Anterior cruciate ligament rupture - state of the art

A rupture of the anterior cruciate ligament causes a pathological anterior translation and an increased internal rotation of the tibia. Subjective symptoms are instability and a decreased activity level.The pathological motion pattern of the knee results in a high incidence of secondary meniscus and chondral damage. The natural history is mainly dependent on the activity level of the subject. Indications for operative reconstruction are young age, high activity and complex ligament injuries of the knee. The anterior cruciate ligament can be reconstructed by an autologous tendon graft. Patellar tendon, hamstring tendon and quadriceps tendon grafts can be used. There are no systematic differences between the outcome related to these grafts. The procedure can be performed arthroscopically or using a mini-open technique with equal result. Main success factors are an anatomical placement of the graft with stable fixation, avoidance of impingement in the intercondylar notch and adequate pretension. Optimum time periods for surgery are the first 48 h after the injury and the secondary phase when the initial inflammation has subsided and the range of motion is free. The rehabilitation must be tailored to the initial mechanical strength of the graft fixation. Preventive training has been proven to be effective to reduce the incidence of anterior cruciate ligament ruptures in handball and soccer players and should be used more widely.