Contents

Search

anterior cruciate ligament [ACL] tear

Epidemiology: - girls are more prone to ACL injuries than boys [2] (3-fold) - peak incidence at 16-18 years [6] - 40% of injuries are attributed to noncontact mechanisms involving pivoting, cutting Pathology: - acute anterior cruciate ligament tear is a common & serious knee injury in young, people - injury may lead to poor knee function, diminished quality of life, & premature osteoarthritis Clinical manifestations: - popping sound may be heard at the time of injury [3,6] - sensation of tearing may be noted - often immediately unable to bear weight [3] - onset of large knee effusion with 2-3 hours may occur [3,6] - knee instability - positive Lachman test Complications: - concomitant injury of - medial collateral ligament (19-38%) - lateral meniscal tear (20-45%) - medial meniscal tear (<28%) [6] - postoperative osteoarthritis on radiography Management: - often requires surgical reconstruction [3] - early neuromuscular training after arthroscopic surgical repair [4,5] - autografts of hamstring tendons (semitendinosus & gracilis muscles) - autograft of patellar tendon - autograft of quadriceps tendon - allografts inferior to autografts - return to sport should be delayed a minimum of 9 months from ACL surgery to optimize biologic graft incorporation & clinical outcomes [6] - only 40-55% of patients return to the same level of activity or higher after undergoing ACL surgery [6] - early & long-term functional outcomes similar with surgery vsphyical therapy [1,8] - partial anterior cruciate ligament tear, sedentary lifestyle & older age favor physical therapy vs early surgical repair - a wait-&-see approach to reconstructing ACL tears results in similar outcomes to repair soon after injury - repetitive jumping exercises (jumping rope) may reduce risk of ACL injury [2]

Related

anterior cruciate ligament; ligamentum cruciatum anterius (ACL) arthroscopic anterior cruciate ligament repair

General

knee injury, traumatic

References

  1. Frobell RB et al Treatment for acute anterior cruciate ligament tear: five year outcome of randomised trial BMJ 2013;346:f232 PMID: 23349407 http://www.bmj.com/content/346/bmj.f232 - Frobell RB et al. A randomized trial of treatment for acute anterior cruciate ligament tears. N Engl J Med 2010 Jul 22; 363:331. PMID: 20660401 Free article - Levy BA. Is early reconstruction necessary for all anterior cruciate ligament tears? N Engl J Med 2010 Jul 22; 363:386. PMID: 20660407
  2. LaBella CR et al Anterior Cruciate Ligament Injuries: Diagnosis, Treatment, and Prevention. Pediatrics. April 28, 2014. PMID: 24777218 http://pediatrics.aappublications.org/content/early/2014/04/22/peds.2014-0623.full.pdf+html
  3. Medical Knowledge Self Assessment Program (MKSAP) 17, 18, 19. American College of Physicians, Philadelphia 2015, 2018, 2021.
  4. Hewett TE et al. Current concepts for injury prevention in athletes after anterior cruciate ligament reconstruction. Am J Sports Med 2012 Oct 9; 41:216. PMID: 23041233 Free PMC Article
  5. Noyes FR, Barber-Westin SD. Neuromuscular retraining intervention programs: do they reduce noncontact anterior cruciate ligament injury rates in adolescent female athletes? Arthroscopy 2014 Jan 7; 30:245. PMID: 24388450
  6. Rothaus C Anterior Cruciate Ligament Tear NEJM Resident 360. June 12, 2019 https://resident360.nejm.org/clinical-pearls/anterior-cruciate-ligament-tear
  7. Musahl V, Karlsson J. Anterior Cruciate Ligament Tear N Engl J Med. 2019 Jun 13;380(24):2341-2348. PMID: 31189037 Review. https://www.nejm.org/doi/10.1056/NEJMcp1805931
  8. Lohmander LS et al. Treatment for acute anterior cruciate ligament tear in young active adults. NEJM Evid 2023 Jun 26; [e-pub]. PMID: 38320141 https://evidence.nejm.org/doi/10.1056/EVIDoa2200287