By Cyril B. Frank (auth.), Shigeo Niwa M.D., Ph.D., Shinichi Yoshino M.D., Ph.D., Masahiro Kurosaka M.D., Ph.D., Konsei Shino M.D., Ph.D., Sumiki Yamamoto M.D., Ph.D. (eds.)

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Sandberg et al. [5] performed prospective and randomized study on acutely injured ACL patients. They compared 100 patients who were treated conservatively by casting and another 100 patients whose ACLs were sutured after an average of 15 months after the operation. The results showed that pivot shift was positive in 47 patients (62%) in the conservative treatment group and positive in 23 patients (28%) of the suture group. In other respects the results did not differ between the two groups. Fruensgaad et al.

If this area is not adequately seen, further resection of the soft tissue along the posterior notch is necessary. The semitendinosus and gracilis tendons are harvested through a 3-cm incision that is one finger-breadth medial and two finger-breadths distal to the tibial tubercle; this should be directly over the pes anserinus tendons. The deep fascia overlying the tendons is incised longitudinally; the individual semitendinosus and gracilis tendons are then dissected free from deep fascial attachments using Metzenbaum scissors (Fig.

The internal edges of the tibial tunnel are then chamfered, and any residual soft tissue at the intraarticular margin of the tibial tunnel is removed. Next, the guidewire is reinserted through the tibial tunnel into the notch, and the isometric point of the graft placement on the lateral femoral condyle is identified. A number of guide systems are available to aid the surgeon in defining the isometric point. Once this area is identified, the knee is flexed at least 90°, and the guidewire is drilled from inside and then out the lateral femoral condyle.

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