188 / 244
187
INTRODUCTION
By the mid 19
th
century [1], anatomists and
surgeons showed interest in the pathology of
the Anterior Cruciate Ligament (ACL) and
provided clinical descriptions.
Appearing in the literature at the beginning of
the 20
th
century [1], were proposals for ACL
repair by suture or reconstruction.
It is only since the late 60’s, that support for
ACL injuries truly began. It seemed interesting
to us to make a point regarding the evolution of
its surgical concepts. It encompasses a vision
Lyonnaise, of which this city’s School of Knee
Surgery is implicated, under the direction of
Albert Trillat, in this pathology for several
decades as evidenced by the organization of its
“Journées Lyonnaises du Genou”,
held since
1970.
LATE 60’s, EARLY 70’s
During this period, making the diagnosis of
ACL tear was not obvious. Clinically, the
insufficiency was diagnosed by looking for the
anterior drawer at 90° of flexion, the foot being
positioned in internal rotation, external rotation
and neutral positions.
The treatment therefore then logically proposed
as its goal, a reduction of this drawer at 90°
of flexion and aimed at restoring tension in
the medial capsuloligamentous structures in
accordance with the techniques described by
O’Donoghue [2], Nicholas [3] and Hughston
[4]. The surgical procedure was followed by a
period of cast immobilization and an often
laborious period of rehabilitation.
1970’s
The real turning point corresponded to English
language journal publications of clinical tests
which afforded clinicians a means of making
the diagnosis of ACL insufficiency.
The first was the “Pivot Shift” (Mac Intosh)
described by Galway [5], then the “Lachman
test” described by Torg [6], corresponding to
the anterior translation of the tibia relative to
the femur. The surgeons’ acquisition of these
tests allowed for the making of a diagnosis of
ACL tear.
Previously in 1967, Lemaire [7] had described
a dynamic test in internal rotation which had
the same significance as the “Pivot Shift”, as
did Noulis [8] in 1875, when he described
anterior translation in extension. Numerous
THE EVOLUTION OF ACL
RECONSTRUCTION OVER
THE LAST 50 YEARS
P. CHAMBAT, C.A. GUIER, J.M. FAYARD,
M. THAUNAT, B. SONNERY-COTTET