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Anterior Cruciate Ligament Analysis

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Anterior Cruciate Ligament Analysis
Introduction:
The anterior cruciate ligament (ACL) is an important stabilizer of the tibiofemoral joint. The ACL has a proximal attachment on the posteromedial portion of the lateral condyle of the femur and creates an anterior medial vector to reach its distal attachment at the anteromedial tibia. The anteromedial vector the ACL makes allows it to prevent primarily anterior translation of the tibia on the femur and secondarily tibial rotation subluxation on the femur and both valgus and varus forces at the tibiofemoral joint. In the United States, there are 200,000 acl injuries per year, making the ACL the most commonly injured ligament in the body (1). ACL injuries are typically due to sports related activities or trauma patients (1).
The …show more content…
If the ACL is torn completely, a grade 3 sprain, the blood supply is damaged (2). If the blood supply is damaged the ACL will not be able to heal correctly as it will not be able to receive the required nutrients. When extracapsular ligaments are damage a local hematoma is formed due to a more robust blood supply that is protected by a thick, strong, soft tissue sheath (3). The hematoma is the first step in the healing process. The hematoma has a mesh of fibrinogen that inflammatory cells can attach to and begin secreting cytokines and growth factors (3). The cytokines and growth factors attract fibroblasts and stems cells to the area of damage where granulation tissue and then scar tissue will be formed (3). The problem is the ACL is not an extracapsular ligament, it is intracapsular. The ACL receives its blood supply …show more content…
The tensile strength of the BPTB graft has been shown to be four times that of a normal ACL (6). The ends of the patellar tendon still have bone attached so integration into the tibial and femoral tunnels is much faster in the BPTB graft (1). The issue with BPTB grafts are the complications. The BPTB graft has an increased incidence of patellar fractures, anterior knee pain, patellar tendon rupture, patellar tendonitis, weakened quadriceps-leading to significant loss of knee extension and osteoarthritis compared to the HS graft (5 and 4). Anterior knee pain can be especially problematic and occurs with up to an incidence of 55% of those that receive a BTPB graft
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