Golden standard: patellar tendon-plasty--technique and management of postoperative complications]

ACL reconstruction with a patellar tendon autograft has reached a high grade of perfection. Surgery can be performed mini-open or arthroscopically, both techniques are presently equal in morbidity and results. The optimal insertion areas for the graft have been defined and can be controlled intra- and postoperatively by radiographs. The bone blocks of the graft allow for stable fixation and an aggressive functional rehabilitation program stressing active full extension of the joint. Disadvantages are a certain donor site morbidity and a rate of restrictions in range-of-motion. The management of arthrofibrosis should address the pathogenesis. Localized arthrofibrosis is caused by a mechanical conflict in the knee and removal of the mechanical block will usually solve the problem. Generalized arthrofibrosis is a complex process involving the entire joint and resulting in a wide-spread proliferative reaction of the connective tissue. The surgical management must be more complex involving open debridement and capsulotomies.