Operative treatment of acute and chronic knee problems.

Attention to detail and anatomic precision is essential to accurate diagnosis. Accurate diagnosis is the keystone of care for the acute or chronic knee problem. The arthroscope is an essential diagnostic tool. Uniplanar instability can usually be treated nonoperatively with good results providing that secondary supporting structures are not anatomically disrupted, the ligaments are protected during their plastic healing phase, and the patient is committed to a complete rehabilitation program. Rotatory instabilities require surgery if a high functional level is desired by the patient, and the secondary restraints are anatomically compromised. Isometric reconstruction with provision for revascularization, whether intra- or extra-articular, is the key to successful surgery for rotatory instability. Multiple back-up procedures and "dynamic transfers" too often compromise a result that would have stood quite well alone. The foregoing may seem to be oversimplified, but the principles have proved satisfactory both in laboratory and clinic settings. When these principles are applied diligently in an active sporting community, the reinjury rate is low and patient satisfaction is high.