Chadwick C. Prodromos, editor. Philadelphia: Saunders; 2008. 650 pages. $229.00. ISBN: 978-1-4160-3834-4.
The Anterior Cruciate Ligament: Reconstruction and Basic Science is a single-volume comprehensive text. Chadwick Prodromos is a fellowship-trained sports-medicine orthopaedist in Chicago, who specializes in knee surgery and notably devised a posterior mini-incision to harvest hamstring grafts. He collaborated with eight associate editors who are established pioneers in knee surgery. In the preface, they convincingly present the need for a comprehensive textbook on the anterior cruciate ligament—one which presents "the essence of the world's accumulated clinically relevant ACL-related knowledge."
The editors and invited authors (as well as their colleagues, research assistants, clinical fellows, residents, and others) have produced eighty-one chapters and more than 600 pages of text. The textbook is organized into two sections—anterior cruciate ligament injury and anterior cruciate ligament reconstruction. The anterior cruciate ligament injury section primarily addresses anatomy, physiology, biomechanics, epidemiology, diagnosis, and nonoperative management. The anterior cruciate ligament reconstruction section is logically divided into many parts, including harvest techniques, tunnel formation, fixation, tensioning, healing, rehabilitation, and complications.
The strength of this textbook lies in its comprehensive nature. In addition to the standard anticipated topics, there are outstanding chapters entirely dedicated to the economics of anterior cruciate ligament reconstruction, injury prevention programs, computer-assisted navigation, biodegradable screw properties, ligamentization, and notchplasty. The chapter titled "Why Synthetic Grafts Failed" provides fascinating historical insight. In fact, for future editions, this reviewer is biased in favor of including additional chapters that detail a more complete historical perspective of anterior cruciate ligament injury and treatment options (such as the techniques and outcomes of anterior cruciate ligament repair), as a lot can be learned from the successes and failures of the past. Furthermore, the future insertion of a chapter on patellar tendon regeneration following harvest might also be considered, as it would make a fine companion chapter to the existing "Hamstring Regeneration Following Harvest" chapter in the section on rehabilitation.
Nearly half of the chapters are primarily focused on specific operative techniques. These chapters are all clearly written. The authors frequently include excellent technical pointers and troubleshooting sections. Outstanding illustrations and exceptional photographs clarify concepts. In addition, these chapters are nicely complemented by the two accompanying DVDs, which include classics from the American Academy of Orthopaedic Surgeons as well as new surgical technique videos. Most importantly, the authors of these chapters provide enough detailed direction to allow the reader to safely perform the corresponding techniques.
The remaining chapters are mostly archetypal narrative reviews, which are common in multiauthored texts. A few chapters report systematic literature reviews. Of note, the utilization of an evidence-based hierarchical perspective in a future edition would greatly strengthen the material in these chapters. Furthermore, while the relative graft strengths and instrumented Lachman stability results are satisfactorily reviewed, data reflecting patient-oriented outcomes are only sparsely presented.
The points made in specific chapters are generally in agreement with well-accepted teaching. Of course, many controversial choices, such as whether to use autograft or allograft, metal or bioabsorbable screws, bone-patellar tendon-bone graft or hamstring graft, and accelerated or protected rehabilitation, are necessarily addressed in this textbook. Multiple viewpoints are typically presented in adjacent chapters.
This textbook exceeded my expectations, and I commend the editors and authors on this colossal undertaking. This book will be a valuable addition to the library of any resident, fellow, or orthopaedic surgeon who has an interest in the anterior cruciate ligament. Additionally, it could serve as a reference in a hospital or university library. I am unaware of a comparably comprehensive textbook that is dedicated solely to the anterior cruciate ligament. I greatly enjoyed reading this textbook and look forward to future editions.