Management of ACL tear

Conservative treatment

• likely to be successful in patient without any associated knee injuries and in patients who are willing to give up highly demanding sports
• treatment methods include:
  • balance and proprioception training
  • muscle strengthening of quadriceps and hamstring muscles
  • knee brace -
    • role of functional knee bracing remains controversial
    • may help in improving joint position sense and by providing mechanical constraint of joint motion (1)

Surgical treatment

The decision to refer for surgical repair is decided on patients age, activity level (recreational and/or occupational) (1,2).

• younger more active patients should have earlier reconstruction due to increased level of activity (3)
• patients who are involved in activities with rapid acceleration and deceleration, cutting, and pivoting should be evaluated for surgery as well
• patients with recurrent giving-way episodes or concomitant meniscal or collateral ligament damage are also recommended for surgical referral (2)

Surgery is usually carried out when the swelling has resolved and the patient has full movement and a pain free gait (4)

• these patients should undergo an extensive rehabilitation which usually includes 10 to 12 week intensive schedule of strength-building activities (2)
• surgical treatment involves intra-articular and extra-articular reconstructions of the ACL using iliotibial band, the semitendinosus and gracilis tendons, the patella tendon, allograft tissue, and various synthetic materials (1)

Reference:

• (1) Kakarlapudi TK, Bickerstaff DR. Knee instability: isolated and complex. West J Med. 2001;174(4):266-72
• (2) Cimino F, Volk BS, Setter D.Anterior cruciate ligament injury: diagnosis, management, and prevention. Am Fam Physician. 2010;82(8):917-22
• (3) Dunn WR et al. The effect of anterior cruciate ligament reconstruction on the risk of knee reinjury. Am J Sports Med. 2004;32(8):1906-14
• (4) Scotney B. Sports knee injuries - assessment and management. Aust Fam Physician. 2010;39(1-2):30-4