Skip to main content

Anterior Cruciate Ligament

  • Chapter
Arthroscopy and Sport Injuries

Abstract

Anterior cruciate ligament (ACL) is a very frequently injured ligament in many sports and usually causes long layoff from the athlete activity. Epidemiology, injury mechanisms, clinical and diagnostic examination, and surgical reconstruction in athletes are pointed out. Successful ACL reconstruction requires physical rehabilitation to return to play (RTP) at the same previous level, and it is more dependent upon the rehabilitation program than different surgical techniques, or type of graft, or fixation. In top-level athletes, we employ the accelerated rehabilitation program that emphasizes full-passive knee extension, immediate motion, immediate full weight bearing, and functional exercises. This chapter particularly focuses on different phases of postoperative rehabilitation and our criteria to RTP based on subjective and objective evaluation.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Boden BP, Griffin LY, Garrett WE (2000) Etiology and prevention of noncontact ACL injury. Phys Sportsmed 28:53–60

    Article  CAS  PubMed  Google Scholar 

  2. Griffin LY, Agel J, Albohm MJ et al (2000) Noncontact anterior cruciate ligament injuries: risk factors and prevention strategies. J Am Acad Orthop Surg 8:141–150

    CAS  PubMed  Google Scholar 

  3. Shimokochi Y, Shultz SJ (2008) Mechanism of noncontact anterior cruciate ligament injury. J Athl Train 43:396–408

    Article  PubMed Central  PubMed  Google Scholar 

  4. Kobayashi H, Kanamura T, Koshida S et al (2010) Mechanisms of the anterior cruciate ligament injury in sports activities: a twenty-year clinical research of 1,700 athletes. J Sports Sci Med 9:669–675

    PubMed Central  PubMed  Google Scholar 

  5. Olsen OE, Myklebust G, Engerbretsen L et al (2003) Relationship between floor type and risk of ACL injury in team handball. Scand J Med Sci Sports 13:299–304

    Article  CAS  PubMed  Google Scholar 

  6. Burkhart B, Ford KR, Myer GD et al (2008) Anterior cruciate ligament tear in an athlete: does increased heel loading contribute to ACL rupture? N Am J Sports Phys Ther 3:141–144

    PubMed Central  PubMed  Google Scholar 

  7. Ferretti A, Papandrea P, Conteduca F et al (1992) Knee ligament injuries in volleyball players. Am J Sports Med 20:203–207

    Article  CAS  PubMed  Google Scholar 

  8. McNair PJ, Marshall RN, Matheson JA (1990) Important features associated with acute anterior cruciate ligament injury. N Z Med J 103:537–539

    CAS  PubMed  Google Scholar 

  9. Livesay GA, Rudy TW, Woo SL et al (1997) Evaluation of the effect of joint constraints on the in situ force distribution in the anterior cruciate ligament. J Orthop Res 15:278–284

    Article  CAS  PubMed  Google Scholar 

  10. Draganich LF, Vahey JW (1990) An in vitro study of anterior cruciate ligament strain induced by quadriceps and hamstring forces. J Orthop Res 8:57–63

    Article  CAS  PubMed  Google Scholar 

  11. Markolf KL, O’Neil G, Jackson SR et al (2004) Effects of applied quadriceps and hamstrings muscle loads on forces in the anterior and posterior cruciate ligaments. Am J Sports Med 32:1144–1149

    Article  PubMed  Google Scholar 

  12. Fung DT, Zhang LQ (2003) Modelling of ACL impingement against the intercondylar notch. Clin Biomech (Bristol, Avon) 18:933–941

    Article  Google Scholar 

  13. Torg JS, Conrad W, Kalen W (1976) Clinical diagnosis of anterior cruciate ligament instability in the athlete. Am J Sports Med 4:84–93

    Article  CAS  PubMed  Google Scholar 

  14. Feagin JA, Cooke TD (1989) Prone examination for anterior cruciate ligament insufficiency. J Bone Joint Surg Br 71:863

    CAS  PubMed  Google Scholar 

  15. Benjamine A, Gokeler A, van der Schans CP (2006) Clinical diagnosis of an anterior cruciate ligament rupture: a meta-analysis. J Orthop Sports Phys Ther 36:267–268

    Article  Google Scholar 

  16. van Eck CF, van den Bekerom MPJ, Fu FH et al (2013) Methods to diagnose acute anterior cruciate ligament rupture: a meta-analysis of physical examinations with and without anaesthesia. Knee Surg Sports Traumatol Arthrosc 21:1895–1903

    Article  PubMed  Google Scholar 

  17. Collette M, Courville J, Forton M et al (2012) Objective evaluation of anterior knee laxity; comparison of the KT-1000 and GNRB arthrometers. Knee Surg Sports Traumatol Arthrosc 20:2233–2238

    Article  PubMed  Google Scholar 

  18. Robert H, Nouveau S, Gageot S et al (2009) A new knee arthrometer, the GNRB: experience in ACL complete and partial tears. Orthop Traumatol Surg Res 95:171–176

    Article  CAS  PubMed  Google Scholar 

  19. Spindler KP, Wright RW (2008) Clinical practice. Anterior cruciate ligament tear. N Engl J Med 359:2135–2142

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  20. Kosaka M, Nakase J, Toratani T et al (2013) Oblique coronal and oblique sagittal MRI for diagnosis of anterior cruciate ligament tears and evaluation of anterior cruciate ligament remnant tissue. Knee 21:54–57

    Article  PubMed  Google Scholar 

  21. Dimond PM, Fadale PD, Hulstyn MJ et al (1998) A comparison of MRI findings in patients with acute and chronic ACL tears. Am J Knee Surg 11:153–159

    CAS  PubMed  Google Scholar 

  22. Irvine GB, Dias JJ, Finlay DBL (1987) Segond fractures of the lateral tibial condyle: brief report. J Bone Joint Surg Br 69:613–614

    CAS  PubMed  Google Scholar 

  23. Vincent JP, Magnussen RA, Gezmez F et al (2012) The anterolateral ligament of the human knee: an anatomic and histologic study. Knee Surg Sports Traumatol Arthrosc 20:147–152

    Article  PubMed  Google Scholar 

  24. Pujol N, Colombet P, Cucurulo T et al (2012) Natural history of partial anterior cruciate ligament tears: a systematic literature review. Orthop Traumatol Surg Res 98(8 Suppl):160–164

    Article  Google Scholar 

  25. Andernord D, Karlsson J, Musahl V et al (2013) Timing of surgery of the anterior cruciate ligament. Arthroscopy 29:1863–1871

    Article  PubMed  Google Scholar 

  26. Cain EL Jr, Clancy WG (2002) Anatomic endoscopic anterior cruciate ligament reconstruction with patella tendon autograft. Orthop Clin North Am 33:717–725

    Article  PubMed  Google Scholar 

  27. Noyes FR (2010) ITB extra-articular tenodesis. In: Noyes FR (ed) Noyes’ knee disorders: surgery, rehabilitation, clinical outcomes. Saunders Elsevier, Philadelphia, pp 170–172

    Google Scholar 

  28. Christel P, Djian P (2002) Plastie extra articulaire antero latérale du genou utilisant une ténodèse courte au fascia-lata. Rev Chir Orthop Reparatrice Appar Mot 88:508–513

    CAS  PubMed  Google Scholar 

  29. Amiel D, Kleiner JB, Roux RD et al (1986) The phenomenon of “ligamentization”: anterior cruciate ligament reconstruction with autogenous patellar tendon. J Orthop Res 4:162–172

    Article  CAS  PubMed  Google Scholar 

  30. Tyler TF, McHugh MP, Gleim GW et al (1998) The effect of immediate weightbearing after anterior cruciate ligament reconstruction. Clin Orthop 357:141–148

    Article  PubMed  Google Scholar 

  31. Zech A, Awiswu F, Pfeifer K (2009) Longitudinal changes of neuromuscular quadriceps function after reconstruction of the anterior cruciate ligament. Curr Orthop Pract 20:276–280

    Article  Google Scholar 

  32. Renström P, Arms SW, Stanwyck TS et al (1986) Strain within the anterior cruciate ligament during hamstring and quadriceps activity. Am J Sports Med 14:83–87

    Article  PubMed  Google Scholar 

  33. Grood ES, Suntay WJ, Noyes FR et al (1984) Biomechanics of the knee-extension exercises. Effects of cutting the anterior cruciate ligament. J Bone Joint Surg Am 66:725–734

    CAS  PubMed  Google Scholar 

  34. Perry MC, Morrissey MC, King JB et al (2005) Effects of closed versus open kinetic chain knee extensor resistance training on knee laxity and leg function in patients during the 8- to 14-week post-operative period after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 13:357–369

    Article  PubMed  Google Scholar 

  35. Mikkelsen C, Werner S, Eriksson E (2000) Closed kinetic chain alone compared to combined open and closed kinetic chain exercises for quadriceps strengthening after anterior cruciate ligament reconstruction with respect to return to sports: a prospective matched follow-up study. Knee Surg Sports Traumatol Arthrosc 8:337–342

    Article  CAS  PubMed  Google Scholar 

  36. Kinzey S, Armstrong C (1998) The reliability of the star-excursion test in assessing dynamic balance. J Orthop Sports Phys Ther 27:356–360

    Article  CAS  PubMed  Google Scholar 

  37. Plisky P, Rauh M, Kaminski TW (2006) Star excursion balance test as a predictor of lower extremity injury in high school basketball players. J Orthop Sports Phys Ther 36:911–919

    Article  PubMed  Google Scholar 

  38. van Grinsven S, van Cingel RE, Holla CJ et al (2010) Evidence-based rehabilitation following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 18:1128–1144

    Article  PubMed  Google Scholar 

  39. Ardern CL, Webster KE, Taylor NF, Feller JA (2011) Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med 45:596–606

    Article  PubMed  Google Scholar 

  40. Seto JL, Orofino AS, Morrissey MC et al (1988) Assessment of quadriceps/hamstring strength, knee ligament stability, functional and sports activity levels five years after anterior cruciate ligament reconstruction. Am J Sports Med 16:170–180

    Article  CAS  PubMed  Google Scholar 

  41. Smith FW, Rosenlund EA, Aune AK et al (2004) Subjective functional assessments and the return to competitive sport after anterior cruciate ligament reconstruction. Br J Sports Med 38:279–284

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  42. Waldén M, Hägglund M, Magnusson H et al (2011) Anterior cruciate ligament injury in elite football: a prospective three-cohort study. Knee Surg Sports Traumatol Arthrosc 19:11–19

    Article  PubMed  Google Scholar 

  43. Ekstrand J (2011) A 94 % return to elite level football after ACL surgery: a proof of possibilities with optimal caretaking or a sign of knee abuse? Knee Surg Sports Traumatol Arthrosc 19:1–2

    Article  PubMed  Google Scholar 

  44. Brophy RH, Schmitz L, Wright RW et al (2012) Return to play and future ACL injury risk after ACL reconstruction in soccer athletes from the Multicenter Orthopaedic Outcomes Network (MOON) group. Am J Sports Med 40:2517–2522

    Article  PubMed Central  PubMed  Google Scholar 

  45. Shah VM, Andrews JR, Fleisig GS et al (2010) Return to play after anterior cruciate ligament reconstruction in National Football league athletes. Am J Sports Med 38:2233–2239

    Article  PubMed  Google Scholar 

  46. Busfield BT, Kharrazi FD, Starkey C et al (2009) Performance outcomes of anterior cruciate ligament reconstruction in the National Basketball Association. Arthroscopy 25:825–830

    Article  PubMed  Google Scholar 

  47. Orchard J, Seward H, McGivern J et al (2001) Intrinsic and extrinsic risk factors for anterior cruciate ligament injury in Australian footballers. Am J Sports Med 29:196–200

    CAS  PubMed  Google Scholar 

  48. Hui C, Salmon LJ, Kok A et al (2011) Fifteen-year outcome of endoscopic anterior cruciate ligament reconstruction with patellar tendon autograft for “isolated” anterior cruciate ligament tear. Am J Sports Med 39:89–98

    Article  PubMed  Google Scholar 

  49. Salmon LJ, Russell VJ, Refshauge K (2006) Long-term outcome of endoscopic anterior cruciate ligament reconstruction with patellar tendon autograft: minimum 13-year review. Am J Sports Med 34:721–732

    Article  PubMed  Google Scholar 

  50. Shelbourne KD, Gray T, Haro M (2009) Incidence of subsequent injury to either knee within 5 years after anterior cruciate ligament reconstruction with patellar tendon autograft. Am J Sports Med 37:246–251

    Article  PubMed  Google Scholar 

  51. Pinczewski LA, Lyman J, Salmon LJ et al (2007) A 10-year comparison of anterior cruciate ligament reconstructions with hamstring tendon and patellar tendon autograft: a controlled, prospective trial. Am J Sports Med 35:564–574

    Article  PubMed  Google Scholar 

  52. Wiger P, Brandsson S, Kartus J et al (1999) A comparison of results after arthroscopic anterior cruciate ligament reconstruction in female and male competitive athletes. A two- to five-year follow-up of 429 patients. Scand J Med Sci Sports 9:290–295

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Pier Paolo Mariani .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Mariani, P.P., Cerullo, G., Iannella, G., Giacobbe, M. (2016). Anterior Cruciate Ligament. In: Volpi, P. (eds) Arthroscopy and Sport Injuries. Springer, Cham. https://doi.org/10.1007/978-3-319-14815-1_41

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-14815-1_41

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-14814-4

  • Online ISBN: 978-3-319-14815-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics