Anterior cruciate ligament rupture

  • Immediate joint dysfunction with an inability to ambulate is the most common symptom associated with ACL rupture. Patients describe immediate swelling of the knee (pictured) after the initial mechanism of injury. Patients most often describe a popping or tearing sensation immediately followed by severe pain. Common complaints include, “My knee buckled under,” or “My knee suddenly gave out.”

  • Initial workup for a ruptured ACL requires a thorough physical exam. Functionality tests should be performed to determine the stability of the joint and ACL. These tests evaluate joint integrity and any degree of separation by applying stress in certain directions and assessing the endpoints. Intact ligaments produce an abrupt, firm end-feel, whereas sprained or torn ligaments have soft, indistinct endpoints.

  • Loss of visualization of anterior cruciate ligament (ACL) on MRI consistent with rupture. An MRI is not required when deciding whether to refer a patient to an orthopedic surgeon, but it can aid in prompt identification.

  • The gold standard treatment for correcting an ACL rupture is surgical reconstruction using autograft or allograft tendons to effectively reproduce knee stability. In short, an orthopedic surgeon removes the injured athlete’s own hamstring tendons or uses donated tendons to reconstruct a new ACL. This x-ray shows the fixation device used in reconstruction.

  • After ACL reconstruction, postoperative rehabilitation is critical for a successful outcome. Techniques that contribute to successful postoperative outcomes include weight-bearing activities, continuous passive motion exercises, and adjunctive modalities.

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The anterior cruciate ligament (ACL) is one of the most commonly injured structures of the knee. An estimated 100,000 ACL ruptures are recorded each year in the United States, 60% of which require some type of surgical intervention.

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