Table of Contents

SECTION I - ACL INJURY

Part A - Anatomy, Physiology, Biomechanics, Epidemiology

1. The Anatomy and Biomechanics of the ACL- James S. Starman, Mario Ferretti, Timo Jarvela,
Anthony Buoncristiani, Freddie H. Fu

2. Mechanisms of Non-Contact ACL Injuries-William E. Garrett, Jr, Bing Yu

3. Risk and Gender Factors for Non-Contact ACL Injury - Letha Y. Griffin, James Kercher

4. The Incidence of ACL Injury as a Function of Gender, Sport, and Injury Reduction Programs -
Chadwick Prodromos, Yung Han

5. Analysis of ACL Injury Prevention Programs for the Female Athlete - Holly J. Silvers, Robert H. Brophy, Bert R. Mandelbaum

Part B - Clinical

6. Diagnosis of ACL Tear - Chadwick Prodromos, Brian Murphy

7. The Non-Operative Treatment of ACL Deficient Patients- Elias Tsepis, Anastasios Georgulies

8. Arthrosis Following ACL Reconstruction - Nicholas E. Ohly, John F. Keating

SECTION II - ACL RECONSTRUCTION

9. The Economics of ACL Reconstruction - Chadwick Prodromos, Brian Joyce

Part A - GRAFT MECHANICAL PROPERTIES

10. The Relative Strengths of ACL Autografts and Allografts - Chadwick Prodromos, Brian Joyce

11. Why Synthetic Grafts Failed - Don Johnson

Part B - AUTOGRAFT HARVEST TECHNIQUES

12. Hamstring Harvest Technique for ACL Reconstruction - Don Johnson

13. Posterior Mini-Incision Hamstring Harvest Approach for ACL Reconstruction-Chadwick Prodromos

14. Technique for Harvesting a Mid-Third Patella Tendon Graft For ACL Reconstruction-Bertram
Zarins

15. The Central Quadriceps Free Tendon for ACL Reconstruction - John P. Fulkerson

Part C - HAMSTRING GRAFT CONFIGURATIONS

16. Hamstring ACL Reconstruction with a Quadrupled or Tripled Senitendinosus Tendon Graft - Alberto Gobbi, Ramces Francisco

17. 2ST/2Gr, 4ST and 3ST/2GR Techniques: and Deciding Which Hamstring Configuration to Use-
Chadwick Prodromos

Part D - PRINCIPLES OF TUNNEL FORMATION

Sub-Part i - Single Femoral Tunnel Formation

18. Use of the Transtibial Technique Avoids PCL and Roof Impingement of an Anterior Cruciate
Ligament Graft-Stephen M. Howell

19. The Anteromedial Portal for ACL Reconstruction-Manfred Bernard, Stavros Ristanis, Vassilis Chouliaras, Hans Paessler, Anastasios Georgoulis

20. The Retrodrill Technique for ACL Reconstruction - G. Puddu, G. Cerullo, M. Cipolla, V. Franco, E. Giann�

21. Femoral Tunnel Placement to Restore Normal Knee Laxity After ACL Reconstruction - Andrew A.
Amis

Sub-Part ii - Double AM and PL Femoral Tunnel Formation

22. Anatomic Double-bundle ACL Reconstruction Procedure Using the Semitendinosus and Gracilis Tendons - Kazunori Yasuda

23. Double Stranded Graft with Four Tunnels for Anatomic ACL Reconstruction - Pascal Christel,
Philippe Colombet, James Robinson, Jean Pierre Franceschi, Patrick Djian, Abdou Sbihi, Guy
Bellier

24. Anatomic Double Bundle ACL Reconstruction with a Semitendinosus Hamstring Tendon Graft -Alberto Gobbi, and Ramces Francisco

25. Anatomic Double Bundle Reconstruction of the ACL- Anthony Buoncristiani, Fotios Paul
Tjoumakaris, James S. Starman, Freddie H. Fu

Sub-Part iii - Notchplasty and Navigation

26. The Notchplasty - Mark R. Hutchinson

27. Computer Assisted Navigation for ACL Reconstruction - Jason Koh

Part E - FIXATION BIOMECHANICS

28. Biomechanics of Intratunnel ACL Graft Fixation - Neal Chen, Charles H. Brown

29. High Stiffness, Slippage Resistant Cortical Fixation Has Many Advantages Over Intratunnel Fixation - Stephen M. Howell

30. Tibial Fixation for ACL Hamstring grafts: Ten techniques that improve fixation - Lonnie E. Paulos

Part F - FIXATION DEVICES AND METHODS SOFT TISSUE GRAFT FEMORAL FIXATION

Sub-Part i - Suspensory Cortical

31. Endobutton ACLR Femoral fixation - Chadwick Prodromos

32. Cortical Screw-Post Femoral Fixation Using Whipstitches, Fabric Loop, or Endobutton: The Universal Salvage - Chadwick Prodromos

33. EZLOC Femoral Fixation Of a Soft Tissue Graft- Stephen M. Howell

Sub-Part ii - Cross Pin

34. Stratis ST Femoral Fixation System � - Paul Re, Tony Wanich, Russell F. Warren

35. Pinn-ACL� CrossPin System for Femoral Graft Fixation - Arturo Almaz�n-D�az, Donald H. Johnson

36. TransFix� ACL Femoral Fixation - Brian P. McKeon

37. Stryker Biosteon Cross-Pin Femoral Fixation for Soft-Tissue ACL Reconstruction - John C. Anderson, Lonnie E. Paulos, Walt Lowe

38. ACL Reconstruction Utilizing the Rigidfix Femoral Sided Fixation-John Richmond, Michael Kuhn

Sub-Part iii - Interference Screw Based

39. Hamstring Tendon Interference Screw Fixation - Michael Wagner, Andreas Weiler

40. Anatomic Retroscrew ACL Fixation: Single Bundle and Double Bundle Anterior Cruciate Ligament Reconstruction with Retroscrew Biointerference in a Single Femoral Socket - Steven Gorin, Craig D. Morgan, David Caborn

Part G - SOFT TISSUE GRAFT TIBIAL FIXATION

Sub-Part i - Cortical

41. Fastlok Device for Tibial Fixation of a Tripled or Quadrupled Semitendinosus Autograft for ACL Reconstruction - Alberto Gobbi, Ramces Francisco

42. Whipstitch-Post Tibial Fixations for ACL - Chadwick Prodromos, Aaron Hecker

43. Washerloc and Bone Dowel Tibial Fixation of a Soft Tissue Graft - Stephen M. Howell

44.Double Spike Plate (DSP): cortical fixation device enabling graft fixation under optional tension - Konsei Shino

Sub-Part ii - Interference Screw Based

45. ACL Hamstring Graft Fixation with Bioscrew� XtralokT - Tibial Fixation Device- Don Johnson

46. Intratunnel Tibial Fixation of Soft Tissue ACL Grafts: Graft Sleeve and Tapered - Charles H. Brown, Nader Darwich

47. Hamstring ACL Reconstruction with IntraFix Tibial Fastener - Joseph Sklar, Charles H. Brown

Part H - BONE-PATELLAR-TENDON-BONE FIXATION: FEMUR OR TIBIA

48. Interference Screw Fixation in Bone-Patella Tendon-Bone ACL Reconstruction - Gene R. Barrett, Taylor D. Brown

49. ACL Reconstruction using a Miniarthrotomy Technique with either an Ipsilateral or Contralateral Autogenous Patellar Tendon Graft - K. Donald Shelbourne

50. Bone-Patella-Bone ACL Reconstruction Using the Endobutton Continuous Loop BTB Fixation System - Stuart E. Fromm

Part I - NEWER INTERFERENCE SCREW MATERIALS

51. The Milagro Osteoconductive Interference Screw for ACL Reconstruction - F. Alan Barber

52. Improving Biodegradable Interference Screw Properties by Combining Polymers - Timo J�rvel�, Janne T. Nurmi, Antti Paakkala, Anna-Stina MoisalaAuvo Kaikkonen, Markku J�rvinen

Part J -GRAFT TENSIONING

53. Graft Tensioning in ACL Reconstruction: Establishing the Minimum Acceptable Tension - Kazanori Yasuda

54. Tensioning ACL Grafts: Avoiding Over-Tensioning - Lonnie E. Paulos

Part K -LIGAMENTIZATION AND GRAFT-TUNNEL HEALING

55. Graft Remodeling and Ligamentization after ACL Reconstruction - Scheffler SU, Unterhauser FN, Andreas Weiler

56. Graft Tunnel Healing-Giuseppe Milano, Laura Deriu, Carlo Fabbriciani

Part L -REVISION ACL RECONSTRUCTION

57. Revision ACL Reconstruction Using Autologous Hamstring Tendons - Andreas Weiler, Michael Wagner

58. Revision ACL Reconstruction- Neil P. Thomas, Hemat G. Pandit

Part M -ACL FOR SKELETALLY IMMATURE PATIENTS OR PARTIAL TEARS

59. ACL Reconstruction in Skeletally Immature Patients - Allen F. Anderson, Christian N. Anderson

60. ACL Reconstruction of Partial Tears: Reconstructing One Bundle - Fotios Paul Tjoumakaris, Anthony Buoncristiani, James S. Starman, Freddie H. Fu

Part N -TREATMENT OF ASSOCIATED LIGAMENT INJURIES OR CARTILAGE DEFICIENCY

61. ACL combined with MCL, PCL, and/or LCL Injury - K. Donald Shelbourne

62. Treatment of Meniscus Tears with ACL Reconstruction - K. Donald Shelbourne and Tinker Gray

63. ACL Reconstruction Combined with HTO, ACI, Microfracture, Osteochondral and/or Meniscal Allograft Transplantation - Chadwick Prodromos, Brian Joyce

Part O - REHABILITATION

64. ACL Strain Behavior During Rehabilitation Exercises - Petteri Kousa, James R. Slauterbeck, and Bruce D. Beynnon

65. Principles of ACL Rehabilitation - K. Donald Shelbourne, Tinker Gray

66. The Stability-Conservative ACL Reconstruction Rehabilitation Protocol - Chadwick Prodromos

67. Hamstring Strength and Regeneration Following Harvest for ACL Reconstruction - Andrew Riff, Mark Miller

68. Proprioception and ACL Reconstruction- Julian A Feller, Kate E Webster

Part P -STABILITY RESULTS

69. Stability Results After ACL Reconstruction - Chadwick Prodromos, Brian Joyce

Part Q -COMPLICATIONS

70. Infections in ACL Surgery - Charalampos G. Zalavras, Michael Patzakis

71. Allograft Complications and Risk Factors - Chadwick Prodromos, Brian Joyce

72. Stiffness: Prevention and Treatment -Anastassios Karistinos, Lonnie E. Paulos, Walter Lowe

73. Osteoporosis after ACL Reconstruction? - Lars Ejerhed, J�ri Kartus

74. Tunnel Widening after ACL Reconstruction - Chadwick Prodromos, Brian Joyce

75. Numbness: Saphenous Nerve - Tomoyuki Mochizuki, Keiichi Akita, Takeshi Muneta

76. Hardware complications after ACL reconstruction - Robert H. Brophy, Robert G. Marx

77. Vascular complications after ACL reconstruction - R.P.A. Janssen

78. Fracture Complications after ACL Reconstruction - Kai Mithoefer, Thomas J. Gill

79. Anterior Knee Problems after ACL Reconstruction-Michael E. Hantes, Apostolos Dimitroulias

Part R - GAIT ANALYSIS AND TISSUE ENGINEERING

80. Gait Analysis in ACL Deficient and Reconstructed Knee - Nicholas Stergiou, Stavros Ristanis, Constantina Moraiti, Anastasios D. Georgoulis

81. Growth Factors and Other New Methods for Graft Healing Enhancement - Harukazu Tohyama, Kazunori Yasuda

About the Author

Stephen M. Howell, MD is a board-certified orthopedic surgeon practicing in Sacramento and Lodi. He joined Adventist Health Lodi Memorial with more than three decades of experience as a clinician, researcher, and innovator in total knee replacement (TKR), anterior cruciate ligament (ACL) reconstruction, and meniscal surgery. Dr. Howell's clinical practice focuses on the treatment of degenerative processes and sports-related injuries to the knee. He performs more than 500 TKRs and 100 ACL reconstructions per year. Dr. Howell also created the kinematic alignment method, which caused a paradigm shift in TKR. His published experience demonstrates that patients report less pain, a quicker recovery, better pain relief, better function, better flexion, and a more natural feeling knee when treated with this method. Dr. Howell is also an Adjunct Professor of Biomedical Engineering at the University of California, Davis. He has published more than 140 scientific articles in peer-reviewed journals.