anterior cruciate ligament [ACL] tear
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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]
More general terms
Additional terms
- anterior cruciate ligament; ligamentum cruciatum anterius (ACL)
- arthroscopic anterior cruciate ligament repair
References
- ↑ 1.0 1.1 Frobell RB et al Treatment for acute anterior cruciate ligament tear: five year outcome of randomised trial BMJ 2013;346:f232 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23349407 <Internet> 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: https://www.ncbi.nlm.nih.gov/pubmed/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: https://www.ncbi.nlm.nih.gov/pubmed/20660407 - ↑ 2.0 2.1 2.2 LaBella CR et al Anterior Cruciate Ligament Injuries: Diagnosis, Treatment, and Prevention. Pediatrics. April 28, 2014. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24777218 <Internet> http://pediatrics.aappublications.org/content/early/2014/04/22/peds.2014-0623.full.pdf+html
- ↑ 3.0 3.1 3.2 3.3 3.4 Medical Knowledge Self Assessment Program (MKSAP) 17, 18, 19. American College of Physicians, Philadelphia 2015, 2018, 2021.
- ↑ 4.0 4.1 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: https://www.ncbi.nlm.nih.gov/pubmed/23041233 Free PMC Article
- ↑ 5.0 5.1 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: https://www.ncbi.nlm.nih.gov/pubmed/24388450
- ↑ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 Rothaus C Anterior Cruciate Ligament Tear NEJM Resident 360. June 12, 2019 https://resident360.nejm.org/clinical-pearls/anterior-cruciate-ligament-tear
- ↑ Musahl V, Karlsson J. Anterior Cruciate Ligament Tear N Engl J Med. 2019 Jun 13;380(24):2341-2348. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31189037 Review. https://www.nejm.org/doi/10.1056/NEJMcp1805931
- ↑ 8.0 8.1 Lohmander LS et al. Treatment for acute anterior cruciate ligament tear in young active adults. NEJM Evid 2023 Jun 26; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/38320141 https://evidence.nejm.org/doi/10.1056/EVIDoa2200287