Cruciate ligament repair

Sherman classification

The Sherman Classification is useful in determining which cruciate tears are most likely to be amenable to repair, Type I being the most likely to be successful.

• Type I - avulsion from the femur bone at the top of the notch
• Type II - tear through the substance of the ACL in the upper 1/3
• Type III - mid-substance tear
• Type IV - distal tear
• Type V - avulsion from distal tibia bone

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Technique of cruciate repair

Cruciate repair (where the torn ends are sewn together) had been abandoned some years ago in favour of cruciate reconstruction (where the original ligament is replaced with a graft).

However, with improved understanding of which cruciate tears heal more readily and with improved technology, the procedure is making a comeback, especially in children where any harvested autograft would be too flimsy to use for a reconstruction and where the growth plates are still open and vulnerable to damage from drilling tunnels for a reconstruction.

There are several options for primary repair of the cruciate, but the main concepts include:

• preparing the femoral notch attachment site with microfracture and a fibrin clot, to encourage the torn end to re-unite with the bone
• augmenting the ligament perhaps with tape, and cinching it back into position
• tensioning and securing the repaired ligament to the outer part of the bone with suture anchors or buttons

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Other relevant links -

• Growth plate
• Cruciate ligament reconstruction
• Anterior cruciate ligament
• Femur
• Tibia
• Sherman classification
• Cruciate repair

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