Current concepts in the diagnosis and treatment of anterior cruciate ligament tears

Anterior cruciate ligament injury is regarded critical to the physiological kinematics of the femoral-tibial joint, its disruption causing longterm functional impairment in athletes. Both the initial trauma and the pathologic motion pattern of the injured knee may result in primary and secondary lesions of the medial and lateral meniscus as well as in biomechanical and macroscopical articular cartilage changes which are associated with the early onset of osteoarthritis. The clinical examination remains the key for diagnosing anterior cruciate ligament ruptures and associated injuries. In addition, magnetic resonance imaging is suitable for the detection of subchondral bone lesions and acute meniscal tears. Indications for operative treatment are the participation in sports with a high risk of pivoting, especially at competitive levels, and episodes of giving way. Timing for surgery should regard a noninflamed knee with full range of motion to be more important with respect to postoperative knee function than the time interval from injury to reconstruction. Autologous graft sources such as the patellar- and hamstring-ten dons have become the most frequently used graft types. Critical factors determining surgical success are considered to be the stable graft fixation and the precise anatomical graft placement. Under surveillance of these factors, the literature reports on encouraging mid to long-term clinical and functional outcomes. Current trends in anterior cruciate ligament surgery aim at a two-bundle reconstruction imitating the natural architecture of the ligament. Computer assisted navigation allows for a more precise geometry at the site of insertion of the transplant, and the administration of autologous growth factors appears to have the potential to facilitate the healing process.