Curbside Consultation of the ACL: 49 clinical questions.

Editor: Bernard R. Bach, Jr. and Nikhil N. Verma; series editor: Bernard R. Bach, Jr.

Bibliographic Data: ISBN: 978-1-55642-825-8; published by: SLACK Incorporated, NJ, USA, 2008; $79.95, 197 pages, soft cover paper.

Subjects: Preoperative, intraoperative, postoperative approach, management of the pediatric/adolescent patients and also after a failed surgery in ACL injury.

DESCRIPTION: A unique reference that offers opinions, preferences and expert advice associated with management of ACL injuries in the questions and answers format which enhanced by images, diagrams and references.

PURPOSE: "Curbside Consultation of the ACL" aims to provide some knowledge more than the basic information in the evaluation and the management of ACL injuries. This information is based on the opinion or the advice of an expert. Quick access of audience to these pearl and pitfalls and evidence-based expert advice for complicated cases in ACL reconstruction in the form of brief answers including current concepts is targeted by the authors.

AUDIENCE: Medical students, orthopedic residents, fellows in sports traumatology, practicing orthopedic surgeons and even high-volume clinicians may benefit "Curbside consultation of ACL". Clinicians other than orthopedic practitioners like physical treatment specialists, sports medicine practitioners, nonphysician medical stuff in sports medicine like physiotherapists and even some curious patients in an extent may benefit this referral.

FEATURES: 49 Clinical questions are outlined in 5 sections. In the first section is about preoperative questions including indications, diagnostic measures, combined ligament injuries, graft choice, preparation before surgery, avulsion of the eminence, examination in posterolateral corner injury. In the second section is preoperative questions are subjected including dropping the graft to the floor, posterior wall blowout, knees without hamstring tendon, graft amputation by interference screw, to avoid vertical tunnel in tibia, fixation methods of graft, femoral and tibial tunnel positioning. Third section is about postoperative questions including postoperative management, differences in postoperative rehabilitation protocols in different type of grafts, postoperative management of meniscal repair, management in difficulties in gaining extension, infection, patellar pain, timing of reoperation in motion problems, criteria returning to sports, outcome measures, outcome in using different grafts, role of bracing. The fourth section is about failed ACL reconstruction including causes, indications for revision, expanded tunnels, graft choice in revision surgery, controlateral patellar tendon graft for revision, rehab protocol after revision surgery, hardware removal, early degenerative joint disease, pain and instability, one stage ACL reconstruction and HTO, patellar fracture in patients with patellar tendon graft, tunnel position in revision setting. The fifth section is about pediatric/adolescent patients including, ACL injury in adolescent with open growth plates, surgical options in adolescents, the risk for adolescent females, the risk for opposite side, prevention program. The last chapter is about miscellaneous questions including non-operative treatment protocol, long-term implications of recurrent instability, and implications of ACL reconstruction on future development of degenerative arthritis.

ASSESMENT:

In the professional practice of the management in ACL injuries many of us have unanswered questions that are not addressed clearly in classical textbooks, which we use to look for the answers in the advises of experienced colleagues. Now the readers have the chance to get these answers for decision making in complicated cases or in complications from the many experts of ACL surgery. In the form of questions and brief answers to learn the current concepts from this pitfalls and pearls by most experienced authors makes me feeling in a safer side in my practice.

Reviewed by: M. Asum Baykan MD, Orthopedic Surgeon, Acibadem Harvard Medical International, Kozyatagi Hospital, Istanbul, Turkey