Management of a Patient with an Anterior Cruciate Ligament Rupture

Abstract

This review article describes management of the patient with a torn anterior cruciate ligament (ACL). The most important finding for determining the condition of the ACL is the Lachman test, which is more reliably verified with instrumented laxity testing than with magnetic resonance imaging and the pivot shift test. Outcome after ACL reconstruction of the knee with chronic instability is the same as an acute reconstruction, as long as the damage to the menisci and cartilage are similar. With the use of nonirradiated, nonchemically treated, fresh-frozen, single-looped tibialis allografts, one can obtain similar results to autogenous double-looped, semitendinosus, and gracilis autografts; however, the use of irradiated and chemically treated allografts do not. Precise tunnel placement with the avoidance of roof and posterior cruciate ligament impingement in conjunction with the use of slippage-resistant, cortical fixation and brace-free, aggressive rehabilitation are the keys to avoiding knee stiffness, maintaining stability, rapidly rehabilitating the patient, and reliably returning them to sport at 4 months. Patients that return to sport at 4 months can expect a similar reinjury rate to those that return after 6 months. However, for those athletes younger than 18 years of age, the rate of reinjury depends on sex and the resumed level of activity and may be as high as 7% to 11% for the reconstructed ACL and 5% to 12% for the contralateral normal ACL, which should be shared with the patient and parents.