Anterior cruciate-deficient knees: a review of the literature

Injury to the anterior cruciate ligament may lead to functional instability, meniscal injury, and premature degenerative changes of the knee or, if treatment and rehabilitation are carried out carefully, to a functionally stable knee with no premature degenerative changes. Unfortunately, the complex anatomy of the three fiber bundles, consisting of multiple collagenous strands, which constitutes the anterior cruciate ligament combined with variation of injuries to the ligament, with or without injury to other structures of the knee, makes any standardization of surgical treatment difficult. In this paper, we review the biomechanics of the knee, the anatomy and vascularization of the anterior cruciate ligament, the healing characteristics of ligamentous material, and the types of surgical repair that have appeared in recent articles. Those repairs can be divided into direct repair, extraarticular substitution and intraarticular augmentation, freeze-dried fascia lata allografts, and temporary supportive prosthesis such as carbon fiber. Essential to the success of any surgical repair of the anterior cruciate-deficient knee is a prolonged, carefully organized rehabilitation program that allows adequate healing and strengthening of the ligament before it is used normally again. The patient's clear understanding of the importance of a prolonged rehabilitation is best established before the surgical procedure is done.