Anterior cruciate ligament injury: symptoms, diagnosis and treatment

By Cristiano Antonino Last updated Nov 6, 2022

What is an anterior cruciate ligament injury? The anterior cruciate ligament (ACL) is one of the cornerstones of knee stability. It prevents the anterior translation movement of the tibia over the femur

Injury of the anterior cruciate ligament occurs fairly frequently in sportspeople and is caused by torsion movements in the vertical axis with anterior dislocation

The injury, which is almost always complete, can sometimes involve the tibial intercondylar spine (which corresponds to the distal insertion of the ligament).

What are the symptoms of an anterior cruciate ligament injury?

Clinically, it presents with pain, swelling (often considerable), and functional impotence.

Diagnosis of an anterior cruciate ligament injury

In the acute phase, it is difficult to assess the involvement of the ligament, so it is necessary to see the patient again after about 15-30 days, during which he will have been at rest and will have recovered his full range of motion.

Magnetic resonance imaging (MRI) can be decisive in cases where the diagnosis is more difficult, but normally the orthopaedic specialist is able to diagnose the injury with 90% reliability.

What is the therapy?

The treatment of an ACL injury is surgical, since it does not heal.

The evolution of surgical technique allows ligament reconstruction to be performed arthroscopically, i.e. without the need to perform an arthrotomy (major open surgery) with less invasiveness and therefore less risk of infection and faster functional recovery.

The reconstruction is based on the use of the patient’s own tendons (patellar tendon, semitendinosus tendon and gracilis tendon), which, appropriately harvested and treated, are inserted in the ‘place’ of the injured cruciate.

For several years now, it has been possible to minimise the sacrifice of the patient’s other tendons by using a tendon graft from a cadaver, which has been appropriately tested and purified.

The patient is passively mobilized as early as the day following the surgery; within two weeks he recovers his entire joint arch and can start walking, first with crutches and then independently.

One month after the surgery he can swim and use the exercise bike.

Within 6-9 months he can return to competitive sports without the need for any knee brace.