ANTERIOR CRUCIATE LIGAMENT, DESCRIPTION, RUPTURE AND TREATMENT

Abstract

Introduction: the anterior cruciate ligament (ACL) along with the posterior cruciate ligament are the central stabilizers of the knee. Rupture of the ACL usually occurs in active and young people. For a correct diagnosis it is necessary a good clinical history, examination and a complementary study. The literature recommends surgical treatment in athletes and young people.

Objective: to detail current information related to anterior cruciate ligament injury, embryology, anatomy, biomechanics, incidence, risk factors, diagnosis, management, approach and treatment of the disease.

Methodology: a total of 72 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 46 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar, SciELO and Cochrane; the terms used to search for information in Spanish, Portuguese, German and English were: ACL, anterior cruciate ligament, anterior cruciate ligament, Vordere Kreuzband.

Results: ACL deficiency not only causes instability episodes but also changes in joint mechanics that may lead to degenerative changes. Meniscal lesions are linked to 50% of these injuries. The Lachman test is the most accurate clinical diagnostic test, with a reported combined sensitivity of 85% and specificity of 94%. The anterior drawer test has high sensitivity and specificity for chronic ACL tears (92% sensitivity and 91% specificity), but lower accuracy for acute cases. In MRI, the following statistics were found in patients with acute ACL injuries in several studies: specificity 98-100% and sensitivity 94%. Conclusions: The ACL is a specialized band of connective tissue located in the knee joint that joins the tibia and femur. It consists primarily of collagen fibers, making up 70% of its dry weight.Variation in the anatomy of the intercondylar groove of the distal femur is a factor that appears to be related to an increased risk of ACL injury. ACL injuries are rarely diagnosed with an MRI, but in some circumstances, such as a meniscal tear or bone contusion, this test may be useful. The decision on the course of treatment for a patient with an ACL injury depends on a number of variables.  Surgical reconstruction in anterior cruciate ligament (ACL) tears has proven to be a very effective technique that usually provides satisfactory results. Patients with ACL insufficiency may receive conservative treatment, which may involve activity modification, rehabilitation, and sometimes bracing. Proprioception and strength deficits should be taken into account when designing rehabilitation programs for knees with ACL insufficiency.