The Crucial Ligaments: Diagnosis and Treatment of Ligamentous Injuries About the Knee, 2d ed.

The Crucial Ligaments, subtitled the Diagnosis and Treatment of Ligamentous Injuries About the Knee, is a comprehensive compilation of case studies and indepth chapters addressing all aspects of ligamentous knee injuries. Twenty-one case studies, followed by scientific and scholarly articles, provide a comprehensive foundation and understanding of knee care, from physical examination, decision making, and surgical care through rehabilitation. The list of contributing authors reads like an international "Who's Who" in the arena of orthopedic medicine. Eighty-four contributing authors, including Shelbourne, Noyes, Andrews, Clancy, Fu, Losee, Larson, Warren, Steadman, and Paulos, have created a symphony of knowledge and wisdom developed through experience. The primary audience for this work is clearly the student of the knee and the experienced orthopedic surgeon.

Five paragraphs, titled "How to Use This Book: A Recipe and a Philosophy," precede the table of contents. The book is divided into two areas. Section 1 is devoted to 21 case studies of injured athletes. Basic principles of diagnosis and treatment are illustrated in the case studies. Sections 2 through 9 support the case studies.

The case studies are subdivided into two sections. The first 14 case studies, subtitled "Primary Care," discuss common knee injuries of relatively uncomplicated nature. Case studies 15 through 21, subtitled "Sequelae," reflect many problems and complications resulting from the common injuries in the "Primary Care" section.

The case studies are organized in a consistent, algorithmic style. The case-study format includes patient history; course of action; plan; postoperative care and rehabilitation; problems, complications, follow-up results; summary; references; and suggested readings. The case studies are full of helpful charts and rich illustrations. Each study represents a total plan--from examination through treatment, preparation for surgery, the surgery, and rehabilitation. The decision-making process and integration of many distinct variables are highlighted. The integration of the variables implicit in the diagnosis, treatment, and follow-up is, in fact, the essence of the case studies. As noted above, each case study has a list of references and recommended readings pertinent to the case. Following the case studies, a 10-page bibliography provides additional references for scholarly pursuit.

The second area of the book, containing of 41 chapters, provides a comprehensive foundation for handling many kinds of cases. These chapters are scientific and scholarly contributions blended with years of experience. Topics covered include history, evolution, epidemiology; anatomy and kinematics; diagnosis; natural history, prevention, counseling; surgical treatment; sequelae; rehabilitation; and prosthetic ligaments. Almost every page makes use of excellent drawings, photographs, charts, photomicrographs, illustrations, or radiological studies. These chapters are exhaustive in their coverage of all aspects of knee care.

Of particular interest to physical therapists are the sections on rehabilitation. Five chapters covering a mere 55 pages is all that is dedicated to rehabilitation. This seems, upon cursory examination, woefully inadequate coverage of this subject, especially when one examines the depth of study in other areas. Additionally, the first two chapters pertaining to rehabilitation appear to take vastly different philosophies to rehabilitating the anterior cruciate ligament reconstructed knee. Arvidsson and Eriksson recommend limiting range of motion of the knee postoperatively to a maximum of 90 degrees of flexion and limiting extension at 30 degrees for the first 8 weeks. They recommend not initiating cautious jogging for 4 months. This is in direct contrast to Shelbourne, Klootwyk, and DeCarlo, who promote full extension the same day of reconstructive surgery and expect 90 degrees of flexion and full weight bearing without crutches 2 weeks postoperatively. The Shelbourne approach allows patients to perform light running as early as 5 weeks postoperatively, if strength requirements are attained.

The information in this book is up-to-date, timely, and addresses historical perspectives and future technological trends regarding ligamentous knee injuries. Surgical techniques appear state-of-the-art, imaging discussions and studies utilize the latest tools in these areas, including radiographs, magnetic resonance imaging, and stress radiography. The bibliographies form a collection of readings from experts around the world, whose contributions form "the core of science and experience that is fundamental to the care of the knee." Rehabilitation concepts incorporate biomechanical principles and considerations of soft tissue healing, and emphasize early return to function. Although more exhaustive coverage of rehabilitation is preferred for physical therapists, rehabilitation concepts are covered in many areas, including each case study.

This is without a doubt a comprehensive, classic text. Although written for surgeons, it would make a valuable addition to the library of anyone working with this patient population. Physical therapists, physical therapist assistants, and athletic trainers will gain valuable insight to the total spectrum of care for the patient with knee injury. Considering the wealth of information provided and the compre-hensive bibliographies and reference sections, it is a reference book to be used time and again.

Dennis E Schnepp, PT Industrial Rehabilitation Associates Inc Indianapolis, Ind