- See:
Partial ACL Deficiency:
- Discussion:
- left untreated, the torn ACL leads to anterior laxity, rotatory instabilities, and
meniscal tears;
- there is a definite increase in X-ray changes of DJD
- 1/3 of pts w/ isolated ACL injuries will show minimal instability
- 2/3 will show instability;
- patients who intend to return to pre-injury athletic activity level will find that re-injury is common;
- re-injury may occur in over 50% of young patients over one year;
- re-injury may occur in over one third of middle aged patients after one year;
-
effects on the menisci: (see
ACL and meniscal tears:
- at the time of injury approximately 1/3 of patients will have meniscal tears, which are equally divided between
the medial and lateral compartments;
- the anterior instability produced by the ACL tear often leads to longitudinal meniscal tears in the medial compartment;
- the degenerative arthritis seen in ACL deficient knees may be more related to concomitant meniscal tears than it is to the ACL deficiency;
-
effects on chondral surfaces:
- cartilage damage will correlate with length of time from injury;
- medial compartment will often show more damage than the lateral compartment;
-
quadriceps avoidance gait: (see:
gait)
- most patients will alter their gait in order to avoid anterior displacement of the tibia which occurs with quadriceps contraction;
- between 0 to 45 deg of flexion, contraction of the quadriceps will cause anterior translation of the quadriceps (which
is normally resisted by the ACL);
- maximum anterior translation of the tibia occurs at 15-25 deg of flexion;
-
late degenerative changes:
- late degenerative changes are most often seen in ACL deficient knees with meniscal injury;
- ref: Long term osteoarthritic changes in anterior cruciate ligament reconstructed knees.
NM Jomha MD et al. CORR No 358 1999 p 188.
- Non Operative Treatment:
- there is no good evidence that brace wear decreases the rate of re-injury;
- older patients w/ isolated ligament injury who are willing to moderate their activity will
find non-operative treatment to be satisfactory in the majority of cases (over 80%);
The lower-extremity musculature in chronic symptomatic instability of the anterior cruciate ligament.
Tears of the anterior cruciate ligament in adolescents.
Conservatively treated tears of the anterior cruciate ligament. Long-term results.
Knee function after surgical or nonsurgical treatment of acute rupture of the anterior cruciate ligament: a randomized study with a long-term follow-up period.
Non-operative treatment of the torn anterior cruciate ligament.
Untreated ruptures of the anterior cruciate ligament. A follow-up study.
The anterior cruciate ligament. A functional analysis based on postmortem studies.
The natural history of the meniscus in anterior cruciate insufficiency. Arthroscopic analysis.
Non-operative treatment of ruptures of the anterior cruciate ligament in middle-aged patients. Results after long-term follow-up.
Controversy about treatment of the knee with anterior cruciate laxity.
The anterior cruciate ligament. A functional analysis based on postmortem studies.
Untreated ruptures of the anterior cruciate ligament. A follow-up study.
Knee function after surgical or nonsurgical treatment of acute rupture of the anterior cruciate ligament: a randomized study with a long-term follow-up period.
Anterior-cruciate-insufficient knees treated with physiotherapy. A three-year follow-up study of patients with late diagnosis.
A clinical and radiographical analysis of 127 anterior cruciate insufficient knees.
Gait adaptations by patients who have a deficient anterior cruciate ligament.
Surgical or non-surgical treatment of acute rupture of the anterior cruciate ligament. A randomized study with long-term follow-up.
Acute tears of the anterior cruciate ligament. Surgical versus conservative treatment.
Conservatively treated tears of the anterior cruciate ligament. Long-term results.
The lower-extremity musculature in chronic symptomatic instability of the anterior cruciate ligament.
Operative versus non-operative treatment of recent injuries to the ligaments of the knee. A prospective randomized study.
Muscle coordination following rupture of the anterior cruciate ligament. Electromyographic studies of 14 patients.
Non-operative treatment of the torn anterior cruciate ligament.
The role of the lateral extraarticular restraints in the anterior cruciate ligament-deficient knee.
The symptomatic anterior cruciate-deficient knee. Part I: the long-term functional disability in athletically active individuals.
Noyes FR. Mooar PA. Matthews DS. Butler DL. Journal of Bone & Joint Surgery - American Volume. 65(2):154-62, 1983 Feb.
The symptomatic anterior cruciate-deficient knee. Part II: the results of rehabilitation, activity modification, and counseling on functional disability.
Noyes FR. Matthews DS. Mooar PA. Grood ES. Journal of Bone & Joint Surgery - American Volume.65(2):163-74, 1983 Feb.
Muscle coordination following rupture of the anterior cruciate ligament. Electromyographic studies of 14 patients.
Followup of the acute nonoperated isolated anterior cruciate ligament tear.
Fate of the ACL injured patient: A prospective outcome study.
DM Daniel et al. Am J. Sports Med. Vol 22. 1994. p 632-644.
