The ACL-Deficient Knee: Some Thoughts—Past and Future

John A. Feagin Jr.

Problems left unattended within the knee do not become easier with the passage of time… Technology is an essential adjunct to our surgical management of the knee. Today we are appropriately selective in our choice of techniques; tomorrow we must be precisely selective in our use of technological advances. We are in the dawn of greatly improved treatment of the knee.

–The Crucial Ligaments, second edition, 1994, page 4

Natural History of the ACL-Deficient Knee

The natural history of the anterior cruciate ligament (ACL)-deficient knee is still imperfect. The patient plays a critical role and partners with the surgeon in establishing the unique natural history of the knee. Sometimes the surgeon can harness the patient’s ability and energy to enhance the end result, but sometimes the patient is not in concert with the optimum treatment plan. Thus, the art and science of knee surgery and the lessons learned through experience are presented in this text.

Patient Selectivity

Not all patients need an ACL. Partial tears of the ACL are common. The ACL is a proprioceptive neural tube. The question often is: Does sufficient strength and function remain after ACL injury to provide adequate function and protect against further knee damage? What are the biomechanical demands?

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