Treatment Strategy for ACL Injury

Abstract

When the ACL is injured, the healing process takes place to some extent. However, even with conservative treatment such as immobilization with limitation of motion, not enough scar/healing tissue is formed in the intra-articular environment, and only tiny, lax scar tissue with or without some continuity remains (Fig. 5.14). In other words, the knee becomes unstable and follows the natural history described in Chap. 4. If sports activities (including jumping, stopping, cutting, full speed running, etc.) are continued without any effort, giving way (anterior dislocation or subluxation of the tibial plateau → reduction) may occur repeatedly, resulting in meniscus and articular cartilage damage. This leads to secondary osteoarthritis at an early stage. Even if the patient abstains from sports activities, the minor anterior subluxation of the tibial plateau persists, and the long-term outcome is the same as in the case of continuing sports activities (Fig. 4.2).