Laboratory Studies

Laboratory studies are not indicated in the evaluation and diagnosis of anterior cruciate ligament injuries.

Imaging Studies

Magnetic resonance imaging (MRI) of the knee usually is recommended prior to surgery for evaluation of the other ligaments and the menisci, because findings can influence the treatment plan.

MRI helps the surgeon to have the correct equipment at hand prior to beginning the surgery.

The sensitivity of MRI has been shown to be greater than 95% and the specificity to be approximately 98%, with a positive predictive value of 95% and a negative value of nearly 99% with fast spin-echo techniques.

Procedures

Perform aspiration of any large hemarthrosis, if indicated, under aseptic conditions, to alleviate patient discomfort. The presence of fat globules suggests an intra-articular fracture. Radiographs may demonstrate an avulsed fragment just lateral to the tibial plateau. This type of fracture, referred to as a Segond fracture, represents an avulsion of the middle third of the lateral capsule from the tibial plateau; it is also known as a lateral capsule sign.

Treatment & Management

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. 2008 Nov 27. [QxMD MEDLINE Link].
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. 2008 Dec 30. [QxMD MEDLINE Link].
Kim SJ, Jo SB, Kumar P, et al. Comparison of single- and double-bundle anterior cruciate ligament reconstruction using quadriceps tendon-bone autografts. Arthroscopy. 2009 Jan. 25(1):70-7. [QxMD MEDLINE Link].
Sanders TL, Maradit Kremers H, Bryan AJ, et al. Incidence of Anterior Cruciate Ligament Tears and Reconstruction: A 21-Year Population-Based Study. Am J Sports Med. 2016 Feb 26. [QxMD MEDLINE Link].
Prentice HA, Lind M, Mouton C, et al. Patient demographic and surgical characteristics in anterior cruciate ligament reconstruction: a description of registries from six countries. Br J Sports Med. 2018 Jun. 52 (11):716-22. [QxMD MEDLINE Link].
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. 1995 Nov-Dec. 23(6):694-701. [QxMD MEDLINE Link].
Hutchinson MR, Ireland ML. Knee injuries in female athletes. Sports Med. 1995 Apr. 19(4):288-302. [QxMD MEDLINE Link].
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. 2008 Dec 23. [QxMD MEDLINE Link].
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]. 1983 Feb. 65(2):154-62. [QxMD MEDLINE Link].
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. 1993 Feb. 32(2):120-2. [QxMD MEDLINE Link].
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. 1989 Jul-Aug. 17(4):525-31. [QxMD MEDLINE Link].
Godshall RW. The predictability of athletic injuries: an eight-year study. J Sports Med. 1975 Jan-Feb. 3(1):50-4. [QxMD MEDLINE Link].
Jackson DW, Jarrett H, Bailey D, et al. Injury prediction in the young athlete: a preliminary report. Am J Sports Med. 1978 Jan-Feb. 6(1):6-14. [QxMD MEDLINE Link].
Shambaugh JP, Klein A, Herbert JH. Structural measures as predictors of injury basketball players. Med Sci Sports Exerc. 1991 May. 23(5):522-7. [QxMD MEDLINE Link].
Souryal TO, Moore HA, Evans JP. Bilaterality in anterior cruciate ligament injuries: associated intercondylar notch stenosis. Am J Sports Med. 1988 Sep-Oct. 16(5):449-54. [QxMD MEDLINE Link].
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. 1993 Jul-Aug. 21(4):535-9. [QxMD MEDLINE Link].
Louboutin H, Debarge R, Richou J, et al. Osteoarthritis in patients with anterior cruciate ligament rupture: a review of risk factors. Knee. 2008 Dec 19. [QxMD MEDLINE Link].
Lyp M, Stanisławska I, Witek B, Majerowska M, Czarny-Dzialak M, Wlostowska E. The Timing of Rehabilitation Commencement After Reconstruction of the Anterior Cruciate Ligament. Adv Exp Med Biol. 2018 May 9. [QxMD MEDLINE Link].
Beynnon BD, Fleming BC, Johnson RJ, et al. Anterior cruciate ligament strain behavior during rehabilitation exercises in vivo. Am J Sports Med. 1995 Jan-Feb. 23(1):24-34. [QxMD MEDLINE Link].
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. 2005 Mar. 33(3):347-59. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Marx RG, Hsu J, Fink C, Eriksson K, Vincent A, van der Merwe WM. Graft choices for pediatric anterior cruciate ligament reconstruction: state of the art. J ISAKOS. 2023 Jan 13. [QxMD MEDLINE Link]. [Full Text].
Wipfler B, Donner S, Zechmann CM, Springer J, Siebold R, Paessler HH. Anterior cruciate ligament reconstruction using patellar tendon versus hamstring tendon: a prospective comparative study with 9-year follow-up. Arthroscopy. 2011 May. 27(5):653-65. [QxMD MEDLINE Link].
Leys T, Salmon L, Waller A, Linklater J, Pinczewski L. Clinical results and risk factors for reinjury 15 years after anterior cruciate ligament reconstruction: a prospective study of hamstring and patellar tendon grafts. Am J Sports Med. 2012 Mar. 40(3):595-605. [QxMD MEDLINE Link].
Müller U, Krüger-Franke M, Schmidt M, et al. Predictive parameters for return to pre-injury level of sport 6 months following anterior cruciate ligament reconstruction surgery. Knee Surg Sports Traumatol Arthrosc. 2014 Sep 2. [QxMD MEDLINE Link].
Villa FD, Ricci M, Perdisa F, et al. Anterior cruciate ligament reconstruction and rehabilitation: predictors of functional outcome. Joints. 2015 Oct-Dec. 3 (4):179-85. [QxMD MEDLINE Link]. [Full Text].
Paterno MV, Rauh MJ, Thomas S, Hewett TE, Schmitt LC. Return-to-Sport Criteria After Anterior Cruciate Ligament Reconstruction Fail to Identify the Risk of Second Anterior Cruciate Ligament Injury. J Athl Train. 2022 Sep 1. 57 (9-10):937-45. [QxMD MEDLINE Link]. [Full Text].
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. 1999 Nov-Dec. 27(6):699-706. [QxMD MEDLINE Link].
Wojtys EM, Huston LJ, Taylor PD, et al. Neuromuscular adaptations in isokinetic, isotonic, and agility training programs. Am J Sports Med. 1996 Mar-Apr. 24(2):187-92. [QxMD MEDLINE Link].
Domingues PC, Serenza FS, Muniz TB, et al. The relationship between performance on the modified star excursion balance test and the knee muscle strength before and after anterior cruciate ligament reconstruction. Knee. 2018 Aug. 25 (4):588-94. [QxMD MEDLINE Link].

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Author

Tarek O Souryal, MD Head Team Physician, Dallas Mavericks; Director, Texas Sports Medicine and Orthopaedic Group; Staff, Department of Orthopaedic Surgery, Presbyterian Hospital of Dallas; Clinical Professor, Departments of Orthopedic Surgery and Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center

Tarek O Souryal, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Michael T Andary, MD, MS Professor, Residency Program Director, 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, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Chief Editor

Stephen Kishner, MD, MHA Clinical Professor, Louisiana State University School of Medicine in New Orleans

Stephen Kishner, MD, MHA is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine

Disclosure: Nothing to disclose.

Additional Contributors

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, Texas Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Kenneth Adams, MD Assistant Professor, Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical School

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.