Physiotherapist doing healing treatment on patient leg. Therapist wearing blue uniform. Osteopathy, Chiropractic leg adjustment

Anterior cruciate ligament injury: symptoms, diagnosis and treatment

By Cristiano Antonino On Dec 16, 2022

Anterior cruciate ligament injury is common in adolescents, especially following severe distortive knee trauma during sports activities

The anterior cruciate ligament is one of the most important structures within the knee joint

This ligament is a major contributor to joint stability.

Within the knee joint, the anterior cruciate ligament connects the lower end of the femur with the upper end of the tibia.

The anterior cruciate ligament prevents the knee from overextending and the tibia from exaggeratedly rotating inward.

Rupture or tear of the anterior cruciate ligament is a serious injury to the knee, which becomes unstable, with limitation of its function.

Anterior cruciate ligament rupture is common in adolescents, especially as a result of severe distortive knee trauma during sports activities.

Girls who participate in sports at high risk of injury have an even higher incidence than boys.

At the time of injury, the patient complains of pain and reports a “cracking” sensation.

The knee swells, due to joint effusion.

The patient reports a feeling of joint failure, as the knee is no longer stable.

Anterior cruciate ligament rupture may be associated with injuries to the meniscus, articular cartilage, and other ligaments of the knee (posterior cruciate ligament, collateral ligaments).

Diagnosis is made through the collection of the medical history, delving very carefully into the pattern of injury, and through a thorough examination.

The diagnosis needs to be confirmed with MRI, which allows the assessment of the damage to the anterior cruciate ligament and highlights additional injuries at the level of other joint structures.

Anterior cruciate ligament injuries do not heal spontaneously and, if left untreated, make the knee unstable

This instability, over the years, may be responsible for other joint injuries (menisci, cartilage) and to the progressive development of osteoarthritis.

Conservative treatment aims at pain reduction, joint recovery, and muscle strengthening in preparation for surgical treatment, which is almost always necessary.

Surgical treatment consists of reconstruction of the anterior cruciate ligament using a tendon from the same patient.

Part of the patellar tendon, part of the quadriceps tendon, or the semitendinosus and gracilis tendons may be used to replace the cruciate ligament.

Surgery is performed arthroscopically

To prevent the occurrence of meniscus and cartilage injuries and in order to allow the adolescent to fully return to sports activities, anterior cruciate ligament reconstruction is a recommended surgical procedure.

However, the adolescent patient often has not completed his or her skeletal growth, and his or her bones are still composed, at least in part, of growth cartilage, which could be damaged by the surgical procedures required for ACL reconstruction.

There are, at present, surgical techniques for preserving growth cartilage in patients who have not yet completed skeletal growth.

However, in the adolescent patient, the choice of reconstructing an anterior cruciate ligament or waiting for full skeletal growth must be evaluated on a case-by-case basis.

As with meniscal injury prevention, to prevent anterior cruciate ligament rupture, it is necessary to engage in strenuous sports activities only after achieving good athletic training, which is essential to reduce the risk of serious knee injury.

The prognosis of conservative treatment is good, but only if the patient agrees to limit his or her sports activities.

Surgical techniques to reconstruct the anterior cruciate ligament allow the patient to resume pre-injury sports activities.

An appropriate postoperative rehabilitation program is a key part of the treatment.

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