50% of patients with ACL
injuries also have meniscal
- Acute >> Lateral
- Chronic >> Medial
Incidence is higher in soccer
players, basketball or any
high risk sports.
95,000 ACL Tear in USA annually
The ACL is composed of densely organized, fibrous
collagenous connective tissue that attaches the
femur to the tibia.
- Antromedia band
- Postrolateral band
On the Femur, the ACL is attached to:
a fossa on the posteromedial edge of the lateral femoral condyle.
On the Tibia, the ACL is inserted to:
a fossa that is anterior to the anterior tibial spine
Function of ACL
primary (85%) restraint to limit anterior
translation of the tibia.
secondary restraint to tibial rotation and
varus/valgus angulation at full extension.
The average tensile strength for the ACL is
- often occurs while changing direction or landing
from a jump.
- "popping" noise.
- Within a few hours, a large hemarthrosis develops.
- pain, swelling, and instability or giving way of the
- - unable to return to play.
Contact and high-energy traumatic injuries:
often are associated with other ligamentous and
- Terrible Triad !!
- immediate effusion >> intra-articular trauma.
2. Assess ROM:
Lack of complete extension.
Any meniscus or collateral tears or sprain.
Before any treatment, encourage strengthening of the
quadriceps and hamstrings, as well as ROM
who are elderly or have a very low activity level.
- surgical intervention be delayed at least 3 weeks
following injury to prevent the complication of
- Method of surgeries:
1- Primary repair .
2- Extra-articular repair.
3- Intra-articular reconstruction.
Grafting can be from :
- patellar tendon
- quadriceps tendon.
the expected long-term success rate of ACL reconstruction
is between 75-95%.
Failure Rate is 8%, which may be attributed to: recurrent
instability, graft failure, or arthrofibrosis.
Therapy protocols divided into the following 4 categories:
Phase I: preoperative period when the goal is to maintain full ROM.
Phase II (0-2 wk): The goal is to achieve full extension, maintain
quadriceps control, minimize swelling, and achieve flexion to 90o.
Phase III (3-5 wk): Maintain full extension and increase flexion up to
Phase IV (6 wk): Increase strength and agility, progressive return to
Return to all sports without activity may take 6-9 months
Once quadriceps strength reaches 65% of the
opposite leg, sports-specific activities may be
performed; >>>>>>>>>>>>>>>>>>> 5-8 weeks
The athlete may return to activity when the
quadriceps strength has reached 80% >>>
Re-growth to takes time, it may be need >>>> 6 months
Lifestyle and home remedies
- Ice. at least every two hours for 20 minutes at a time.
The 3 major categories of failure in an ACL reconstruction
(1) arthrofibrosis (due to inflammation of the synovium and
(2) pain that limits motion,
(3) recurrent instability, secondary to significant laxity in the
ACL is one of the ligament that stabilize the knee.
ACL tear is a popular injury in high risk sports.
History & clinical examination is the most important
tools in diagnosis.
MRI is the gold standard in diagnosis.
The goal of surgery is to stabilize the knee.
Success rate of ACL reconstruction is up to 95 %.
Physiotherapy is an important factor in treatment.
Matthew Gammons MD, Anterior Cruciate Ligament Injury ,
Medscape Updated: May 4, 2012
AAOS, American Orthopaedic Society for Sports Medicine ,
Anterior Cruciate Ligament Injuries , March 2009.
ACL injury , Myoclinin Family Health Book, Fourth Edition.