Course

Anterior Cruciate Ligament

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10 Lessons

The knee is one of the most common locations for injury in football players (second only to the thigh). While anterior cruciate ligament (ACL) injuries represent less than 1% of all injuries, their impact on a players career is very significant. As a result these injuries are well known and widely publicised.

In this module we will review the clinical assessment of patients with an ACL injury. In particular we will review aspects of the history and examination which are suggestive of this injury. We will also discuss the imaging of acute knee injuries and examine the different options available for treatment of ACL deficiency.

Presented by

Mark Fulcher

Learning outcomes

  • How to recognise an anterior cruciate ligament (ACL) injury from clinical history taking
  • The clinical examination techniques which are required to make a diagnosis of an ACL injury
  • The role of imaging in ACL injury
  • The different treatment options for ACL injury
  • How to implement an ACL prevention program

Tasks

  • Watch or listen to embedded multimedia content
  • Review the clinical examination techniques and image library
  • Complete required reading
  • Complete the relevant assessment module

Required reading

F-MARC Football Medicine Manual 2nd Edition:

Chapter 3.1 (pages 161-166).

Suggested Reading

Brukner & Khan’s
Clinical Sports Medicine – 4th Edition
Chapter 32 (pages 626-683)

References

  1. Frobell RB, Roos HP, Roos EM, Roemer FW, Ranstam J, Lohmander LS. Treatment for acute anterior cruciate ligament tear: Five year outcome of randomised trial. BMJ 2013 Jan 24;346:f232.
  2. Pinczewski L, Roe J, Salmon L. Why autologous hamstring tendon reconstruction should now be considered the gold standard for anterior cruciate ligament reconstruction in athletes. Br J Sports Med 2009 May;43(5):325-7.
  3. Rahr-Wagner L, Thillemann TM, Pedersen AB, Lind M. Comparison of hamstring tendon and patellar tendon grafts in anterior cruciate ligament reconstruction in a nationwide population-based cohort study: Results from the danish registry of knee ligament reconstruction. Am J Sports Med 2014 Feb;42(2):278-84.
  4. Carmichael JR, Cross MJ. Why bone-patella tendon-bone grafts should still be considered the gold standard for anterior cruciate ligament reconstruction. Br J Sports Med 2009 May;43(5):323-5.
  5. Magnussen RA, Carey JL, Spindler KP. Does autograft choice determine intermediate-term outcome of ACL reconstruction? Knee Surg Sports Traumatol Arthrosc 2011 Mar;19(3):462-72.
  6. Shelbourne KD, Patel DV. Timing of surgery in anterior cruciate ligament-injured knees. Knee Surg Sports Traumatol Arthrosc 1995;3(3):148-56.
  7. Cannon WD,Jr, Vittori JM. The incidence of healing in arthroscopic meniscal repairs in anterior cruciate ligament-reconstructed knees versus stable knees. Am J Sports Med 1992 Mar-Apr;20(2):176-81.
  8. Levy BA, Dajani KA, Whelan DB, Stannard JP, Fanelli GC, Stuart MJ, Boyd JL, MacDonald PA, Marx RG. Decision making in the multiligament-injured knee: An evidence-based systematic review. Arthroscopy 2009 Apr;25(4):430-8.
  9. Millett PJ, Willis AA, Warren RF. Associated injuries in pediatric and adolescent anterior cruciate ligament tears: Does a delay in treatment increase the risk of meniscal tear? Arthroscopy 2002 Nov-Dec;18(9):955-9.
  10. Wright RW, Dunn WR, Amendola A, Andrish JT, Bergfeld J, Kaeding CC, Marx RG, McCarty EC, Parker RD, Wolcott M, et al. Risk of tearing the intact anterior cruciate ligament in the contralateral knee and rupturing the anterior cruciate ligament graft during the first 2 years after anterior cruciate ligament reconstruction: A prospective MOON cohort study. Am J Sports Med 2007 Jul;35(7):1131-4.
  11. Bizzini M, Hancock D, Impellizzeri F. Suggestions from the field for return to sports participation following anterior cruciate ligament reconstruction: Soccer. J Orthop Sports Phys Ther 2012 Apr;42(4):304-12.
  12. Zaffagnini S, Grassi A, Marcheggiani Muccioli GM, Tsapralis K, Ricci M, Bragonzoni L, Della Villa S, Marcacci M. Return to sport after anterior cruciate ligament reconstruction in professional soccer players. Knee 2014 Jun;21(3):731-5.
  13. Ardern CL, Webster KE, Taylor NF, Feller JA. Return to sport following anterior cruciate ligament reconstruction surgery: A systematic review and meta-analysis of the state of play. Br J Sports Med 2011 Jun;45(7):596-606.
  14. Bizzini M, Silvers HJ. Return to competitive football after major knee surgery: More questions than answers? J Sports Sci 2014;32(13):1209-16.
  15. Myklebust G, Bahr R. Return to play guidelines after anterior cruciate ligament surgery. Br J Sports Med 2005 Mar;39(3):127-31.
  16. Mall NA, Paletta GA. Pediatric ACL injuries: Evaluation and management. Curr Rev Musculoskelet Med 2013 Jun;6(2):132-40.
  17. Vavken P, Murray MM. Treating anterior cruciate ligament tears in skeletally immature patients. Arthroscopy 2011 May;27(5):704-16.
  18. Renstrom P, Ljungqvist A, Arendt E, Beynnon B, Fukubayashi T, Garrett W, Georgoulis T, Hewett TE, Johnson R, Krosshaug T, et al. Non-contact ACL injuries in female athletes: An international olympic committee current concepts statement. Br J Sports Med 2008 Jun;42(6):394-412.