[Rupture of the anterior cruciate ligament in the athlete]

Athletic trauma is the main cause for rupture of the anterior cruciate ligament (ACL). In order to regain joint stability and return to unrestricted sports activities operative management is indicated. The patella tendon autograft with bone plugs on each end is presently the most commonly used graft to reconstruct the ACL. The concept of synthetic augmentation was developed for protection of the biological tissue during revascularization and remodeling. We use as augmentation device the TETRA-L3, which is a 3-mm-wide and 1-mm-thick Trevira braid. The function of the composite graft, which is sufficiently strong to allow early stress, is based on the principle of load-sharing. Isometric placement of the graft without impingement is achieved by using the miniarthrotomy technique and specially designed drill guides. Graft fixation is performed with ligament staples. An accelerated rehabilitation program emphasizing full extension and weight bearing follows. The total rehabilitation program we recommend--preoperative rehabilitation, a reliable surgical procedure, postoperative rehabilitation, and the patient's return to activity--is a team effort. A detailed follow-up evaluation of 41 athletes with ACL reconstruction using a central patellar BTB graft and synthetic augmentation with the TETRA-L3 showed that restoration of stability (KT 1000 testing, maximum manual excursion, < 3 mm difference) and full ROM, muscle strength and power (> 85% of the uninvolved knee) and functional capacity (Hop index > 90%) are the main prerequisites for sports activities at the desired level.