ANTERIOR CRUCIATE LIGAMENT INJURY - THE COMPETITIVE ATHLETE

The competitive elite athlete who sustains an anterior cruciate ligament (ACL) rupture has few options for treatment. If they wish to continue to compete at the preinjury level, then the only viable option is to undergo an ACL reconstruction. Otherwise, the athlete is at a substantial risk with a ACL deficient knee of sustaining subsequent degenerative changes in the knee at a young age. The athlete's presentation following injury includes reporting of a contact or noncontact acceleration or deceleration twisting injury to the knee, a 'pop' or the sensation of the joint 'coming apart', haemarthrosis, a positive Lachman test, loss of extension, and a positive pivot shift test. A magnetic resonance image may be used as an adjunct in the diagnosis. Treatment of the patient with an acutely injured ACL rupture begins with the first report of injury and continues until the patient has regained full strength and range of motion. The timing of the surgery depends on both the patient's physical and mental recovery from the acute injury. There are various surgical techniques employed in the ACL reconstruction: repair through the patellar defect, arthroscopically assisted techniques, and the miniarthrotomy technique we use. These techniques all give both excellent and reproducible results. A major emphasis is now placed on the preoperative and postoperative rehabilitation with an ACL reconstruction. An accelerated and aggressive programme which relies on early return and maintenance of full hyperextension equal to the-contralateral knee, early weight bearing, and closed kinetic chain exercises is recommended. The programme is divided into 3 phases with each phase having specific goals to be met before proceeding to the next phase. The individual rehabilitation programmes allow the highly motivated patient to proceed through the process at a more rapid pace. Most elite athletes are also highly motivated and may be allowed a more rapid return to play with this programme.