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The first article in this series drew attention to the evidence that ligament damage is more common than any other type of knee injury pathology. The mean delay from anterior cruciate ligament (ACL) injury to diagnosis at a specialist knee clinic was reported as 22 months. The management of the resulting instability from isolated ligament injuries and from more complex injuries is the subject of this the next article in the series.
The paper has been written by Derek Bickerstaff and Trinath Kakarlapudi from the Northern General Hospital in Sheffield. Derek Bickerstaff has a special interest in complex knee injuries and revision surgery. He is a member of the advisory committee producing national guidelines for the practice of ACL reconstruction and he has close associations with top level teams in several sports. Since his sports surgery fellowship in Adelaide, Australia, he has published and presented prolifically on the subject of knee injuries. His colleague, Trinath Kakarlapudi, is a specialist registrar who has just begun a fellowship in knee surgery in Toronto, Canada.
The article addresses the issues of assessment, treatment, and rehabilitation of the major isolated ligament injuries as well as the common combined instability patterns. It makes the point that treatment is aimed at restoring stability and function rather than preventing long term degenerative change, as there is no evidence that reconstruction reduces the development of arthritis. However, evidence is emerging that ACL reconstruction may reduce the incidence of subsequent meniscal damage and allow retention of their protective effect. ACL reconstruction is now such a popular and common operation world wide that data comparing the long term results of modern methods of reconstruction with the natural history of the deficient knee will soon be available.
For the future, the challenges mentioned are prevention of associated degenerative change and advances in prosthetic structures rather than grafts.
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