Clinical problems associated with the ACL

During clinical examination, three tests are routinely performed. The anterior drawer test is performed with the patient supine, the hip flexed at 45° and the knee flexed at 90° (Fig. 20.5). The foot is then stabilized and the tibia is drawn forward on the femur. The patient is stiU in the supine position for the Lachman test, but the knee is flexed to 30°. One hand is placed over 

Zantop et al. studied the rupture pattern of ACL-injured knees and noted that 56% of the patients had a complete rupture of the two bundles at the same location, the proximal portion being the most frequent. For 12%, the PL bundle was still intact, but all the patients had ruptured their AM bundle. According to these authors, when the PL bundle is intact, it should be carefully dissected and preserved to provide landmarks for tunnel placement and to enhance proprioceptive properties and vascularity of the graft in the postoperative period. 

Indications for ACL reconstruction include symptomatic instability with activities of daily living and/or athletic activities, functional impairment in patients unwilling to alter their lifestyle, and failure of nonoperative management. Relative contraindications include the presence of degenerative 

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