The Reversal

Excerpt

I have just finished reading Michael Connolly’s new book, The Reversal. Harry Bosch and Mickey Haller are working on an old case; a case that is trickier than they first assumed. They solve the case, along a winding road. I came to think about the treatment of ACL injuries—especially when it comes to ACL reconstruction—which is also a tricky case, and an old one as well. In fact, it is so tricky that we have not solved it—not yet anyway. Reversal, what are we talking about now? Is there possibly a completely new treatment for ACL injuries? Perhaps, we do not need to operate on ACL injuries any more? Is that a possibility? Hardly, I would go so far as to say. Instead, I guess that we will see new advances in the diagnostic evaluation and treatment of ACL injuries, whether they are surgical or non-surgical. During the last few years, we have seen several important improvements in the treatment of ACL injuries. The most important improvements are related to a better understanding of the surgical technique. This is where ‘the reversal’ comes into play. Several terms that we have felt to be more or less necessary, like isometry, o’clock reference and notch plasty, are probably just descriptions of past times; they have come and have now gone (at least, more or less). Instead, we have reversed; we have new terms and a new understanding of how to perform an ACL reconstruction. Most important is the anatomical way of thinking. One important issue is the double-bundle technique, but we should make it clear that double-bundle ACL reconstruction is not necessarily the same as anatomical reconstruction. Double bundle can still be done in a non-anatomical fashion. Single-bundle ACL reconstruction can be done anatomically. …