ACL

Question 1

why does the MCL heal well but the ACL doesn’t?

Answer 1

• MCL has a broad attachment
• ACL is bathed in synovial fluid - some studies suggests it contains plasmin - breaks up fibrous clot

Question 2

How do you measure ACL laxity on anterior draw test and lachman test?

Question 3

Graft choice for ACL

Answer 3

hamstring
- smaller incision
- better load to failure - double BPBG
- less anterior knee pain
- less morbidty long term

Bone-patella tendon - bone
- direct incorporation - bone to bone healing - quicker
- hamstrings not used - so preserves proprioception and power
- increased morbidity with laxity and OA

new option is quads
- lowest load to failure

autograft over allograft
-allograft has higher rerupture due to preparation processes

Question 4

extra-articular tenodesis

Answer 4

• 50% of ITB taken from insertion longitudinally
• passed under lcl and back on itself and reattached with a staple
• to help with rotational control

Question 5

ACL bundles

Answer 5

AM - anterior translation - anterior draw
PL - rotation - pivot

Question 6

blood supply to acl and segund fracture

Answer 6

medial genicular ligament
segund fracture - Anterolateral ligament

Question 7

revision graft choices for ACL

Answer 7

autograft and allograft
Allograft has lower rates of:
* laxity
* re-operations
* complications

Question 8

ACL tunnel positions

Answer 8

tibia
- 10cm anterior of PCL insertion
- <75 deg from horizontal

femoral
- 10pm right knee or 2am left knee position

Question 9

ACL rehab

Answer 9

• closed chain rehab

avoid open chain exercises - mimics original injury