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assic fitness and health white logoassic fitness and health white logoAnterior Cruciate Ligament (ACL) InjuryAnterior Cruciate Ligament (ACL) Injury

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Anterior Cruciate Ligament (ACL) Injury

Categories
  • Joint/Tendon
  • Knee
Tags
  • knee injury
Knee Anatomy & Examination

Knee anatomy

Coronal view right knee

Coronal view right knee

Posterior (back of knee)

Axial view right knee

ACL injury mechanism

ACL injury mechanism

Non-contact injury mechanism:

Valgus knee with Tibia internally rotated  while femur externally rotated

ACL injury mechanism

ACL injury: isolated or combination of knee ligamentous injury. O’Donoghue described the unhappy knee injury triad, comprising injuries to: ACL, medial collateral ligament & the medial meniscus

ACL injury mechanism

Contact injury mechanism:

Mild knee flexion with anterior tibia translation

Knee Sprain

ACL injury symptoms & signs

  • Usually non-contact twisting injury
  • A “pop or snap” may be experienced at the time of injury
  • The injured individual is usually unable to continue with the activity
  • Swelling within the 1st hour
  • Instability symptoms will manifest with the feeling of the knee giving way, this is especially noticeable when changing direction while running
  • Concomitant symptoms & signs of meniscal injury may be present if additional associated injury present
Medial View of The Knee

ACL Injury classification

  • Isolated ACL injury: partial or complete tear
  • Combination of another knee ligamentous or soft tissue injury
  • May be associated with knee dislocation injury
ACL injury mechanism

ACL injury: isolated or combination of knee ligamentous injury. O’Donoghue described the unhappy knee injury triad, comprising injuries to: ACL, medial collateral ligament & the medial meniscus

Knee Sprain

ACL injury may be combined with other related knee ligament injuries

Dislocation of the knee

ACL injury may be related to knee dislocation

Investigations

Knee X-rays

  • Fractures including avulsion cruciate ligament injury can be excluded with knee X-rays
  • Associated X-ray radiological avulsion fractures include Segond fracture

MRI scan:

  • Gold standard investigation for soft tissue knee injury
  • Preoperative planning include associated identification of meniscus tear characteristics

ACL and Meniscus tears

  • ACL can be associated with a meniscus tear
  • Variation in meniscus tear pattern
ACL and Meniscus tears

Common meniscus tear patterns

Management ACL injury

Non-surgical treatment

  • Isolated Grd 1-2
Strengthening with ROM knee

Strengthening with ROM knee exercises.

Progressive return to sport after 6-8 weeks.

Surgery

  • Failed conservative treatment for low-grade ACL tear
  • Functional instability in an ACL deficient knee
  • Multiligamentous knee injury

ACL reconstruction surgery principles

Download ASSIC Performance Fingerprint or Strength & Conditioning apps for guideline ACL rehab routines

apple app store  google play store

References

  • Markolf KL, Feeley BT, Jackson SR, McAllister DR: Where should the femoral tunnel of a posterior cruciate ligament reconstruction be placed to best restore anteroposterior laxity and ligament forces? Am J Sports Med 2006; 34:604-611.
  • Matava M J, Ellis E, Gruber B. Surgical Treatment of Posterior Cruciate Ligament Tears: An Evolving Technique. J Am Acad Orthop Surg 2009;17: 435-446.
  • Mannor DA, Shearn JT, Grood ES, Noyes FR, Levy MS: Two-bundle posterior cruciate ligament reconstruction: An in vitro analysis of graft placement and tension. Am J Sports Med 2000;28:833-845.
  • Eakin CL, Cannon WDJ. Arthrometric evaluation of posterior cruciate ligament injuries. Am J Sports Med. 1998;26:96-102.
  • Petrie RS, Harner CD. Evaluation and management of the posterior cruciate injured knee. Oper Tech Sports Med. 1999;7:93-103.
  • Harner CD, Baek GH, Vogrin TM, Carlin GJ, Kashwaguchi S, Woo SL: Quantitative analysis of human cruciate ligament insertions. Arthroscopy 1999; 15:741-749.
  • Takahashi M, Matsubara T, Doi M, Suzuki D, Nagano A: Anatomical study of the femoral and tibial insertions of the anterolateral and posteromedial bundles of the human posterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 2006;14:1055-1059.
  • Edwards A, Bull AM, Amis AA: The attachments of the fiber bundles of the posterior cruciate ligament: An anatomic study. Arthroscopy 2007;23:284-290.

Contributor:

Dr M Y Hassan

Learn More

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