Anterior Cruciate Ligament Augmentation for One-Bundle Tears

Abstract

One-bundle anterior cruciate ligament (ACL) tears continue to pose a dilemma for orthopaedic surgeons. Though relatively rare, 1-bundle tears can be symptomatic and often evolve into complete tears. Early management of these injuries could prove invaluable to decreased injury-related morbidity. Diagnosis of these injuries relies on clinical history, examination, imaging studies, and arthroscopic evaluation. The key to success lies in the confirmation of the diagnosis on the basis of functional symptoms. Examination under anesthesia is indicated for this purpose, with pivot shift testing remaining the cornerstone for evaluation of ACL function. Final operative treatment decisions must be made only after thorough arthroscopic testing. When implemented successfully, the ACL augmentation surgical technique follows the anatomic, individualized ACL reconstruction concept, focusing on reconstruction of the injured bundle while sparking the intact ligament’s fibers. Though large randomized controlled trials have not been done, studies have shown that in appropriately selected patients, ACL augmentation surgery leads to improved graft orientation, mechanical stability, vascularity, proprioceptive innervation, faster graft remodeling, and a safer, more rapid rehabilitation.