Treatment of Anterior Cruciate Ligament Injuries, Part I

• Published in: The American journal of sports medicine 2005-10, Vol.33 (10), p.1579-1602
• Main Authors: Beynnon, Bruce D., Johnson, Robert J., Abate, Joseph A., Fleming, Braden C., Nichols, Claude E.
• Format: Article
• Language: English
• Subjects: Anterior Cruciate Ligament - surgery; Anterior Cruciate Ligament Injuries; Biological and medical sciences; Biomechanical Phenomena; Bone-Patellar Tendon-Bone Grafting; Contusions - complications; Diseases of the osteoarticular system; Fundamental and applied biological sciences. Psychology; Humans; Joint and ligament injuries; Knee; Knee Injuries - complications; Knee Injuries - physiopathology; Knee Injuries - surgery; Knee Injuries - therapy; Ligaments, Articular - injuries; Medical sciences; Miscellaneous; Muscle, Skeletal - physiopathology; Osteoarthritis; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Randomized Controlled Trials as Topic; Reconstructive Surgical Procedures; Risk Factors; Rupture; Skin & tissue grafts; Sports medicine; Tibial Meniscus Injuries; Transplantation, Autologous; Transplantation, Homologous; Vertebrates: body movement. Posture. Locomotion. Flight. Swimming. Physical exercise. Rest. Sports
• ISSN: 0363-5465; 1552-3365
• DOI: 10.1177/0363546505279913

Anterior cruciate ligament injuries are common among athletes. Although the true natural history remains unclear, anterior cruciate ligament injuries are functionally disabling; they predispose the knee to subsequent injuries and the early onset of osteoarthritis. This article, the first in a 2-part series, was initiated with the use of the PubMed database and a comprehensive search of articles that appeared between January 1994 to the present, using the keywords anterior cruciate ligament . A total of 3810 citations were identified and reviewed to determine the current state of knowledge about the treatment of these injuries. Articles pertaining to the biomechanical behavior of the anterior cruciate ligament, the prevalence of anterior cruciate ligament injury, the natural history of the anterior cruciate ligament–deficient knee, injuries associated with anterior cruciate ligament disruption, risk factors for anterior cruciate ligament injury, indications for treatment of anterior cruciate ligament injuries, and nonoperative and operative treatments were obtained, reviewed, and served as the basis for part I. Part II, to be presented in another issue of this journal, includes technical aspects of anterior cruciate ligament surgery, bone tunnel widening, graft healing, rehabilitation after reconstruction, and the effect of sex, age, and activity level on the outcome of surgery. Our approach was to build on prior reviews and to provide an overview of the literature for each of the before-mentioned areas of study by summarizing the highest level of scientific evidence available. For the areas that required a descriptive approach to research, we focused on the prospective studies that were available; for the areas that required an experimental approach, we focused on the prospective, randomized controlled trials and, when necessary, the highest level of evidence available. We were surprised to learn that considerable advances have been made during the past decade regarding the treatment of this devastating injury. Keywords: anterior cruciate ligament knee reconstruction