Chronically Anterior Cruciate Ligament Deficient Knee

When addressing concomitant injury to articular cartilage in the context of the chronically ACL deficient knee, several very important points must be weighed: (1) the extent of damage to articular cartilage, (2) the status of the menisci, and (3) evidence of angular malalignment. Accurate determination of extent of articular involvement in the painful, unstable knee is perhaps of paramount importance. Significant involvement of two or more compartments may preclude attempts at joint salvage. Unicom-partmental arthritis in the ACL-deficient knee, however, can be approached with ACL reconstruction and unloading osteotomy and/or meniscal transplantation where indicated.20

In select ACL-deficient patients without angular malalign-ment, isolated ACL reconstruction can be considered. Shel-bourne et al18 reported significant and durable pain relief (5.5 years mean follow-up) in a group of 58 patients with a chroni

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