) ligament in repairs of acute medial ligament tears of the knee.
United States Patent No. 5306301, Graft attachment device and J Bone Jt Surg 55-A:923–940
method of using same, 26 April 1994 126. Hughston JC, Andrews JR, Cross MJ, Moschi A (1976) Classifi-
105. Grafton RD, Wolf EM (1998) United States Patent No. 5895425, cation of knee ligament instabilities. Part I: the medial compartment
Bone implant, 6 Feb 1998 and cruciate ligaments. J Bone Jt Surg 58-A:159–172
106. Hardin GT, Bach BR Jr, Bush-Joseph CA, Farr J (1992) 127. Indelicato PA, Pascale MS, Huegel MO (1989) Early experience
Endoscopic single-incision anterior cruciate ligament recon- with gore-tex polytetrafluoroethylene anterior cruciate ligament
struction using patellar tendon autograft. Surgical technique. Am prosthesis. Am J Sports Med 17:55–62
J Knee Surg 5:144–155 128. Insall JN, Joseph DM, Aglietti P, Campbell RD (1981) Bone-
107. Harner CD, Olson E, Irrgang JJ, Silverstein S, Fu FH, Silbey M block iliotibial-band transfer for anterior cruciate insufficiency.
(1996) Allograft versus autograft anterior cruciate ligament recon- J Bone Jt Surg 63-A:560–569
struction: 3–5 year outcome. Clin Orthop Relat Res 324:134–144 129. Insall JN (1984) Chronic instabilities of the knee. In: Insall JN
108. Hauser EDW (1947) Extra-articular repair for ruptured collateral (ed) Surgery of the knee. Churchill Livingstone, New York,
and cruciate ligaments. Surg Gynecol Obstet 84:339–345 pp 295–352
123
130. Iselin M, De La Plaza R, Flores A (1963) Surgical use of 151. Kennedy JC, Hawkins RJ, Willis RB, Danylchuck KD (1976)
homologous tendon grafts preserved in Cialit. Plast Reconstr Tension studies of human knee ligaments: yield points, ultimate
Surg 32:401–413 failure, and disruption of the cruciate and tibial collateral liga-
131. Ivey FM, Blazina ME, Fox JM, Del Pizzo W (1980) Intra- ments. J Bone Jt Surg 58-A:350–355
articular substitution for anterior cruciate insufficiency. A clin- 152. Kennedy JC, Stewart R, Walker DM (1978) Anterolateral
ical comparison between patellar tendon and meniscus. Am J rotatory instability of the knee joint: An early analysis of the
Sports Med 8:405–410 Ellison procedure. J Bone Jt Surg 60-A:1031–1039
132. Jackson RW, Abe I (1972) The role of arthroscopy in the 153. Kennedy JC (1983) Application of prosthetics to anterior cru-
management of disorders of the knee; an analysis of 200 con- ciate ligament reconstruction and repair. Clin Orthop Relat Res
secutive examinations. J Bone Jt Surg 54-B:310–322 172:125–128
133. Jäger M, Wirth CJ (1978) Kapselbandläsionen: Biomechanik, 154. Kirschner M (1909) Über freie Sehnen und Fascientransplanta-
Diagnostik und Therapie [Ligament and capsular lesions: bio- tion [On free tendon and fascia transplantation]. Bruns Beitr klin
mechanics, diagnostics and therapies] Thieme, Stuttgart Chir 65:472–503
134. Jakob RP, Hassler H, Stäubli HU (1981) Observations on 155. Kirschner M (1913) Der gegenwärtige Stand und die nächsten
rotatory stability of the lateral compartment of the knee. Aussichten der autoplastischen, freien Fascien-Übertragung
Experimental studies on the functional anatomy and the patho- [Current state of affairs and future prospects of autologous
mechanism of the true and reversed pivot shift sign. Acta Orthop transplantation of free fascia]. Bruns Beitr klin Chir 86:5–149
Scand 52(Suppl 191):1–32 156. Kondo E, Yasuda K, Azuma H, Tanabe Y, Yagi T (2008)
135. Jakob RP (1992) Instability-related osteoarthritis: special indi- Prospective clinical comparisons of anatomic double-bundle
cations for osteotomies in the treatment of the unstable knee. In: versus single-bundle anterior cruciate ligament reconstruction
Jakob RP, Stäubli H-J (eds) The knee and the cruciate ligaments. procedures in 328 consecutive patients. Am J Sports Med
Springer, Berlin, pp 543–567 36:1675–1687
136. James SL, Woods GW, Homsy CA, Prewitt JM III, Slocum DB 157. Kondo E, Merican AM, Yasuda K, Amis AA (2011) Biome-
(1979) Cruciate ligament stents in reconstruction of the unstable chanical comparison of anatomic double-bundle, anatomic sin-
knee. Clin Orthop Relat Res 143:90–96 gle-bundle, and nonanatomic single-bundle anterior cruciate
137. Janik B (1955) Kreuzbandverletzungen des Kniegelenkes ligament reconstructions. Am J Sports Med 39:279–288
[Cruciate ligament injuries of the knee joint]. Walter De 158. König W (1955) Kreuzbandplastik ohne Eröffnung des Knie-
Gruyter, Berlin gelenkes [Cruciate reconstruction without opening of the knee-
138. Jaroshy W (1929) Zwei Fälle von vollständigem plastischen joint]. Bruns Beitr Klin Chir 190:453–456
Ersatz zerissener Kreuzbänder [Two cases of plastic recon- 159. Kopf S, Forsythe B, Wong AK, Tashman S, Anderst W, Irrgang
struction of torn cruciate ligaments]. Zentralbl Chir 27:1716 JJ, Fu FH (2010) Nonanatomic tunnel position in traditional
139. Jaureguito J, Paulos L (1996) Why grafts fail. Clin Orthop Relat transtibial single-bundle anterior cruciate ligament reconstruc-
Res 325:25–41 tion evaluated by three-dimensional computed tomography.
140. Jenkins DH (1978) The repair of cruciate ligaments with flexible J Bone Jt Surg 92-A:1427–1431
carbon fibre. A longer term study of the induction of new lig- 160. Kopf S, Pombo MW, Szczodry M, Irrgang JJ, Fu FH (2011) Size
aments and of the fate of the implanted carbon. J Bone Jt Surg variability of the human anterior cruciate ligament insertion
60-B:520–522 sites. Am J Sports Med 39:108–113
141. Jones KG (1963) Reconstruction of the anterior cruciate liga- 161. Kurosaka M, Yoshiya S, Andrish JT (1987) A biomechanical
ment. J Bone Jt Surg 45-A:925–932 comparison of different surgical techniques of graft fixation in
142. Jones KG (1970) Reconstruction of the anterior cruciate liga- anterior cruciate ligament reconstruction. Am J Sports Med
ment using the central one-third of the patellar ligament: a fol- 15:225–229
low-up report. J Bone Jt Surg 52-A:1302–1308 162. Kurosawa H, Yamakoshi K, Yasuda K, Sasaki T (1991) Simulta-
143. Jones KG (1980) Results of use of the central one-third of the neous measurement of changes in length of the cruciate ligaments
patellar ligament to compensate for anterior cruciate ligament during knee motion. Clin Orthop Relat Res 265:233–240
deficiency. Clin Orthop Relat Res 147:39–44 163. Lam SJS (1968) Reconstruction of the anterior cruciate ligament
144. Jones R, Smith AS (1913) On rupture of the crucial ligaments of using the Jones procedure and its guy’s hospital modification.
the knee, and on fractures of the spine of the tibia. Br J Surg J Bone Jt Surg 50-A:1213–1224
1:70–89 164. Lambert KL (1983) Vascularized patellar tendon graft with rigid
145. Jones R (1916) Disabilities of the knee joint. Br Med J internal fixation for anterior cruciate ligament insufficiency. Clin
2:169–173 Orthop Relat Res 172:85–89
146. Jones R, Lovett RW (1943) Orthopaedic surgery. Hodder & 165. Lange F (1903) Über die Sehnenplastik [On tendon recon-
Stoughton, London struction]. Verh Dtsch Orthop Ges 2:10–12
147. Jonsson H, Riklund-Ahlstrom K, Lind J (2004) Positive pivot 166. Lange F (1907) Künstliche Gelenkbänder aus Seide [On artifi-
shift after ACL reconstruction predicts later osteoarthrosis: 63 cial silk ligaments]. Munch Med Wschr 52:834–836
patients followed 5–9 years after surgery. Acta Orthop Scand 167. Lange M (1933) Künstliche Gelenkbänder aus Seide [Artificial
75:594–599 silk ligaments] Siebenundzwanzigster Kongress der Deutschen
148. Karlsson J, Irrgang JJ, van Eck CF, Samuelsson K, Mejia HA, Orthopädischen Gesellschaft, Mannheim, 1932. Verh Dtsch
Fu FH (2011) Anatomic single- and double-bundle anterior Orthop Ges 27:256–258
cruciate ligament reconstruction, part 2: clinical application of 168. Lange M (1949) Unfallorthopädie. Ferdinand Enke, Stuttgart
surgical technique. Am J Sports Med 39:2016–2026 169. Lange M (1957) Kritische Stellungnahme zur Frage der kon-
149. Kennedy JC, Fowler PJ (1971) Medial and anterior instability of servativen oder operative Behandlung schwerer Kniebandver-
the knee. An anatomical and clinical study using stress letzungen [Critical account on the question of conservative
machines. J Bone Jt Surg 53-A:1257–1270 versus operative treatment for severe knee ligament injuries]. In:
150. Kennedy JC, Willis RB (1976) Synthetic cruciate ligaments: Reconstruction surgery and traumatology, vol. 4. Karger, Basel,
preliminary report. J Bone Jt Surg 58-B:142 pp. 197–222
123
170. Lange M (1968) Orthopädisch-Chirurgische Operationslehre. 190. Marcacci M, Zaffagnini S, Iacono F, Neri MP, Loreti I, Petitto A
Ergänzungsband: Neueste Operationsverfahren. Bergmann, (1998) Arthroscopic intra- and extra-articular anterior cruciate
München ligament reconstruction with gracilis and semitendinosus ten-
171. Langer MK (1858) Das Kniegelenk des Menschen. Dritter Beitrag dons. Knee Surg Sports Traumatol Arthrosc 6:68–75
zur vergleichenden Anatomie und Mechanik der Gelenke. Sit- 191. Marcacci M, Zaffagnini S, Giordano G, Iacono F, Presti ML
zungsberichte der Mathematisch-Naturwissenschaftlichen Classe (2009) Anterior cruciate ligament reconstruction associated with
der Kaiserlichen Akademie der Wissenschaften 32:99–142 extra-articular tenodesis: a prospective clinical and radiographic
172. Lemaire M (1967) Ruptures anciennes du ligament croisé ant- evaluation with 10- to 13-year follow-up. Am J Sports Med
érieur. Fréquence-Clinique-Traitement. J Chir 93:311–320 37:707–714
173. Lemaire M (1975) Instabilité chronique du genou. Techniques et 192. Marcacci M, Zaffagnini S, Marcheggiani Muccioli GM, Neri
resultants des plasties ligamentaires en traumatologie sportive. MP, Bondi A, Nitri M, Bonanzinga T, Grassi A (2011)
J Chir 110:281–294 Arthroscopic intra- and extra-articular anterior cruciate ligament
174. Levitt RL, Malinin T, Posada A, Michalow A (1994) Recon- reconstruction with gracilis and semitendinosus tendons: a
struction of anterior cruciate ligaments with bone-patellar ten- review. Curr Rev Musculoskelet Med 4:73–77
don-bone and Achilles tendon allografts. Clin Orthop Relat Res 193. Marshall JL, Warren RF, Wickiewicz TL, Reider B (1979) The
303:67–78 anterior cruciate ligament: a technique of repair and recon-
175. Li AD (1958) [Plastic restoration of the cruciate ligaments of the struction. Clin Orthop Relat Res 143:97–106
knee joint without opening the joint capsule] Russian. Chirurgija 194. Martin SD, Martin TL, Brown CH (2002) Anterior cruciate
Moskva 34:88–93, cited in Zentralbl Chir (1959) 84:510–511 ligament fixation. Orthop Clin N Am 33:685–696
176. Lindemann K (1950) Über den plastischen Ersatz der 195. Marumoto J, Mitsunaga M, Richardson A, Medoff RJ, Mayfield
Kreuzbänder durch gestielte Sehnenverpflanzungen [On the GW (1996) Late patellar tendon rupture after removal of the
replacement of cruciate ligaments using pedunculated tendon central third for anterior cruciate ligament reconstruction. Am J
transplants]. Z Orthop 79:316–334 Sports Med 24:698–701
177. Lindström N (1959) Cruciate ligament plastic with meniscus. 196. Matter P, Burri C, Rüdi T (1970) Spätzustände nach sofort und
Acta Orthop Scand 29:150–152 sekundär versorgter unhappy triad [Late conditions following
178. Lipscomb AB, Jonhston RK, Synder RB, Warburton MJ, Gilbert immediate and secondary management of the unhappy triad].
PP (1982) Evaluation of hamstring strength following use of Z Unfallmed Berufskr 63:34–46
semitendinosus and gracilis tendons to reconstruct the anterior 197. Matti H (1918) Ersatz des gerissenen vorderen Kreuzbandes
cruciate ligament. Am J Sports Med 10:340–342 durch extraartikuläre freie Fascientransplantation [Replacement
179. Loh JC, Fukuda Y, Tsuda E, Steadman RJ, Fu FH, Woo SL of the torn anterior cruciate with extra-articular free fascia
(2003) Knee stability and graft function following anterior graft]. Munch Med Wschr 17:451–452
cruciate ligament reconstruction: comparsion between 11 198. Mauck HP (1936) A new operative procedure for instability of
o’clock and 10 o’clock femoral tunnel placement. 2002 Richard the knee. J Bone Jt Surg 18:984–990
O’Connor Award paper. Arthroscopy 19:297–304 199. Mauck HP (1942) Severe acute injuries of the knee. Am J Surg
180. Lohmander LS, Ostenberg A, Englund M, Roos H (2004) High 56:54–63
prevalence of knee osteoarthritis, pain, and functional limita- 200. Mayo Robson AW (1903) Ruptured crucial ligaments and their
tions in female soccer players twelve years after anterior cru- repair by operation. Ann Surg 37:716–718
ciate ligament injury. Arthr Rheum 50:3145–3152 201. McMaster JH, Weinert CR Jr, Scranton P Jr (1974) Diagnosis
181. Losee RE, Johnson TR, Southwick WO (1978) Anterior sub- and management of isolated anterior cruciate ligament tears: a
luxation of the lateral tibial plateau: a diagnostic test and preliminary report on reconstruction with the gracilis tendon.
operative repair. J Bone Jt Surg 60-A:1015–1030 J Trauma 14:230–235
182. Ludloff K (1927) Der operative Ersatz des vorderen Kreuz- 202. Melhorn JM, Hennig CE (1987) The relationship of the femoral
bandes am Knie [Surgical replacement of the anterior cruciate attachment site to the isometric tracking of the anterior cruciate
ligament]. Zentralbl Chir 54:3162–3166 ligament graft. Am J Sports Med 15:539–542
183. Macey HB (1939) A new operative procedure for the repair of 203. Menschik A (1974) Mechanik des Kniegelenkes [Mechanics of
ruptured cruciate ligaments of the knee joint. Surg Gynecol the knee joint]. Z Orthop 112:481–495
Obstet 69:108–109 204. von Meyer H (1853) Die Mechanik des Kniegelenks. Arch Anat
184. MacGuire CJ (1926) Acute knee injuries. Ann Surg 83:651–662 Physiol (Müllers Archiv) 1853:497–547
185. MacIntosh DL, Darby TA (1976) Lateral substitution recon- 205. Meystre J-L (1992) Use of semitendinosus tendon for anterior
struction. J Bone Jt Surg 58-B:142 cruciate ligament reconstruction. In: Jakob RP, Stäubli H-J (eds)
186. MacIntosh DL, Tregonning RJ (1977) A follow-up study and The knee and the cruciate ligaments. Springer, Berlin, pp 376–383
eventuation of over-the-top repair of acute tears of the anterior 206. Micheli E (1933) Riconstruzione dei legamenti crociati del
cruciate ligament. In: Proceedings of the Canadian Orthopaedic ginocchio con tendine di canguro. Risolto a distanza. Boll Soc
Association. J Bone Jt Surg 59-B(Supp l):505 Piemont Chir 3:874–883
187. Mae T, Shino K, Miyama T, Shinjo H, Ochi T, Yoshikawa H, 207. Milch H (1935) Injuries to the cruciate ligaments. Arch Surg
Fujie H (2001) Single- versus two-femoral socket anterior cru- 30:805–819
ciate ligament reconstruction technique: biomechanical analysis 208. Milch H (1941) Fascial reconstruction of the tibial collateral
using a robotic simulator. Arthroscopy 17:708–716 ligament. Surgery 10:811–825
188. Maletius W, Messner K (1996) The effect of partial meniscec- 209. Miller SL, Gladstone JN (2002) Graft selection in anterior
tomy on the long-term prognosis of knees with localized, severe cruciate ligament reconstruction. Orthop Clin N Am 33:675–683
chondral damage. A twelve- to fifteen-year followup. Am J 210. Moloney G, Kopf S, Fu F, Tashman S (2011) Dynamic in vivo
Sports Med 24:258–262 joint kinematics after anatomic double-bundle anterior cruciate
189. Maletius W, Gillquist J (1997) Long-term results of anterior ligament reconstruction. Pittsburgh Orthop J 22:165
cruciate ligament reconstruction with a Dacron prosthesis. The 211. Mott W (1983) Semitendinosus anatomic reconstruction for
frequency of osteoarthritis after seven to eleven years. Am J anterior cruciate ligament insufficiency. Clin Orthop Relat Res
Sports Med 25:288–293 172:90–92
123
212. Moyen BJ, Jenny JY, Mandrino AH, Lerat JL (1992) Compar- 233. Payr E (1927) Der heutige Stand der Gelenkchirurgie [Current
ison of reconstruction of the anterior cruciate ligament with and state of joint surgery] Verhandlungen der Deutschen Gesell-
without a Kennedy ligament-augmentation device. A random- schaft für Chirurgie, 21st congress. Arch klin Chir 148:404–521
ized prospective study. J Bone Jt Surg 74-A:1313–1319 234. Peacock EE Jr, Madden JW (1967) Human composite flexor
213. Müller W (1983) The knee. Springer, Berlin allografts. Ann Surg 166:624–629
214. Müller W (1992) Treatment of acute tears. In: Jakob RP, Stäubli 235. Penner DA, Daniel DM, Wood P, Mishra D (1988) An in vitro
H-J (eds) The knee and the cruciate ligaments. Springer, Berlin, study of anterior cruciate ligament graft placement and isome-
pp 279–288 try. Am J Sports Med 16:238–243
215. Nicholas JA (1973) The five-one reconstruction for anterome- 236. Perthes G (1926) Über die Wiederbefestigung des abgerissenen
dial instability of the knee. J Bone Jt Surg 55-A:899–922 vorderen Kreuzbandes im Kniegelenk. [On the re-attachment of
216. Nicholas JA (1978) Acute and chronic lateral instabilities of the the torn anterior cruciate ligament of the knee joint]. Zentralbl
knee: diagnosis, characteristics, and treatment. In: McCollister Chir 53:866–872
Evarts C (ed) Symposium on reconstructive surgery of the knee, 237. Pfab B (1927) Zur Blutgefäßversorgung der Menisci und
Rochester, New York, May 1976. Mosby, Saint Louis, pp 187–206 Kreuzbänder [On blood supply of menisci and cruciate liga-
217. Nicholas JA, Minkoff J (1978) Iliotibial band transfer through ments]. Dtsch Z Chir 205:258–264
the intercondylar notch for combined anterior instability (ITPT 238. Pfab B (1927) Experimentelle Studien zur Pathologie der Bin-
procedure). Am J Sports Med 6:341–353 nenverletzungen des Kniegelenkes [Experimental studies on the
218. Norwood LA, Cross MJ (1979) Anterior cruciate ligament: pathology of internal derangements of the knee]. Dtsch Z Chir
functional anatomy of its bundles in rotatory instabilities. Am J 205:265–284
Sports Med 7:23–26 239. Pietsch P, Richter E, Brückner H (1969) Ergebnisse plastischer
219. Noulis G (1875) Entorse du genou [Knee sprain]. Thèse N 142. Wiederherstellungsoperationen der Kreuz- und Seitenbänder am
Fac Med, Paris, pp 1–53 Kniegelenk bei 80 Patienten [Results of plastic repair of the
220. Noyes FR, DeLucas JL, Torvik PJ (1974) Biomechanics of cruciate and collateral ligaments of the knee joint in 80 patients].
anterior cruciate ligament failure: an analysis of strain rate Mschr Unfallheilk 72:141–154
sensitivity and mechanism of failure in primates. J Bone Jt Surg 240. Pinczewski LA, Clingeleffer AJ, Otto DD, Bonar SF, Corry IS
56-A:236–253 (1997) Integration of hamstring tendon graft with bone in
221. Noyes FR, Matthews DS, Mooar PA, Grood ES (1983) The reconstruction of the anterior cruciate ligament. Arthroscopy
symptomatic anterior cruciate-deficient knee. Part II: the results 13:641–643
of rehabilitation, activity modification, and counselling on 241. Plitz W, Wirth CJ (1981) Dynamische Festigkeitsuntersuchun-
functional disability. J Bone Jt Surg 65-A:163–174 gen an Kunstoffbändern für die temporäre Gelenkführung
222. O’Brien S, Warren R, Pavlov H, Panariello R, Wickiewicz TL [Dynamic strength measurement of synthetic ligaments used for
(1991) Reconstruction of the chronically insufficient anterior temporary joint stabilisation]. In: Jäger M, Hackenbroch H,
cruciate ligament with the central third of the patellar tendon. Refior HJ (eds) Kapselbandläsionen des Kniegelenkes. Georg
J Bone Jt Surg 73-A:278–286 Thieme, Stuttgart, pp 209–215
223. Ochi M, Adachi N, Deie M, Kanaya A (2006) Anterior cruciate 242. Plitz W, Huber J (1983) Mechanical properties of temporary
ligament augmentation procedure with a 1-incision technique: ligament replacement. In: Burri C, Claes L (eds) Alloplastic
anteromedial bundle or posterolateral bundle reconstruction. ligament replacement. Hans Huber, Bern, pp 63–66
Arthroscopy 22:463.e1–463.e5 243. Putti V (1920) La ricostruzione dei legamenti crociati del gin-
224. Odensten M, Gillquist J (1985) Functional anatomy of the occhio. Chir Org Movim 4:96–101
anterior cruciate ligament and a rationale for reconstruction. 244. Rasmussen TJ, Feder SM, Butler DL, Noyes FR (1994) The
J Bone Jt Surg 67:257–262 effect of 4 mrad gamma irradiation on the initial mechanical
225. O’Donoghue DH (1950) Surgical treatment of fresh injuries to properties of bone-patellar tendon-bone grafts. Arthroscopy
the major ligaments of the knee. J Bone J Surg 32-A:721–738 10:188–197
226. O’Donoghue DH (1955) An analysis of end results of surgical 245. Rihn JA, Irrgang JJ, Chhabra A, Fu FH, Harner CD (2006) Does
treatment of major injuries to the ligaments of the knee. J Bone J irradiation affect the clinical outcome of patellar tendon allo-
Surg 37-A:1–13 graft ACL reconstruction? Knee Surg Sports Traumatol Arth-
227. O’Donoghue DH (1963) A method for replacement of the rosc 14:885–896
anterior cruciate ligament of the knee. J Bone Jt Surg 246. Ritchey SJ (1960) Ligamentous disruption of the knee. A review
45-A:905–924 with analysis of 28 cases. US Armed Forces Med J 11:167–176
228. O’Donoghue DH (1973) Reconstruction for medial instability of 247. Roe J, Pinczewski LA, Russell VJ, Salmon LJ, Kawamata T,
the knee: techniques and results in sixty cases. J Bone Jt Surg Chew MA (2005) 7-year follow-up of patellar tendon and
55-A:941–954 hamstring tendon grafts for arthroscopic anterior cruciate liga-
229. O’Neill DB (1996) Arthroscopically assisted reconstruction of ment reconstruction: differences and similarities. Am J Sports
the anterior cruciate ligament. A prospective randomized anal- Med 33:1337–1345
ysis of three techniques. J Bone Jt Surg 78-A:803–813 248. Rosenberg T (1994) Techniques for ACL reconstruction with
230. Otto D, Pinczewski L, Clingeleffer A, Odell R (1998) Five-year Multi-Trac drill guide. Accufex Microsurgical Inc, Mansfield MA
results of single incision arthroscopic anterior cruciate ligament 249. Rostrup O (1964) Reconstruction of the anterior cruciate liga-
reconstruction with patellar tendon autograft. Am J Sports Med ments. West J Surg Obstet Gynecol 72:199–202
26:181–188 250. Rubin RM, Marshall JL, Wang J (1975) Prevention of knee
231. Paessler HH, Mastrokalos DS (2003) Anterior cruciate ligament instability: experimental model for prosthetic anterior cruciate
reconstruction using semitendinosus and gracilis tendons, bone ligament. Clin Orthop Relat Res 113:212–236
patellar tendon, or quadriceps tendon-graft with press-fit fixation 251. Rushton N, Dandy DJ, Naylor CP (1983) The clinical, arthro-
without hardware. A new and innovative procedure. Orthop Clin scopic and histological findings after replacement of the anterior
N Am 34:49–64 cruciate ligament with carbon-fibre. J Bone Jt Surg 65:308–309
232. Palmer I (1938) On the injuries to the ligaments of the knee 252. Rüther H (1949) Die Verwendung von Supramid in der oper-
joint: a clinical study. Acta Chir Scand 81(Suppl 53):1–282 ativen Orthopädie. Z Orthop 78:161–169
123
253. Sachs R, Daniel D, Stone M, Garfein RF (1989) Patellofemoral mean 24 months follow-up. Knee Surg Sports Traumatol Arth-
problems after anterior cruciate ligament reconstruction. Am J rosc 18:47–51
Sports Med 17:760–765 273. Stahelin AC, Weiler A (1997) All-inside anterior cruciate liga-
254. Sakane M, Fox RJ, Woo SL, Livesay GA, Li G, Fu FH (1997) ment reconstruction using semitendinosus tendon and soft
In situ forces in the anterior cruciate ligament and its bundles in threaded biodegradable interference screw fixation. Arthroscopy
response to anterior tibial loads. J Orthop Res 15:285–293 13:773–779
255. Schede F (1921) Die Nachahmung des natürlichen Kniegelen- 274. Stark J (1850) Two cases of rupture of the crucial ligament of
kes. Münch Med Wchschr 68:200 the knee-joint. Edinb Med Surg 74:267–271
256. Schmieding R (1994) United States Patent No. 5320626, 275. Stäubli HU, Schatzmann L, Brunner P, Rincon L, Nolte LP
Endoscopic drill guide, 14 June 1994 (1996) Quadriceps tendon and patellar ligament: cryosectional
257. Scopp JM, Jasper LE, Belkoff SM, Moorman CT 3rd (2004) The anatomy and structural properties in young adults. Knee Surg
effect of oblique femoral tunnel placement on rotational con- Sports Traumatol Arthrosc 4:100–110
straint of the knee reconstructed using patellar tendon autografts. 276. Staudinger G (1932) Eine neue Kniegelenksbandage [A new
Arthroscopy 20:294–299 knee joint brace]. Sechundzwanzigster Kongress der Deutschen
258. Seedhom BB, Dowson D, Wright V (1974) The load-bearing Orthopädischen Gesellschaft, Berlin, 1931. Verh Dtsch Orthop
function of the menisci in the knee. In: Ingwersen OS, Van Ges 26:412–413
Linge B, Van Rens TJG, Rösingh GE, Veraart BEEMJ, Le Vay 277. Straßer H (1917) Lehrbuch der Muskel- und Gelenkmechanik.
D (eds) The knee joint: recent advances in basic research and Bd. III. Die untere Extremität. Springer, Berlin
clinical aspects. American Elsevier Publishing, New York, 278. Strickler FP (1937) A satisfactory method of repairing cruciate
pp 37–42 ligaments. Ann Surg 105:912–916
259. Segond PF (1879) Recherches cliniques et expérimentales sur 279. Strover AE, Firer P (1985) The use of carbon fibre implants in
les épanchements sanguins du genou par entorse [Clinical and anterior cruciate ligament surgery. Clin Orthop Relat Res
experimental research on blood effusion following knee 196:88–98
sprains]. Prog Méd 16:297–421 280. Strover AE (1992) The ABC ligament for chronic anterior
260. Shelbourne KD, Nitz P (1992) Accelerated rehabilitation after cruciate ligament insufficiency. In: Aichroth PM, Cannon WD
anterior cruciate ligament reconstruction. J Orthop Sports Phys Jr, Patel DV (eds) Knee surgery: current practice. Martin Dunitz,
Ther 15:256–264 London, pp 281–297
261. Shelbourne KD, Gray T (1997) Anterior cruciate ligament 281. Strum GM, Fox JM, Ferkel RD, Dorey FH, Del Pizzo W, Friedman
reconstruction with autogenous patellar tendon graft followed by MJ, Snyder SJ, Markolf K (1989) Intraarticular versus intraarticular
accelerated rehabilitation. A two- to nine-year followup. Am J and extraarticular reconstruction for chronic anterior cruciate lig-
Sports Med 25:786–795 ament instability. Clin Orthop Relat Res 245:188–198
262. Shino K, Kawasaki T, Hirose H, Gotoh I, Inoue M, Ono K 282. Tashman S, Collon D, Anderson K, Kolowich P, Anderst W
(1984) Replacement of the anterior cruciate ligament by an (2004) Abnormal rotational knee motion during running after
allogenic tendon graft: an experimental study in the dog. J Bone anterior cruciate ligament reconstruction. Am J Sports Med
Jt Surg 66-B:672–681 32:975–983
263. Shino K, Kimura T, Hirose H, Inoue M, Ono K (1986) 283. Thompson SK, Calver A, Monk CJE (1978) Anterior cruciate
Reconstruction of the anterior cruciate ligament by allogeneic ligament repair for rotatory instability: the Lindemann dynamic
tendon graft. An operation for chronic ligamentous insuffi- muscle-transfer procedure. J Bone Jt Surg 60-A:917–920
ciency. J Bone Jt Surg 68-B:739–746 284. Tillberg B (1977) The late repair of torn cruciate ligaments
264. Simonian P, Mann F, Mandt P (1995) Indirect forces and using menisci. J Bone Jt Surg 59:15–19
patellar fracture after anterior cruciate ligament reconstruction 285. Torg JS, Conrad W, Kalen V (1976) Clinical diagnosis of
with the patellar ligament: case report. Am J Knee Surg 8:60–64 anterior cruciate ligament instability in the athlete. Am J Sport
265. Sledge SL, Steadman JR, Silliman JF, Peloza J, Fullstone AH Med 4:84–91
(1992) Five-year results with the gore-tex anterior cruciate lig- 286. Trillat A, Ficat P (1972) Laxités post-traumatiques du genou.
ament prosthesis. Am J Knee Surg 5:65–70 Rev Chir Orthop (Suppl 58):32–114
266. Slocum DB, Larson RL (1968) Rotatory instability of the knee. 287. Trillat A, Dejour H, Bosquet G (1978) Chirurgie du genou.
Its pathogenesis and a clinical test to demonstrate its presence. Simep, Villeurbanne
J Bone Jt Surg 50-A:211–225 288. Van Eck CF, Lesniak BP, Schreiber VM, Fu FH (2010) Ana-
267. Slocum DB, Larson RL (1968) Pes anserinus transplantation. A tomic single- and double-bundle anterior cruciate ligament
surgical procedure for control of rotatory instability of the knee. reconstruction flowchart. Arthroscopy 26:258–268
J Bone Jt Surg 50-A:226–242 289. Viernstein K, Keyl W (1973) Operationen am Kniegelenk. In:
268. Smith AS (1918) The diagnosis and treatment of injuries to the Breitner B (ed) Chirurgische operatonslehre, vol. IV/2. Urban &
crucial ligaments. Br J Surg 6:176–189 Schwarzenberg, München, pp 1–78
269. Smith AS (1928) Sidelights on knee-joint surgery. In: Fairbank 290. Von Meyer H (1853) Mechanik des Kniegelenkes [Mechanics of
HAT, Bristow WR, Platt H (eds) The Robert Jones birthday the knee joint]. Archiv für Anatomie und Physiologie (Müller’s
volume–a collection of surgical essays. Oxford University Press, Archiv) 497–547
London, pp 279–300 291. Wachsmuth W (1956) Die operationen an den extremitäten.
270. Smith CW, Young IS, Kearney JN (1996) Mechanical properties Springer, Berlin
of tendons: changes with sterilisation and preservation. J Bio- 292. Wagner P (1913) Isolierte Ruptur der Ligamenta Cruciata
mech Eng 118:56–61 [Isolated rupture of the cruciate ligaments]. Inaugural Disserta-
271. Sonnery-Cottet B, Chambat P (2006) Anatomic double bundle: a tion zur Erlangung der Doktorwürde an der hohen medizinis-
new concept in anterior cruciate ligament reconstruction using chen Fakultät der Universität Leipzig. Verlag von FCW Vogel,
the quadriceps tendon. Arthroscopy 22:1249.e1–1249.e4 Leipzig
272. Sonnery-Cottet B, Lavoie F, Ogassawara R, Scussiato RG, 293. Walker PS, Erkman MJ (1974) The role of the menisci in force
Kidder JF, Chambat P (2010) Selective anteromedial bundle transmission across the knee. Clin Orthop Relat Res
reconstruction in partial ACL tears: a series of 36 patients with 109:184–192
123
294. Walsh JJ Jr (1972) Meniscal reconstruction of the anterior cru- 305. Woods GW, Homsy CA, Prewitt JM, Tullos HS (1979) Proplast
ciate ligament. Clin Orthop Relat Res 89:171–177 leader for use in cruciate ligament reconstruction. Am J Sports
295. Warren R (1915) A textbook of surgery. J&A Churchill, London Med 7:314–320
296. Warren RF, Marshall JL (1978) Injuries to the anterior cruciate 306. Yagi M, Wong EK, Kanamori A, Debski RE, Fu FH, Woo SL
ligament and medial collateral ligament of the knee. A long- (2002) Biomechanical analysis of an anatomic anterior cruciate
term follow-up of 86 Cases: part II. Clin Orthop Relat Res ligament reconstruction. Am J Sports Med 30:660–666
136:198–211 307. Yasuda K, Kondo E, Ichiyama H, Kitamura N, Tanabe Y,
297. Weber W, Weber E (1836) Mechanik der menschlichen Tohyama H, Minami A (2004) Anatomic reconstruction of
Gehwerkzeuge. Dieterichsche Buchhandlung, Göttingen [Weber the anteromedial and posterolateral bundles of the anterior cruciate
W, Weber E (1992) Mechanics of the human walking apparatus ligament using hamstring tenden grafts. Arthroscopy 20:1015–1025
(trans: Maquet P, Furlong R). Springer, Berlin] 308. Yasuda K, van Eck CF, Hoshino Y, Fu FH, Tashman S (2011)
298. Webster D, Werner F (1983) Freeze-dried flexor tendons in Anatomic single- and double-bundle anterior cruciate liga-
anterior cruciate ligament reconstruction. Clin Orthop Relat Res ment reconstruction, part 1: basic science. Am J Sports Med
181:238–243 39:1789–1799
299. Wilk RM, Richmond JC (1993) Dacron ligament reconstruction 309. Zaffagnini S, Marcacci M, Lo Presti M, Giordano G, Iacono F,
for chronic anterior cruciate ligament insufficiency. Am J Sports Pia Neri M (2006) Prospective and randomized evaluation of
Med 21:374–379 ACL reconstruction with three techniques: a clinical and
300. Wirth CJ, Artmann M (1974) Ist die Länge der Patellarsehne für radiographic evaluation at 5 years follow-up. Knee Surg Sports
die vordere Kreuzbandplastik ausreichend? [Is the patellar lig- Traumatol Arthrosc 14:1060–1069
ament sufficient in length for the reconstruction of the anterior 310. Zaffagnini S (2011) Personal communication
cruciate ligament?]. Arch Orthop Unfallchir 79:149–152 311. Zarins B, Rowe CR (1986) Combined anterior cruciate-ligament
301. Wirth CJ, Artmann M, Jäger M, Refior HJ (1974) Der plastische reconstruction using semitendinosus tendon and iliotibial tract.
Ersatz veralterter vorderer Kreuzbandrupturen nach Brückner J Bone Jt Surg 68-A:160–177
und seine Ergebnisse [Plastic reconstruction of old anterior 312. Zelle BA, Brucker PU, Feng MT, Fu FH (2006) Anatomical
cruciate ligament ruptures by the Brückner procedure]. Arch double-bundle anterior cruciate ligament reconstruction. Sports
Orthop Unfall Chir 78:362–373 Med 36:99–108
302. Wittek A (1927) Über Verletzungen der Kreuzbänder des Kni- 313. Zuppinger H (1904) Die aktive Flexion im unbelasteten Kniegelenk
egelenkes. Mit 13 Abbildungen [On the injuries to the cruciate [Active flexion of the unloaded knee joint]. Anatomische Hefte.
ligaments. With 13 illustrations]. Dtsch Z Chir 200:491–515 Beiträge und Referate zur Anatomie und Entwicklungsgeschichte
303. Wittek A (1935) Kreuzbandersatz aus dem Ligamentum patellae 77:701–764
(nach zur Veth) [Replacement of the cruciate ligament with 314. Zur Verth M (1933) Aussprache, Siebenundzwanzigster Kon-
patellar tendon (according to zur Verth)]. Schweiz Med Woc- gress der Deutschen Orthopädischen Gesellschaft [Debate at the
henschr 65:103–104 27th congress of the German Orthopaedic Society], Mannheim,
304. Woods GA, Indelicato PA, Prevot TJ (1991) The Gore-Tex 1932. Verh Dtsch Orthop Ges 269–270
anterior cruciate ligament prosthesis. Two versus three year 315. Lord Moynihan (1933) Sir Arthur Mayo-Robson KBE, CB,
results. Am J Sports Med 19:48–55 DSc, FRCS. BMJ 3798:761–762
123

Acl History PDF

Uploaded by

Copyright:

Available Formats

Acl History PDF

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Acl History PDF

Uploaded by

Copyright:

Available Formats

Knee Surg Sports Traumatol Arthrosc

Surgery for anterior cruciate ligament deficiency:

Received: 27 September 2011 / Accepted: 26 October 2011

Fig. 1 Illustration from

Fig. 3 Sliding frame designed

Fig. 5 Illustration of two

Fig. 6 Schematic drawing

Ernest Hey Groves of Bristol (1872–1944) who in 1920

Fig. 9 Payr’s technique to

were shared by Werner Müller of Bale who believed that

Pioneers of ACL reconstruction: 1914–1920

Clinicians eventually realised that a number of patients

criticising the incomplete nature of the construct, ‘‘as it

Fig. 12 Smith of Cardiff re-

Fig. 14 Knee brace introduced by Staudinger in 1931 using a

Fig. 16 One of the first ACL

Fig. 18 ACL reconstruction

Fig. 21 Werner Müller’s model

Fig. 23 Quadriceps tendon

Fig. 24 Double-bundle ACL

Fig. 25 Riccardo Galeazzi

Fig. 27 The Lindemann ‘dynamic reconstruction’ technique intro-

Fig. 29 The first ACL augmentation device as presented by Ludloff

Fig. 30 Corner’s attempt of

Fig. 32 Synthetic anterior cruciate ligament stent in situ according to

The first account of an extra-articular procedure was

strip which he positioned underneath the lateral collateral

Fig. 35 David MacIntosh of

Fig. 36 Lateral extra-articular

will often result in failure’’ [296]. In their biomechanical

Fig. 38 Illustration taken from

To achieve greater surgical precision and reliable graft

described the so called ’transition line’, which he believed

Fig. 43 ‘Anatomic double-

Fig. 45 Antero-posterior radiograph of a double-bundle ACL recon-

Modern double-bundle reconstruction aims to re-estab-

Fig. 46 Anatomic landmarks

Fig. 47 ACL reconstruction

Fig. 49 Brückner’s tibial

Fig. 50 Screw fixation of a

which, due to its relatively ‘smooth’ thread and spherical

Fig. 51 Interference screw fixation of patellar tendon graft with AO

published in 1987 whilst working at the Cleveland Clinic in

Fig. 53 Trans-articular ACL

Fig. 54 Arthroscopic ACL

You might also like

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.