The Anterior Cruciate Ligament

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.

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. Gianni 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 (R) - Paul Re, Tony Wanich, Russell F. Warren 35. Pinn-ACL(R) CrossPin System for Femoral Graft Fixation - Arturo Almazan-Diaz, Donald H. Johnson 36. TransFix(R) 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(R) 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 Jarvela, Janne T. Nurmi, Antti Paakkala, Anna-Stina MoisalaAuvo Kaikkonen, Markku Jarvinen 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, Juri 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