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Anterior cruciate ligament injury

Author
Ryan P Friedberg, MD
Section Editor
Karl B Fields, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM

INTRODUCTION

The anterior cruciate ligament (ACL) is an important stabilizing ligament of the knee that is frequently injured by athletes and trauma victims. There are between 100,000 and 200,000 ACL ruptures per year in the United States alone [1,2].

This topic review will discuss the presentation, evaluation, and management of ACL injuries. A discussion of the general approach to the patient with knee pain, including descriptions of examination techniques, and discussions of other specific knee injuries are found elsewhere. (See "Approach to the athlete or active adult with knee pain" and "Medial collateral ligament injury of the knee" and "Meniscal injury of the knee" and "Patellofemoral pain" and "Posterior cruciate ligament injury" and "Lateral collateral ligament injury and related posterolateral corner injuries of the knee".)

ANATOMY AND FUNCTION

The primary function of the anterior cruciate ligament (ACL) is to control anterior translation of the tibia. The ACL also is a secondary restraint to tibial rotation as well as varus or valgus stress [3]. The ACL originates at the posteromedial aspect of the lateral femoral condyle. It courses distally in an anterior and medial fashion to the anteromedial aspect of the tibia between the condyles. The position on the tibia is approximately 15 mm behind the anterior border of the tibial articular surface, and medial to the attachment of the anterior horn of the lateral meniscus (figure 1 and picture 1 and figure 2) [4]. The ACL is often said to be comprised of two bundles: an anteromedial bundle that is tight in flexion and a posterolateral bundle that is tight in extension. The blood supply to the ACL is from branches of the middle geniculate artery and its innervation comes from the posterior articular nerve, a branch of the tibial nerve [5]. The anatomy and biomechanics of the knee joint are discussed in detail separately. (See "Physical examination of the knee", section on 'Anatomy' and "Physical examination of the knee", section on 'Biomechanics'.)

EPIDEMIOLOGY

The anterior cruciate ligament (ACL) is the most commonly injured knee ligament. In the United States there are between 100,000 and 200,000 ACL ruptures per year, with an annual incidence in the general population of approximately 1 in 3500, although the actual incidence may be higher [1,2,6-8]. Data are limited by the absence of any standard surveillance mechanism for the general population. Registries exist for injuries sustained by United States college and high school athletes, but these account for a small percentage of the total number of injuries [9,10].

The great majority of ACL tears occur from noncontact athletic injuries. According to the National Collegiate Athletic Association (NCAA) injury surveillance system, which has tracked all injuries associated with United States college athletics since 1988, American football players sustain the greatest number of ACL tears (53 percent of total), but female gymnasts sustain the highest rate of injury (0.33 ACL injuries/1000 athletic exposures). One athlete participating in a single game or practice equals one exposure. Among skiers, recreational alpine skiers have the highest incidence of ACL rupture, while expert recreational skiers the lowest [11]. Competitive alpine skiers sustain ACL injuries at a high rate [12]. Participants in women's ice hockey and men's baseball have a low incidence [13].

                              

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Literature review current through: Nov 2016. | This topic last updated: Fri Sep 16 00:00:00 GMT 2016.
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