Approaching the ruptured anterior cruciate ligament

Abstract

Anterior cruciate ligament (ACL) disruptions are common injuries that currently hold a fearsome reputation among athletes of all abilities and disciplines. Indeed, if the diagnosis is missed at first presentation, it is difficult to attribute ongoing instability and recurrent injury to an ACL tear. Classically, patients then often improve shortly before repeatedly reinjuring their knee. At some point, the knee may lock, necessitating an arthroscopic meniscectomy. Tragically, this then hastens the progression of joint arthrosis and the decline of the joint function. While the burden of responsibility does not lie solely with the junior doctor or the general practitioner, it is often at the first consultation that the natural history of this devastating injury is decided. The ability to recognise, institute early management and reassure patients with ACL tears about the future is an invaluable asset to the non-specialist junior doctor. Once diagnosed, the responsibility of advising and further counselling of patients with ACL injuries is best left to the orthopaedic knee specialist. Family practitioners and emergency room doctors should not feel pressured to offer advice on specialist areas such as return to sports without reconstruction or indeed the need for reconstruction. Indeed, decisions to return to sports with ACL-deficient knees have all too often led to disastrous reinjury events to the articular cartilage and/or the menisci.

Overrepresentation of the COL3A1 AA genotype in Polish skiers with anterior cruciate ligament injury

“…As a consequence, the knee may lock, necessitating an arthroscopic meniscectomy. Making matters worse, this then hastens the progression of joint arthrosis and the decline of joint function [ 21 ]. Osteoarthritis prevalence following ACL injury is as high as 80%, and most young patients suffer from early-onset osteoarthritis with associated knee pain and reduced quality of life between 30 and 50 years of age [ 22 ].…”

Review article: Best practice management of common knee injuries in the emergency department (part 3 of the musculoskeletal injuries rapid review series)

“…A survey of emergency physicians, sports medicine physicians and orthopaedic surgeons on their practice patterns regarding the use of early immobilisation in common acute soft tissue injuries showed that emergency physicians were more likely to prescribe immobilisation than other specialties, demonstrating that there is variation in care between different health providers . Although complete knee joint immobilisation using either a splint or locked hinged brace may protect tissues and alleviate pain, there can be harmful effects of prolonged joint immobilisation such as joint stiffness and muscle atrophy . Prescription of gentle range of motion exercises, basic quadriceps strengthening exercises and consideration for early follow up for rehabilitation and clinical review is essential to avoid any deleterious effects of prolonged immobilisation.…”

“…70 Although complete knee joint immobilisation using either a splint or locked hinged brace may protect tissues and alleviate pain, there can be harmful effects of prolonged joint immobilisation such as joint stiffness and muscle atrophy. 41,70,71 Prescription of gentle range of motion exercises, basic quadriceps strengthening exercises and consideration for early follow up for rehabilitation and clinical review is essential to avoid any deleterious effects of prolonged immobilisation.…”

State-of-the-art anterior cruciate ligament tears: A primer for primary care physicians

“…The ideal goal of either treatment plan is to provide the knee with the stability needed to meet the demands of the patient and to decrease the risk of associated future knee pathology such as meniscal tears and osteoarthritis. The determination of the optimal treatment remains controversial [1,3,8,38,39]. While surgical repair is widely accepted in the treatment of ACL rupture in young persons and athletes, conservative treatment may have good outcomes in the general population [40].…”

“…ACL reconstruction is typically performed arthroscopically. Tendon allografts are chosen in~40% of primary ACL reconstructions performed in the United States, with the remaining 60% utilizing autografts, which are tendons from the patient's hamstring (semitendinosus and gracilis), patellar tendon, or quadriceps tendon [1,38,39,58]. Graft selection depends on different factors such as patients' age, previous level of activity, desired activity level after surgery, and lifestyle.…”