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Ebook ACL Made Simple: Part 2

(BQ) A CD-ROM keyed to each chapter complements the text and makes it easy for users to locate sections of particular interest. The numerous graphics and narrated video clips are dynamic tools that highlight topics including the mechanism of injury, physical examination, and surgical techniques. | 5 Graft Selection History The type of graft that the surgeon chooses for ACL reconstruction has evolved over the past few decades. In the 1970s Erickson popularized the patellar tendon graft autograft that Jones had originally described in 1960. This became the most popular graft choice for the next three decades. In fact in a survey of American Academy of Orthopaedic Surgeon members done in 2000 80 still favored the use of the patellar tendon graft. In the light of harvest site morbidity and postoperative stiffness associated with the patellar tendon graft many surgeons began to look at other choices such as semitendinosus grafts allografts and synthetic grafts. Fowler and then Rosenberg popularized the use of the semi-tendinosus. However even Fowler was not convinced of the strength of the graft. Then Kennedy and Fowler developed the ligament augmentation device LAD to supplement the semitendinosus graft. Gore-Tex Flagstaff AZ Leeds-Keio and Dacron Stryker Kalamazoo MI were choices for an alternative synthetic graft to try to avoid the morbidity of the patellar tendon graft. The initial experience was usually satisfactory but the results gradually deteriorated with longer follow-up. Allograft was another choice that avoided the problem of harvest site morbidity. The initial allograft that was sterilized with ethylene oxide had very poor results. Today the freeze-dried fresh-frozen and cryopreserved are the most popular methods of preservation of allografts. The allograft has become a popular alternative to the autograft because it reduces the harvest site morbidity and operative time. However Noyes has reported a 33 failure with the use of allografts for revision ACL reconstruction. The aggressive postoperative rehabilitation program advocated by Shelbourne in the 1990s greatly diminished the problems associated with the patellar tendon graft. Before that the patient had to be an athlete just to survive the operation and rehabilitation program. The 45 46 5. Graft