eMedicine Specialties > Physical Medicine and Rehabilitation > Lower Limb Musculoskeletal Conditions

Anterior Cruciate Ligament Injury: Follow-up

Author: Tarek Souryal, MD, Head Team Physician, Dallas Mavericks; Former Chief, Department of Surgery, Division of Orthopedic Surgery, Las Colinas Medical Center; Clinical Professor, Departments of Orthopedic Surgery and Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center
Coauthor(s): Kenneth Adams, MD, Assistant Professor, Department of Physical Medicine and Rehabilitation, University of Texas Southwestern
Contributor Information and Disclosures

Updated: Jan 2, 2009

Follow-up

Further Inpatient Care

Further Outpatient Care

Deterrence

  • See Causes . In a paper published by Hewett and coauthors, a jump training program was recommended strongly.19 Another paper, by Wojtys and colleagues, showed that plyometrics and exercises requiring agility, such as running through cones, figure eights, and single leg jumps, are proven methods to improve muscle reaction time significantly.20 Ultimately, physical conditioning and balanced knee strengthening (hamstrings as well as quadriceps) are the keys to reducing the risk of an ACL tear.

Complications

Prognosis

  • Most patients achieve good health and mobility after treatment for ACL injury. (More than 75% of all patients who undergo ACL repair return to their previous level of functioning.) They perform ADL without difficulty and return to participation in their previous sporting or recreational activities.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Medical/legal issues from anterior cruciate ligament (ACL) injury and graft replacement generally arise from complications during surgery. Initial misdiagnosis of ACL injury also can be a source of potential litigation. Obtain a complete history from the patient. The mechanism of injury for an ACL tear is fairly consistent. A thorough physical examination helps the physician to confirm the diagnosis, and an MRI scan identifies additional possible injuries to other ligaments or cartilage.
  • The potential for a lawsuit arising from improper physical therapy also exists. If the therapist is too aggressive in rehabilitation exercises and rupture of the ACL graft occurs, some patients might consider litigation.
 


More on Anterior Cruciate Ligament Injury

Overview: Anterior Cruciate Ligament Injury
Differential Diagnoses & Workup: Anterior Cruciate Ligament Injury
Treatment & Medication: Anterior Cruciate Ligament Injury
Follow-up: Anterior Cruciate Ligament Injury
References
[ CLOSE WINDOW ]

References

  1. Arendt E, Dick R. Knee injury patterns among men and women in collegiate basketball and soccer. NCAA data and review of literature. Am J Sports Med. Nov-Dec 1995;23(6):694-701. [Medline].

  2. Hutchinson MR, Ireland ML. Knee injuries in female athletes. Sports Med. Apr 1995;19(4):288-302. [Medline].

  3. Nagano Y, Ida H, Akai M, et al. Biomechanical characteristics of the knee joint in female athletes during tasks associated with anterior cruciate ligament injury. Knee. Dec 23 2008;[Medline].

  4. Noyes FR, Mooar PA, Matthews DS, et al. The symptomatic anterior cruciate-deficient knee. Part I: the long-term functional disability in athletically active individuals. J Bone Joint Surg [Am]. Feb 1983;65(2):154-62. [Medline].

  5. Acasuso Diaz M, Collantes Estevez E, Sanchez Guijo P. Joint hyperlaxity and musculoligamentous lesions: study of a population of homogeneous age, sex and physical exertion. Br J Rheumatol. Feb 1993;32(2):120-2. [Medline].

  6. Kibler WB, Chandler TJ, Uhl T, et al. A musculoskeletal approach to the preparticipation physical examination. Preventing injury and improving performance. Am J Sports Med. Jul-Aug 1989;17(4):525-31. [Medline].

  7. Godshall RW. The predictability of athletic injuries: an eight-year study. J Sports Med. Jan-Feb 1975;3(1):50-4. [Medline].

  8. Jackson DW, Jarrett H, Bailey D, et al. Injury prediction in the young athlete: a preliminary report. Am J Sports Med. Jan-Feb 1978;6(1):6-14. [Medline].

  9. Shambaugh JP, Klein A, Herbert JH. Structural measures as predictors of injury basketball players. Med Sci Sports Exerc. May 1991;23(5):522-7. [Medline].

  10. Souryal TO, Moore HA, Evans JP. Bilaterality in anterior cruciate ligament injuries: associated intercondylar notch stenosis. Am J Sports Med. Sep-Oct 1988;16(5):449-54. [Medline].

  11. Souryal TO, Freeman TR. Intercondylar notch size and anterior cruciate ligament injuries in athletes. A prospective study [published erratum appears in Am J Sports Med 1993 Sep-Oct;21(5):723]. Am J Sports Med. Jul-Aug 1993;21(4):535-9. [Medline].

  12. Beynnon BD, Fleming BC, Johnson RJ, et al. Anterior cruciate ligament strain behavior during rehabilitation exercises in vivo. Am J Sports Med. Jan-Feb 1995;23(1):24-34. [Medline].

  13. [Best Evidence] Beynnon BD, Uh BS, Johnson RJ, et al. Rehabilitation after anterior cruciate ligament reconstruction: a prospective, randomized, double-blind comparison of programs administered over 2 different time intervals. Am J Sports Med. Mar 2005;33(3):347-59. [Medline].

  14. Louboutin H, Debarge R, Richou J, et al. Osteoarthritis in patients with anterior cruciate ligament rupture: a review of risk factors. Knee. Dec 19 2008;[Medline].

  15. Barker T, Leonard SW, Trawick RH, et al. Modulation of inflammation by vitamin E and C supplementation prior to anterior cruciate ligament surgery. Free Radic Biol Med. Nov 27 2008;[Medline].

  16. Wu C, Noorani S, Vercillo F, et al. Tension patterns of the anteromedial and posterolateral grafts in a double-bundle anterior cruciate ligament reconstruction. J Orthop Res. Dec 30 2008;[Medline].

  17. Kim SJ, Jo SB, Kumar P, et al. Comparison of single- and double-bundle anterior cruciate ligament reconstruction using quadriceps tendon-bone autografts. Arthroscopy. Jan 2009;25(1):70-7. [Medline].

  18. Muneta T, Sekiya I, Ogiuchi T, et al. Effects of aggressive early rehabilitation on the outcome of anterior cruciate ligament reconstruction with multi-strand semitendinosus tendon. Int Orthop. 1998;22(6):352-6. [Medline].

  19. Hewett TE, Lindenfeld TN, Riccobene JV, et al. The effect of neuromuscular training on the incidence of knee injury in female athletes. A prospective study. Am J Sports Med. Nov-Dec 1999;27(6):699-706. [Medline].

  20. Wojtys EM, Huston LJ, Taylor PD, et al. Neuromuscular adaptations in isokinetic, isotonic, and agility training programs. Am J Sports Med. Mar-Apr 1996;24(2):187-92. [Medline].

  21. Aglietti P, Buzzi R, D'Andria S, et al. Long-term study of anterior cruciate ligament reconstruction for chronic instability using the central one-third patellar tendon and a lateral extraarticular tenodesis. Am J Sports Med. Jan-Feb 1992;20(1):38-45. [Medline].

  22. Aglietti P, Buzzi R, Zaccherotti G, et al. Patellar tendon versus doubled semitendinosus and gracilis tendons for anterior cruciate ligament reconstruction. Am J Sports Med. Mar-Apr 1994;22(2):211-7; discussion 217-8. [Medline].

  23. Bach BR Jr, Jones GT, Sweet FA, et al. Arthroscopy-assisted anterior cruciate ligament reconstruction using patellar tendon substitution. Two- to four-year follow-up results. Am J Sports Med. Nov-Dec 1994;22(6):758-67. [Medline].

  24. Baechle TR. Women in resistance training. Clin Sports Med. 1984;3:791-880.

  25. Biedert RM, Bachmann M. [Women's soccer. Injuries, risks, and prevention]. Orthopade. May 2005;34(5):448-53. [Medline].

  26. Buss DD, Min R, Skyhar M, et al. Nonoperative treatment of acute anterior cruciate ligament injuries in a selected group of patients. Am J Sports Med. Mar-Apr 1995;23(2):160-5. [Medline].

  27. Butler DL, Noyes FR, Grood ES. Ligamentous restraints to anterior-posterior drawer in the human knee. A biomechanical study. J Bone Joint Surg [Am]. Mar 1980;62(2):259-70. [Medline].

  28. Ellen MI, Young JL, Sarni JL. Musculoskeletal rehabilitation and sports medicine. 3. Knee and lower extremity injuries. Arch Phys Med Rehabil. May 1999;80(5 Suppl 1):S59-67. [Medline].

  29. Fitzgerald GK. Open versus closed kinetic chain exercise: issues in rehabilitation after anterior cruciate ligament reconstructive surgery. Phys Ther. Dec 1997;77(12):1747-54. [Medline]. [Full Text].

  30. Frank CB, Jackson DW. The science of reconstruction of the anterior cruciate ligament. J Bone Joint Surg Am. Oct 1997;79(10):1556-76. [Medline].

  31. Fu FH, Bennett CH, Lattermann C, et al. Current trends in anterior cruciate ligament reconstruction. Part 1: biology and biomechanics of reconstruction. Am J Sports Med. Nov-Dec 1999;27(6):821-30. [Medline].

  32. Gottlob CA, Baker CL Jr, Pellissier JM, et al. Cost effectiveness of anterior cruciate ligament reconstruction in young adults. Clin Orthop Relat Res. Oct 1999;272-82. [Medline].

  33. Griffin LY. The female as a sports participant. J Med Assoc Ga. Jun 1992;81(6):285-7. [Medline].

  34. Ha TP, Li KC, Beaulieu CF, et al. Anterior cruciate ligament injury: fast spin-echo MR imaging with arthroscopic correlation in 217 examinations. AJR Am J Roentgenol. May 1998;170(5):1215-9. [Medline]. [Full Text].

  35. Harner CD, Marks PH, Fu FH, et al. Anterior cruciate ligament reconstruction: endoscopic versus two-incision technique. Arthroscopy. Oct 1994;10(5):502-12. [Medline].

  36. Huston LJ, Greenfield ML, Wojtys EM. Anterior cruciate ligament injuries in the female athlete. Potential risk factors. Clin Orthop Relat Res. Mar 2000;50-63. [Medline].

  37. Huston LJ, Wojtys EM. Neuromuscular performance characteristics in elite female athletes. Am J Sports Med. Jul-Aug 1996;24(4):427-36. [Medline].

  38. Marder RA, Raskind JR, Carroll M. Prospective evaluation of arthroscopically assisted anterior cruciate ligament reconstruction. Patellar tendon versus semitendinosus and gracilis tendons. Am J Sports Med. Sep-Oct 1991;19(5):478-84. [Medline].

  39. Myklebust G, Bahr R. Return to play guidelines after anterior cruciate ligament surgery. Br J Sports Med. Mar 2005;39(3):127-31. [Medline]. [Full Text].

  40. Roberts DM, Stallard TC. Emergency department evaluation and treatment of knee and leg injuries. Emerg Med Clin North Am. Feb 2000;18(1):67-84, v-vi. [Medline].

  41. Schenck RC Jr, Blaschak MJ, Lance ED, et al. A prospective outcome study of rehabilitation programs and anterior cruciate ligament reconstruction. Arthroscopy. Jun 1997;13(3):285-90. [Medline].

  42. Shelbourne KD, Whitaker HJ, McCarroll JR, et al. Anterior cruciate ligament injury: evaluation of intraarticular reconstruction of acute tears without repair. Two to seven year followup of 155 athletes. Am J Sports Med. Sep-Oct 1990;18(5):484-8; discussion 488-9. [Medline].

  43. Simon RR, Koenigsknecht SJ. Emergency Orthopedics: The Extremities. 2nd ed. Stamford, Conn: Appleton & Lange; 1987.

  44. Sonzogni JJ. Examining the injured knee. Emerg Med. 1996;28:76-86.

  45. Traina SM, Bromberg DF. ACL injury patterns in women. Orthopedics. Jun 1997;20(6):545-9; quiz 550-1. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

anterior cruciate ligament injury, ligament, knee surgery, ligaments, knee injury, knee injuries, torn ACL, ACL injury, ACL reconstruction, torn ligament, knee ligaments, anterior cruciate ligament, anterior cruciate, ligament tear, ACL tear, anteromedial bundle, posterolateral bundle, hemarthrosis, Segond fracture

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Tarek Souryal, MD, Head Team Physician, Dallas Mavericks; Former Chief, Department of Surgery, Division of Orthopedic Surgery, Las Colinas Medical Center; Clinical Professor, Departments of Orthopedic Surgery and Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center
Tarek Souryal, MD is a member of the following medical societies: American Orthopaedic Society for Sports Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Kenneth Adams, MD, Assistant Professor, Department of Physical Medicine and Rehabilitation, University of Texas Southwestern
Kenneth Adams, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM, President and Director, Georgia Pain Physicians, PC; Clinical Associate Professor, Department of Physical Medicine and Rehabilitation, Emory University School of Medicine
Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Medical Association, International Association for the Study of Pain, Physiatric Association of Spine, Sports and Occupational Rehabilitation, and Texas Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Michael T Andary, MD, MS, Residency Program Director, Professor, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine
Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Association of Academic Physiatrists
Disclosure: allergan Honoraria Speaking and teaching

CME Editor

Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Alegent Health Care, Immanuel Rehabilitation Center
Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.