ACL Rupture

The aim of this chapter is to review the epidemiology, applied anatomy, clinical and imagenological assessment as well as treatment of ACL tears. Rupture of the ACL is a relatively common injury in young people. Seventy percent of the ACL tears result from sports injuries. Almost all lesions occur in patients between 15 and 45 years. The ACL is essentially a bridge between the femur and the tibia and, as such, both insertions are critical to the complex function of the ACL. The ACL serves as a primary restraint against anterior tibial translation and a secondary restraint against internal tibial rotation. Semiology is a key aspect of ACL injury diagnosis. An interview with the patient is mandatory. Semiological evaluation of ACL injury includes three maneuvers: Lachman test, anterior drawer test, and pivot shift test. They should be performed comparatively with the contralateral knee. Radiographs are the initial evaluation method while magnetic resonance imaging (MRI) is the method of choice. Nonoperative treatment as a viable strategy in selected patients. It is indicated in low-demand patients with decreased laxity or recreational athletes who do not participate in cutting/pivoting activities. It consists of physical therapy and lifestyle modifications. ACL reconstruction is indicated in young and active patients, in children, in older and active patients, in partial tears with clinical and functional instability and in failures of previous ACL reconstructions. Anatomic ACL reconstruction aims to restore the ACL to its proper native kinematics, orientation and insertion sites. Currently, the majority of ACL reconstructions performed at the authors’ institution are performed with hamstring autografts, fixed with cortical buttons in the femur and biodegradable interference screws in the tibia. Specifically in competitive athletes performing cutting and pivoting sports, the authors prefer to use BPTB autograft fixed with interference screws.