Anterior Cruciate Ligament Injury Guidelines

Updated: Feb 26, 2021
  • Author: Matthew Gammons, MD; Chief Editor: Sherwin SW Ho, MD  more...
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Guidelines Summary

AAOS practice guideline for ACL tears

The American Academy of Orthopaedic Surgeons (AAOS) has issued evidence-based practice guideline for the management of ACL tears. Recommendations include the following [24, 25] :

  • To protect the knee joint, patients who are surgical candidates should undergo reconstructive surgery within 5 months following an ACL injury; however, the evidence for this recommendation was considered to be only moderate

  • A relevant history should be obtained and a musculoskeletal exam of the lower extremities performed

  • Magnetic resonance imaging (MRI) should be performed to confirm the ACL diagnosis and reveal any associated joint and cartilage problems

  • Either autograft or appropriately processed allograft tissue can be used in ACL reconstruction, since measured outcomes for both types of graft have been similar; however, the guideline cautions that such results may not apply in all cases

  • Patellar or hamstring tendons should be used in intra-articular ACL reconstruction employing autograft tissue

  • A single- or double-bundle technique should be used in intra-articular ACL reconstruction; both techniques have similar measured outcomes

American Academy of Pediatrics guidelines

In 2014, the American Academy of Pediatrics released clinical guidelines on the diagnosis, treatment, and prevention of ACL injuries in children and adolescents. [26, 27] Recommendations include the following:

  • The best physical examination test for detecting an ACL tear is the Lachman test

  • MRI may be necessary in young patients in whom physical examination is not possible because of pain, swelling, and/or lack of cooperation

  • ACL tears in pediatric patients are not a surgical emergency, and patients should explore their options

  • In young patients who are skeletally immature, measurement of skeletal age with an anteroposterior radiograph of the left hand and wrist and Tanner stage may help guide treatment

  • Treatment of ACL injuries often involves surgery and/or months of rehabilitation

  • Pediatric patients with ACL tears are at increased risk for early-onset osteoarthritis in the affected knee

  • Musculoskeletal changes that affect dynamic joint stability may be the most important factor underlying the higher rate of noncontact ACL injuries in adolescent female athletes; neuromuscular training initiated in early to middle adolescence may reduce their risk