Anterior cruciate ligament (ACL) injuries cause due to low-velocity, noncontact deceleration and rotational contact injuries.
Contact sports can injure the ACL due to twisting, valgus stress, or hyperextension during collisions.
Females show higher ACL injury prevalence than males in activities. About 50% of ACL injury patients have meniscal tears.
In acute ACL injuries, lateral meniscus tears are common while chronic injuries affect medial meniscus.
A study estimates ACL injuries occur in 1 in 3500 people to approximately 95,000 new ruptures annually.
The ACL is crucial for athletes needing stability in running and cutting with deficiencies linked to degenerative changes and meniscal injuries.
ACL reconstruction has a long-term success rate of 75-95% with an 8% failure rate due to instability and graft issues.
Epidemiology
Approximately 200,000 annual ACL injuries in the United States reported.
About 100,000 ACL reconstructions occur yearly in individuals engaged in high-risk sports like basketball and football.
Females exhibit a 2.4-9.7 times higher injury prevalence than males with increased participation frequency.
Gornitzky et al studied and found ACL tear rates in high school female athletes exceed males by 1.6-fold.
Anatomy
Pathophysiology
The knee joint forms as a cleft between femur and tibia mesenchymal rudiments in week eight.
Cruciate ligaments develop from vascular synovial mesenchyme simultaneously.
The ACL and PCL receive their blood supply primarily from the middle geniculate artery. The ACL connects to bone via fibrocartilage and mineralized cartilage.
The ACL is a fibrous connective tissue with anteromedial and posterolateral bands to connect femur of the tibia.
Etiology
High-risk sports
Gender
Femoral notch stenosis
Footwear
Genetics
Prognostic Factors
Surgical ACL reconstruction shows 82-95% long-term success with recurrent instability and graft failure in 8%.
Nonoperative knee treatment results in fair/poor outcomes 50% of the time with 40% having no giving way.
Patients with ACL ruptures face osteoarthrosis risk post-reconstruction surgery aims to stabilize knees and delay arthritis development.
Surgery delay of at least 6 weeks increases medial meniscal tear risk by 4.3 times. Other risk factors include younger age and premature sports participation.
Clinical History
Collect details including initial symptoms, mechanism of injury, and medical history to understand clinical history of patient.
Physical Examination
Palpation
Range of Motion
Functional Testing
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Acute symptoms are:
Sudden onset of severe knee pain, rapid swelling, difficulty bearing weight or walking, sensation of knee
Chronic symptoms are:
Intermittent episodes of knee instability, chronic knee pain, secondary injuries
Differential Diagnoses
Medial Collateral Knee Ligament Injury
Posterior Cruciate Ligament Injury
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Patients should be encouraged for strengthening of the quadriceps and hamstrings as well as range of motion exercises.
ROM improves effusion reduction, motion recovery, and strength restoration.
Delay surgical intervention for at least 3 weeks post-injury to avoid arthrofibrosis.
Females had lower cartilage injury risk, while older males faced higher risk with delayed surgeries.
Primary repair is discouraged except for adolescent bony avulsions; ACL’s intra-location limits healing due to synovial fluid exposure.
Extra-articular repair uses iliotibial tract tenodesis to prevent pivot shift, but not anterior tibial translation.
Nonoperative treatment is suitable for elderly patients or less active athletes avoiding pivoting sports.
In the acute diagnosis phase, the goal is to ensure patient stability, control pain and inflammation.
Pharmacologic therapy is effective in the treatment phase as it includes the use of NSAID’S and Cyclooxygenase-2 inhibitors.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and surgical interventional therapies.
The regular follow-up visits with the surgeon are scheduled to check the improvement of patients along with treatment response.
»
Home » CAD » Anterior Cruciate Ligament Injury
Anterior Cruciate Ligament Injury
Updated :
January 31, 2025
Anterior cruciate ligament (ACL) injuries cause due to low-velocity, noncontact deceleration and rotational contact injuries.
Contact sports can injure the ACL due to twisting, valgus stress, or hyperextension during collisions.
Females show higher ACL injury prevalence than males in activities. About 50% of ACL injury patients have meniscal tears.
In acute ACL injuries, lateral meniscus tears are common while chronic injuries affect medial meniscus.
A study estimates ACL injuries occur in 1 in 3500 people to approximately 95,000 new ruptures annually.
The ACL is crucial for athletes needing stability in running and cutting with deficiencies linked to degenerative changes and meniscal injuries.
ACL reconstruction has a long-term success rate of 75-95% with an 8% failure rate due to instability and graft issues.
Approximately 200,000 annual ACL injuries in the United States reported.
About 100,000 ACL reconstructions occur yearly in individuals engaged in high-risk sports like basketball and football.
Females exhibit a 2.4-9.7 times higher injury prevalence than males with increased participation frequency.
Gornitzky et al studied and found ACL tear rates in high school female athletes exceed males by 1.6-fold.
The knee joint forms as a cleft between femur and tibia mesenchymal rudiments in week eight.
Cruciate ligaments develop from vascular synovial mesenchyme simultaneously.
The ACL and PCL receive their blood supply primarily from the middle geniculate artery. The ACL connects to bone via fibrocartilage and mineralized cartilage.
The ACL is a fibrous connective tissue with anteromedial and posterolateral bands to connect femur of the tibia.
High-risk sports
Gender
Femoral notch stenosis
Footwear
Surgical ACL reconstruction shows 82-95% long-term success with recurrent instability and graft failure in 8%.
Nonoperative knee treatment results in fair/poor outcomes 50% of the time with 40% having no giving way.
Patients with ACL ruptures face osteoarthrosis risk post-reconstruction surgery aims to stabilize knees and delay arthritis development.
Surgery delay of at least 6 weeks increases medial meniscal tear risk by 4.3 times. Other risk factors include younger age and premature sports participation.
Collect details including initial symptoms, mechanism of injury, and medical history to understand clinical history of patient.
Palpation
Range of Motion
Functional Testing
Acute symptoms are:
Sudden onset of severe knee pain, rapid swelling, difficulty bearing weight or walking, sensation of knee
Chronic symptoms are:
Intermittent episodes of knee instability, chronic knee pain, secondary injuries
Medial Collateral Knee Ligament Injury
Posterior Cruciate Ligament Injury
Patients should be encouraged for strengthening of the quadriceps and hamstrings as well as range of motion exercises.
ROM improves effusion reduction, motion recovery, and strength restoration.
Delay surgical intervention for at least 3 weeks post-injury to avoid arthrofibrosis.
Females had lower cartilage injury risk, while older males faced higher risk with delayed surgeries.
Primary repair is discouraged except for adolescent bony avulsions; ACL’s intra-location limits healing due to synovial fluid exposure.
Extra-articular repair uses iliotibial tract tenodesis to prevent pivot shift, but not anterior tibial translation.
Nonoperative treatment is suitable for elderly patients or less active athletes avoiding pivoting sports.
Use crutches or a walker to reduce weight-bearing during the acute phase.
Use chairs or beds of appropriate height to reduce strain on the knee.
Knee braces enhance stability and minimize reinjury risk during activities.
Proper awareness about anterior cruciate ligament injury should be provided and its related causes with management strategies.
Appointments with a surgeon and preventing recurrence of disorder is an ongoing life-long effort.
Ketorolac:
It inhibits prostaglandin synthesis to decrease the activity of the enzyme.
Celecoxib:
It inhibits COX-2 as inducible isoenzyme during pain and inflammatory stimuli.
Surgical intervention for ACL injury ranges from ACL Reconstruction, Meniscal Repair, and Cartilage Repair.
In the acute diagnosis phase, the goal is to ensure patient stability, control pain and inflammation.
Pharmacologic therapy is effective in the treatment phase as it includes the use of NSAID’S and Cyclooxygenase-2 inhibitors.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and surgical interventional therapies.
The regular follow-up visits with the surgeon are scheduled to check the improvement of patients along with treatment response.
Anterior cruciate ligament (ACL) injuries cause due to low-velocity, noncontact deceleration and rotational contact injuries.
Contact sports can injure the ACL due to twisting, valgus stress, or hyperextension during collisions.
Females show higher ACL injury prevalence than males in activities. About 50% of ACL injury patients have meniscal tears.
In acute ACL injuries, lateral meniscus tears are common while chronic injuries affect medial meniscus.
A study estimates ACL injuries occur in 1 in 3500 people to approximately 95,000 new ruptures annually.
The ACL is crucial for athletes needing stability in running and cutting with deficiencies linked to degenerative changes and meniscal injuries.
ACL reconstruction has a long-term success rate of 75-95% with an 8% failure rate due to instability and graft issues.
Approximately 200,000 annual ACL injuries in the United States reported.
About 100,000 ACL reconstructions occur yearly in individuals engaged in high-risk sports like basketball and football.
Females exhibit a 2.4-9.7 times higher injury prevalence than males with increased participation frequency.
Gornitzky et al studied and found ACL tear rates in high school female athletes exceed males by 1.6-fold.
The knee joint forms as a cleft between femur and tibia mesenchymal rudiments in week eight.
Cruciate ligaments develop from vascular synovial mesenchyme simultaneously.
The ACL and PCL receive their blood supply primarily from the middle geniculate artery. The ACL connects to bone via fibrocartilage and mineralized cartilage.
The ACL is a fibrous connective tissue with anteromedial and posterolateral bands to connect femur of the tibia.
High-risk sports
Gender
Femoral notch stenosis
Footwear
Surgical ACL reconstruction shows 82-95% long-term success with recurrent instability and graft failure in 8%.
Nonoperative knee treatment results in fair/poor outcomes 50% of the time with 40% having no giving way.
Patients with ACL ruptures face osteoarthrosis risk post-reconstruction surgery aims to stabilize knees and delay arthritis development.
Surgery delay of at least 6 weeks increases medial meniscal tear risk by 4.3 times. Other risk factors include younger age and premature sports participation.
Collect details including initial symptoms, mechanism of injury, and medical history to understand clinical history of patient.
Palpation
Range of Motion
Functional Testing
Acute symptoms are:
Sudden onset of severe knee pain, rapid swelling, difficulty bearing weight or walking, sensation of knee
Chronic symptoms are:
Intermittent episodes of knee instability, chronic knee pain, secondary injuries
Medial Collateral Knee Ligament Injury
Posterior Cruciate Ligament Injury
Patients should be encouraged for strengthening of the quadriceps and hamstrings as well as range of motion exercises.
ROM improves effusion reduction, motion recovery, and strength restoration.
Delay surgical intervention for at least 3 weeks post-injury to avoid arthrofibrosis.
Females had lower cartilage injury risk, while older males faced higher risk with delayed surgeries.
Primary repair is discouraged except for adolescent bony avulsions; ACL’s intra-location limits healing due to synovial fluid exposure.
Extra-articular repair uses iliotibial tract tenodesis to prevent pivot shift, but not anterior tibial translation.
Nonoperative treatment is suitable for elderly patients or less active athletes avoiding pivoting sports.
Use crutches or a walker to reduce weight-bearing during the acute phase.
Use chairs or beds of appropriate height to reduce strain on the knee.
Knee braces enhance stability and minimize reinjury risk during activities.
Proper awareness about anterior cruciate ligament injury should be provided and its related causes with management strategies.
Appointments with a surgeon and preventing recurrence of disorder is an ongoing life-long effort.
Ketorolac:
It inhibits prostaglandin synthesis to decrease the activity of the enzyme.
Celecoxib:
It inhibits COX-2 as inducible isoenzyme during pain and inflammatory stimuli.
Surgical intervention for ACL injury ranges from ACL Reconstruction, Meniscal Repair, and Cartilage Repair.
In the acute diagnosis phase, the goal is to ensure patient stability, control pain and inflammation.
Pharmacologic therapy is effective in the treatment phase as it includes the use of NSAID’S and Cyclooxygenase-2 inhibitors.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and surgical interventional therapies.
The regular follow-up visits with the surgeon are scheduled to check the improvement of patients along with treatment response.
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