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Jack C. Hughston
Memorial Jack C. Hughston
I
t is interesting that the words that reflect Jack Hughston’s philosophy of knee ligament repair are to be included in an issue devoted to the anatomic reconstruction of the anterior cruciate ligament. Dr. Hughston often is thought to have been against the repair of the anterior cruciate ligament (ACL) and to have belittled its importance. Nothing is further from the truth. He was not fond of the term anterior cruciate deficient-knee and, in an editorial in 1983 in the American Journal of Sports Medicine, he spoke out against it. His concern was that emphasis was being placed on the anterior cruciate ligament injury only and not on the resulting disability from associated injuries to the capsular ligaments and the menisci. One of Dr. Hughston’s most important legacies is his philosophy of treating knee injuries. It can be summed up by the following: 1. 2. 3. 4.
Establish a diagnosis. Rehabilitate conservatively. Re-examine the knee before surgery. Operate only on the basis of an objective demonstration of the need for surgery, not on the basis of the patient’s history alone. 5. Anatomy is the “key” to the knee. According to Dr. Hughston, the reason for not repairing and augmenting the ACL in patients before 1985 was the high rate of complications, such as ankylosis, posterolateral instability, and medial subluxation of the patella, that occurred when such a procedure was performed. The results of these procedures were never satisfactory; the techniques were altered, but there were no substantive results. Dr. Hughston later published an article in the Journal of Bone and Joint Surgery titled “The importance of the posterior oblique ligament in repairs of acute tears of the medial ligaments in knees with and without an associated rupture of the anterior cruciate ligament. Results of long-term follow-up.”1 In this article, he reported the results at an average of 22 years of follow-up in 41 patients who had had a repair of an acute tear of the medial ligaments. In 24 of these patients, the ACL had also been torn. He stated, “This operative technique has undergone no fundamental change since the first of the original 50 repairs was performed. Because the technique is based on restoring all of the anatomy to its proper position, we are not allowing much room for change to what nature has already 2
1048-6666/05/$-see front matter © 2005 Elsevier Inc. All rights reserved. doi:10.1053/j.oto.2004.10.007
Jack C. Hughston, MD
established over the past couple of million years.” The results of his treatment of this subgroup of 24 patients with combined ACL and MCL injuries, in which he débrided the torn ACL in 17 knees, repaired the ACL in 6 knees, and augmented the repaired ACL in 1 knee, were remarkable. There was no difference between the results in patients in whom the ACL was intact and in whom the ACL was torn, and 38 of the 41 patients had a stable knee with full range of motion. There were no radiographic changes, no instability, and no operations for stiffness.
Memorial: Jack C. Hughston The emphasis at the time Dr. Hughston made his earliest surgical observations was on restoring the anatomy to its correct position. Techniques have evolved since Dr. Hughston’s early operative experience and, now, with the aid of the arthroscope, anatomic reconstruction of the torn ACL is possible. In this issue, we find the collaborative experience of those in the field who are treating ACL injuries. Dr. Hughston believed that the key to success is always “to repair what is torn, to look closely at long-term follow-up, and then to document your results.” This statement has become relevant again today in the context of the double-bundle ACL reconstruction, because with this procedure we attempt to restore the ACL to its exact anatomic location. The results of ACL
3 repair techniques today should be compared with and held to the standard of Dr. Hughston’s experience of repair of the associated collateral ligaments. Champ L. Baker, Jr, MD The Hughston Clinic Columbus, GA
Reference 1. Hughston JC: The importance of the posterior oblique ligament in repairs of acute tears of the medial ligaments in knees with and without an associated rupture of the anterior cruciate ligament. Results of long-term follow-up. J Bone Joint Surg Am 76:1328-1344, 1994
I
t is interesting that the words that reflect Jack Hughston’s philosophy of knee ligament repair are to be included in an issue devoted to the anatomic reconstruction of the anterior cruciate ligament. Dr. Hughston often is thought to have been against the repair of the anterior cruciate ligament (ACL) and to have belittled its importance. Nothing is further from the truth. He was not fond of the term anterior cruciate deficient-knee and, in an editorial in 1983 in the American Journal of Sports Medicine, he spoke out against it. His concern was that emphasis was being placed on the anterior cruciate ligament injury only and not on the resulting disability from associated injuries to the capsular ligaments and the menisci. One of Dr. Hughston’s most important legacies is his philosophy of treating knee injuries. It can be summed up by the following: 1. 2. 3. 4.
Establish a diagnosis. Rehabilitate conservatively. Re-examine the knee before surgery. Operate only on the basis of an objective demonstration of the need for surgery, not on the basis of the patient’s history alone. 5. Anatomy is the “key” to the knee. According to Dr. Hughston, the reason for not repairing and augmenting the ACL in patients before 1985 was the high rate of complications, such as ankylosis, posterolateral instability, and medial subluxation of the patella, that occurred when such a procedure was performed. The results of these procedures were never satisfactory; the techniques were altered, but there were no substantive results. Dr. Hughston later published an article in the Journal of Bone and Joint Surgery titled “The importance of the posterior oblique ligament in repairs of acute tears of the medial ligaments in knees with and without an associated rupture of the anterior cruciate ligament. Results of long-term follow-up.”1 In this article, he reported the results at an average of 22 years of follow-up in 41 patients who had had a repair of an acute tear of the medial ligaments. In 24 of these patients, the ACL had also been torn. He stated, “This operative technique has undergone no fundamental change since the first of the original 50 repairs was performed. Because the technique is based on restoring all of the anatomy to its proper position, we are not allowing much room for change to what nature has already 2
1048-6666/05/$-see front matter © 2005 Elsevier Inc. All rights reserved. doi:10.1053/j.oto.2004.10.007
Jack C. Hughston, MD
established over the past couple of million years.” The results of his treatment of this subgroup of 24 patients with combined ACL and MCL injuries, in which he débrided the torn ACL in 17 knees, repaired the ACL in 6 knees, and augmented the repaired ACL in 1 knee, were remarkable. There was no difference between the results in patients in whom the ACL was intact and in whom the ACL was torn, and 38 of the 41 patients had a stable knee with full range of motion. There were no radiographic changes, no instability, and no operations for stiffness.
Memorial: Jack C. Hughston The emphasis at the time Dr. Hughston made his earliest surgical observations was on restoring the anatomy to its correct position. Techniques have evolved since Dr. Hughston’s early operative experience and, now, with the aid of the arthroscope, anatomic reconstruction of the torn ACL is possible. In this issue, we find the collaborative experience of those in the field who are treating ACL injuries. Dr. Hughston believed that the key to success is always “to repair what is torn, to look closely at long-term follow-up, and then to document your results.” This statement has become relevant again today in the context of the double-bundle ACL reconstruction, because with this procedure we attempt to restore the ACL to its exact anatomic location. The results of ACL
3 repair techniques today should be compared with and held to the standard of Dr. Hughston’s experience of repair of the associated collateral ligaments. Champ L. Baker, Jr, MD The Hughston Clinic Columbus, GA
Reference 1. Hughston JC: The importance of the posterior oblique ligament in repairs of acute tears of the medial ligaments in knees with and without an associated rupture of the anterior cruciate ligament. Results of long-term follow-up. J Bone Joint Surg Am 76:1328-1344, 1994