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Anterior Cruciate Ligament TearAka: ACL Tear, Anterior Cruciate Deficiency

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  1. Epidemiology
    1. Common injury associated with contact sports
  2. Mechanism
    1. Knee hyperextension injury
      1. Sudden foot plant with cut to opposite side
      2. Valgus stress causes tibial anterior displacement
      3. ACL ruptures as tibia displaces anteriorly
    2. High risk sports
      1. Skiing
      2. Basketball
      3. Football
      4. Volleyball
  3. Symptoms
    1. Painful "popping" sensation at time of injury
    2. Swelling (hemarthrosis) within 1-2 hours of injury
    3. "Giving way" or buckling sensation of knee
  4. Signs: Anterior Cruciate Ligament (ACL) Stability Tests
    1. Lachman Test (most sensitive)
    2. Knee Anterior Drawer Test
    3. Pivot Shift Test (MacIntosh Test)
  5. Radiology
    1. Knee XRay
      1. Evaluate for tibial spine avulsion Fracture
    2. Knee MRI Indications
      1. Preparation for ACL reconstruction
      2. Assess pediatric patient with suspected ACL tear
  6. Management: Conservative
    1. Quadriceps strengthening Exercises
    2. Knee Brace
    3. Activity modification
      1. Avoid cutting sports
      2. Avoid jumping sports
  7. Management: Adults Surgical ACL Reconstruction
    1. Acute surgical repair is associated with poor results
    2. Athletic patient
      1. Participating in "cutting" or jumping sports
    3. Requires 9-12 months of rehabilitation post-operatively
    4. Bracing after ACL repair is not effective
      1. Does not prevent reinjury or speed recovery
      2. McDevitt (2004) Am J Sports Med 32:1887
  8. Management: Children
    1. Non-displaced Type I Avulsion Fracture
      1. Long-leg Cast Immobilization for 4-6 weeks
    2. Displaced Type II to III Avulsion Fractures
      1. Open Reduction and Internal Fixation
      2. Long-leg Cast Immobilization for 4-6 weeks
    3. Intrasubstance Tears
      1. Operative Management
        1. Indicated for older children near skeletal maturity
      2. Non-operative Management (See above)
        1. Indicated in Young Children (Open growth plates)
        2. Perform operative reconstruction when mature
  9. Complications of Un-repaired ACL
    1. Meniscal Injury
    2. Knee Osteoarthritis
  10. References
    1. Mercier (1995) Practical Orthopedics, Mosby, p. 217-9
    2. Smith (1995) Am Fam Physician 51(4):799
    3. Lastihenos (1996) Phys Sportsmed 24(4):59

Rupture of anterior cruciate ligament (C0409312)

ConceptsInjury or Poisoning (T037)
EnglishACL - Anterior cruciate ligament rupture, Anterior cruciate ligament rupture, Rupture of anterior cruciate ligament, Tear of anterior cruciate ligament
Spanishruptura del ligamento cruzado anterior
Parent ConceptsRupture of ligament of knee joint (C0435122)
SourcesSCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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