What’s New in Sports Medicine
Joshua D. Nelson, MD, Pharm D; MaCalus V. Hogan, MD; Mark D. Miller, MD

This update is based on the scientific and investigational activities in the specialty of sports medicine from August 2008 to September 2009. It includes a review of pertinent research and articles published in the three premier journals of our specialty, namely, The Journal of Bone and Joint Surgery (American Volume), The American Journal of Sports Medicine, and Arthroscopy: The Journal of Arthroscopic and Related Surgery.

Anterior Cruciate Ligament

Anterior cruciate ligament reconstruction is perhaps the most investigated topic in sports medicine. Recent enthusiasm for double-bundle techniques and more horizontal femoral tunnel placement has sparked research focusing on the biomechanical evaluation of rotational control and its corresponding clinical importance. Graft choice and the method of fixation continue to be debated, with patellar tendon and hamstring autografts dominating the graft selection for most surgeons. Additionally, the role of anterior cruciate ligament reconstruction and osteoarthritis has yet to be stratified, with meniscal injury, graft choice, surgical technique, and chondral impact injuries confounding valid correlations.

Single-bundle reconstruction traditionally has been associated with good results and is thought to function biomechanically as the anteromedial bundle and less like the posterolateral bundle. Placement of a more vertical femoral tunnel is believed to create anterior-to-posterior stability with insufficient rotational control. Recent changes to proposed tunnel placement include a more horizontal femoral tunnel (the ten o’clock/two o’clock position), which has improved resistance to pivot-shifting. To obtain this position, many surgeons are either utilizing an accessory portal for femoral tunnel placement or changing the angle of the tibial tunnel to a more medial position for transtibial femoral tunnel reaming.

Proponents of the double-bundle technique suggest that their technique provides better rotational control as well as decreased anterior-to-posterior laxity when compared with single-bundle reconstruction, most markedly from 0° to 30°; however, this suggestion has been refuted by others1. One cadaver biomechanical …


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