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The Anterior Cruciate Ligament: What is it & what does it do?
The Anterior Cruciate Ligament: What is it & what does it do?
Published: 2012/05/30
Channel: HipandKneeTV
Anterior Cruciate Ligament (ACL) Injuries
Anterior Cruciate Ligament (ACL) Injuries
Published: 2013/04/05
Channel: Roy Dwyer
Top 3 Signs You Have an ACL tear (Tests You Can Do At Home)
Top 3 Signs You Have an ACL tear (Tests You Can Do At Home)
Published: 2015/08/28
Channel: physicaltherapyvideo
Arthroscopic ACL Reconstruction (Detailed)
Arthroscopic ACL Reconstruction (Detailed)
Published: 2012/06/19
Channel: E. Edward Khalfayan, M.D.
Anterior Cruciate Ligament (ACL) Reconstruction Animation
Anterior Cruciate Ligament (ACL) Reconstruction Animation
Published: 2007/11/28
Channel: BertramZarinsMD
Anterior Cruciate Ligament (ACL) Injury
Anterior Cruciate Ligament (ACL) Injury
Published: 2014/12/23
Channel: Elara Systems
Knee Surgery | Torn ACL | Nucleus Health
Knee Surgery | Torn ACL | Nucleus Health
Published: 2011/02/07
Channel: Nucleus Medical Media
Knee Ligament Anatomy Animation
Knee Ligament Anatomy Animation
Published: 2007/12/17
Channel: BertramZarinsMD
Anterior Drawer Test⎟Anterior Cruciate Ligament Rupture
Anterior Drawer Test⎟Anterior Cruciate Ligament Rupture
Published: 2015/11/30
Channel: Physiotutors
ACL Surgery - 3D Reconstruction
ACL Surgery - 3D Reconstruction
Published: 2011/12/28
Channel: imsportsvideos
Anterior Cruciate Ligament Reconstruction with Neil Bradbury
Anterior Cruciate Ligament Reconstruction with Neil Bradbury
Published: 2015/12/21
Channel: NeiltheKnee
ACL Reconstruction Surgery
ACL Reconstruction Surgery
Published: 2013/11/26
Channel: The Lyman Knee Clinic
Lachman
Lachman's Test , ACL Injury - Everything You Need To Know - Dr. Nabil Ebraheim
Published: 2015/07/17
Channel: nabil ebraheim
ACL Tear Stretches & Exercises - Ask Doctor Jo
ACL Tear Stretches & Exercises - Ask Doctor Jo
Published: 2016/06/13
Channel: AskDoctorJo
ACL Injury and Treatment
ACL Injury and Treatment
Published: 2009/08/26
Channel: Denver-Vail Orthopedics, P.C
ACL injury compilation
ACL injury compilation
Published: 2016/08/22
Channel: AI AR
How to Read Knee MRI of ACL Tear | Anterior Cruciate Ligament Injury | Colorado Knee Surgeon
How to Read Knee MRI of ACL Tear | Anterior Cruciate Ligament Injury | Colorado Knee Surgeon
Published: 2015/07/30
Channel: Robert LaPrade
ACL Tear (Sports Injury)
ACL Tear (Sports Injury)
Published: 2010/01/03
Channel: Human ARVR
ACL & Meniscus Surgery Road to Recovery.  My first 30 days.
ACL & Meniscus Surgery Road to Recovery. My first 30 days.
Published: 2016/09/16
Channel: Dylan Kowalski
Information on ACL Anterior Cruciate Ligament Non surgical Repair
Information on ACL Anterior Cruciate Ligament Non surgical Repair
Published: 2016/02/03
Channel: William Inman
ACL Physio Anterior Cruciate Ligament Exercises - Week 1 & 2
ACL Physio Anterior Cruciate Ligament Exercises - Week 1 & 2
Published: 2013/07/02
Channel: nilo78
How to tape a knee - ACL / anterior cruciate ligament sprain - sports taping series
How to tape a knee - ACL / anterior cruciate ligament sprain - sports taping series
Published: 2015/05/03
Channel: Joey Hayes
ACL Exam Lachman
ACL Exam Lachman's Test, Pivot Shift, Drawer Test performed by Dr. Eric Janssen
Published: 2011/11/21
Channel: SportsMED Orthopaedic Surgery & Spine Center
Anterior Cruciate Ligament Arthroscopic Repair PreOp® Patient Education
Anterior Cruciate Ligament Arthroscopic Repair PreOp® Patient Education
Published: 2010/03/26
Channel: PreOp® Orthopedic Center
ACL Reconstruction and Knee Arthroscopy
ACL Reconstruction and Knee Arthroscopy
Published: 2012/01/20
Channel: Munjed Al Muderis
ACL Reconstruction using patellar tendon
ACL Reconstruction using patellar tendon
Published: 2012/08/26
Channel: Your Practice Online
Knee Examination - Anterior Cruciate Ligament Tests
Knee Examination - Anterior Cruciate Ligament Tests
Published: 2012/09/27
Channel: Jason Craig
Anterior cruciate ligament tear ? Sparrc can help you recover avoiding surgery
Anterior cruciate ligament tear ? Sparrc can help you recover avoiding surgery
Published: 2012/04/07
Channel: Sparrc Institute
Anterior Cruciate Ligament (ACL) Reconstruction Surgery from GoPro (unedited)
Anterior Cruciate Ligament (ACL) Reconstruction Surgery from GoPro (unedited)
Published: 2017/01/25
Channel: Spriggins Orthopaedics
The Normal Function of the Anterior Cruciate Ligament
The Normal Function of the Anterior Cruciate Ligament
Published: 2013/11/25
Channel: Gordon Buchanan
Cruciate Ligament Rupture in Dogs: Healing Without Surgery
Cruciate Ligament Rupture in Dogs: Healing Without Surgery
Published: 2015/04/05
Channel: Veterinary Secrets
Anterior Cruciate Ligament (ACL) Taping
Anterior Cruciate Ligament (ACL) Taping
Published: 2007/10/16
Channel: www.sportsinjuryclinic.net
Anterior Cruciate Ligament (ACL) Repair
Anterior Cruciate Ligament (ACL) Repair
Published: 2016/06/01
Channel: Online Medical – Website Design & Development for Healthcare Professionals
Anterior cruciate ligament tear in MR imaging by RadiologieTV
Anterior cruciate ligament tear in MR imaging by RadiologieTV
Published: 2014/04/08
Channel: Radiologie TV
Anterior Cruciate Ligament Tear | HydroWorx Pool Protocol
Anterior Cruciate Ligament Tear | HydroWorx Pool Protocol
Published: 2013/01/22
Channel: HydroWorx International Inc.
What are the symptoms of an Anterior Cruciate Ligament Tear
What are the symptoms of an Anterior Cruciate Ligament Tear
Published: 2011/10/11
Channel: Craig McAllister
Anterior Cruciate Ligament Reconstruction (ACL) / Vlog
Anterior Cruciate Ligament Reconstruction (ACL) / Vlog
Published: 2017/10/31
Channel: Liam Craigie Gymnast / TV
Anterior Cruciate Ligament ACL tear - Prolotherapy
Anterior Cruciate Ligament ACL tear - Prolotherapy
Published: 2011/05/02
Channel: Caring Medical Regenerative Medicine Clinics
Warning!  Leg Extension Machine Can Cause ACL Injury / Harm Anterior Cruciate Ligament
Warning! Leg Extension Machine Can Cause ACL Injury / Harm Anterior Cruciate Ligament
Published: 2015/09/24
Channel: Fitness Oriented
Canine ACL Tears and TPLO Surgery discussed by Dr. Bauer, DVM, DACVS
Canine ACL Tears and TPLO Surgery discussed by Dr. Bauer, DVM, DACVS
Published: 2012/03/08
Channel: Colorado Canine Orthopedics & Rehab
Anterior Cruciate Ligament: Pathology and Management | Animated Tutorial
Anterior Cruciate Ligament: Pathology and Management | Animated Tutorial
Published: 2017/02/17
Channel: 3D4Medical
Anterior Cruciate Ligament (ACL) Reconstruction Surgery _ Orthopedics
Anterior Cruciate Ligament (ACL) Reconstruction Surgery _ Orthopedics
Published: 2016/11/04
Channel: Sadikatul Bari Sadik
01 2   Anterior Cruciate Ligament
01 2 Anterior Cruciate Ligament
Published: 2017/01/20
Channel: Radiology MasterClass
Ligaments Of The Knee, ACL, PCL, and Collateral Ligaments
Ligaments Of The Knee, ACL, PCL, and Collateral Ligaments
Published: 2014/04/22
Channel: ePainAssist
Anterior Cruciate Ligament (ACL)
Anterior Cruciate Ligament (ACL)
Published: 2012/03/20
Channel: rightonthedot
Anterior Cruciate Ligament Tear
Anterior Cruciate Ligament Tear
Published: 2007/08/28
Channel: HalfDome.TV
Anterior Cruciate Ligament (ACL) Repair
Anterior Cruciate Ligament (ACL) Repair
Published: 2009/04/17
Channel: Kevin R. Stone, MD
Strengthening exercises for ACL injury (anterior cruciate ligament) rehabilitation.
Strengthening exercises for ACL injury (anterior cruciate ligament) rehabilitation.
Published: 2010/09/24
Channel: www.sportsinjuryclinic.net
Cranial Cruciate Ligament Rupture - 3D Animation for Veterinary Undergraduates
Cranial Cruciate Ligament Rupture - 3D Animation for Veterinary Undergraduates
Published: 2013/08/27
Channel: The Dick Vet
Causes of anterior cruciate ligament injuries in football
Causes of anterior cruciate ligament injuries in football
Published: 2014/12/08
Channel: football4football
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WIKIPEDIA ARTICLE

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Anterior cruciate ligament
Knee diagram.svg
Diagram of the right knee. Anterior cruciate ligament labeled at center left.
Details
From lateral condyle of the femur
To intercondyloid eminence of the tibia
Identifiers
Latin ligamentum cruciatum anterius
Dorlands
/Elsevier
l_09/12492099
TA A03.6.08.007
FMA 44614
Anatomical terminology

The anterior cruciate ligament (ACL) is one of a pair of cruciate ligaments (the other being the posterior cruciate ligament) in the human knee. The two ligaments are also called cruciform ligaments, as they are arranged in a crossed formation. In the quadruped stifle joint (analogous to the knee), based on its anatomical position, it is also referred to as the cranial cruciate ligament.[1] The anterior cruciate ligament is one of the four main ligaments of the knee, providing 85% of the restraining force to anterior tibial displacement at 30 degrees and 90 degrees of knee flexion.[2]

Structure[edit]

The ACL originates from deep within the notch of the distal femur. Its proximal fibers fan out along the medial wall of the lateral femoral condyle. There are two bundles of the ACL: the anteromedial and the posterolateral, named according to where the bundles insert into the tibial plateau. (The tibia plateau is a critical weight-bearing region on the upper extremity of the tibia). The ACL attaches in front of the intercondyloid eminence of the tibia, where it blends with the anterior horn of the lateral meniscus.

Purpose[edit]

These attachments allow the ACL to resist anterior translation and medial rotation of the tibia, in relation to the femur.

Clinical significance[edit]

Injury[edit]

MRI of anterior cruciate ligament tear

An ACL tear is one of the most common knee injuries, with over 100,000 tears occurring annually in the US. Most ACL tears are a result of landing or planting in cutting or pivoting sports, with or without contact. Because the ACL is crucial for stabilizing the knee when turning or planting, most serious athletes will require an ACL reconstruction if they have a complete tear and want to return to sports. Reconstruction is most commonly done by autograft, meaning the tissue used for the repair is from within the patient’s body. Cadavers may also be utilized for tissue. The two most common sources for tissue are the patellar tendon and the hamstrings tendon. The surgery is arthroscopic, meaning that a tiny camera is inserted through a small surgical cut. The camera sends video to a large monitor so that the surgeon can see any damage to the ligaments. In the event of an autograft, the surgeon will make a larger cut to get the needed tissue. In the event of an allograft, in which material is donated, this is not necessary. The surgeon will make holes in the patient’s bones to run the new tissue through, and that tissue serves as the patient’s new ACL. Recovery time ranges between one and two years or longer. A week or so after the occurrence of the injury, the athlete is usually deceived by the fact that he/she is walking normally and not feeling much pain. This is dangerous as some athletes start resuming some of their activities such as jogging which, with a wrong move or twist, could damage the bones. It is important for the injured athlete to understand the significance of each step of an ACL injury to avoid complications and ensure a proper recovery.[citation needed]

Tearing the anterior cruciate ligament can sometimes be part of a knee injury known as “the terrible triad”. This consists of the simultaneous tearing of the anterior cruciate ligament (ACL), medial collateral ligament (MCL) and medial meniscus.[3]

Non-operative treatment of the ACL[edit]

The ACL can be treated non operatively with strengthening and rehabilitation when the ACL is not completely torn and the knee is still stable or if the patient is not doing activities requiring cutting and pivoting or similar actions. The mainstay of ACL non-operative treatment is strengthening of the muscles around the knee, especially the hamstrings. Focused therapy supervised by a physical therapist can be an effective way to accomplish this.[citation needed]

Anterior cruciate ligament surgery is a complex operation that requires expertise in the field of orthopedic and sports medicine. Many factors should be considered when discussing surgery including the athlete's level of competition, age, previous knee injury, other injuries sustained, leg alignment and graft choice. Occasionally, stimulation of the body's natural ability to heal the native ligament, called a “healing response”, is relied upon. More commonly, the ligament must be replaced by a graft from the patient's own tissue or tissue from a cadaver. Graft choice could be confusing, requiring expert counseling from a doctor.[citation needed]

Rehabilitation is crucial to any ACL surgery; complete recovery and return to sports or other activities typically takes six to nine months. Revision ACL surgery will often take nine months to more than a year. During this time, the physical therapist should guide the patient through the rehabilitation process. The early rehab, usually lasting around six weeks, focuses on maintaining full knee motion and preventing scar tissue. The second phase of rehab is directed toward regaining knee strength. Finally, activity-specific rehabilitation is administered. The rehabilitation program can also be composed of aggressive motions and weight-bearing exercises.[citation needed]

If the doctor recommends surgery for ACL, he or she may prescribe "prehab" before operating, as many studies have shown that inducing good motion before the surgery will benefit the patient during recovery.[citation needed]

A 2010 Los Angeles Times review of two medical studies discussed whether ACL reconstruction was advisable. One study found that children under 14 who had ACL reconstruction fared better after early surgery than those who underwent a delayed surgery. But for adults 18 to 35, patients who underwent early surgery followed by rehabilitation fared no better than those who had rehabilitative therapy and a later surgery.[4]

The first report focused on children and the timing of an ACL reconstruction. ACL injuries in children are a challenge because children have open growth plates in the bottom of the femur or thigh bone and on the top of the tibia or shin. An ACL reconstruction will typically cross the growth plates, posing a theoretical risk of injury to the growth plate, stunting leg growth or causing the leg to grow at an unusual angle.[5]

The second study noted in the L.A. Times piece focused on adults. It found no significant statistical difference in performance and pain outcomes for patients who receive early ACL reconstruction vs. those who receive physical therapy with an option for later surgery. This would suggest that many patients without instability, buckling or giving way after a course of rehabilitation can be managed non-operatively. However, the study points to the need for more extensive research, was limited to outcomes after two years and did not involve patients who were serious athletes.[4] Patients involved in sports requiring significant cutting, pivoting, twisting or rapid acceleration or deceleration may not be able to participate in these activities without ACL reconstruction. The randomized control study was originally published in the New England Journal of Medicine.[6]

ACL injuries in women[edit]

Women have been known to suffer ACL injuries more frequently than men; current research gives some explanations for this. The joint through which the anterior cruciate ligament passes, along with the actual size of the anterior cruciate ligament, is significantly smaller in women than in men. This makes it more susceptible to damage. Along with these aspects, women tend to not activate their hamstring muscles as much as their male counterparts during certain cutting movements causing less stability in the knee joint. In addition, the quadriceps angle, or Q-angle, between the anterior superior iliac spine and patellar ligament may contribute to the predisposition of ACL tears. There is some evidence that suggests since women are known to have larger Q-angles than their male counterparts, they might be more susceptible to ACL tears.[7]

Additional images[edit]

See also[edit]

References[edit]

  1. ^ "Canine Cranial Cruciate Ligament Disease" (PDF). Melbourne Veterinary Referral Centre. pp. 1–2. Archived from the original (PDF) on 19 July 2008. Retrieved September 8, 2009. 
  2. ^ Ellison A, Berg E. Embryology, anatomy, and function of the anterior cruciate ligament. Orthop Clin North Am 1985;16:3-14. PubMed Abstract
  3. ^ "The Unhappy Triad". Archived from the original on December 3, 2012. Retrieved December 12, 2012. 
  4. ^ a b Stein, Jeannine (2010-07-22). "Studies on ACL surgery". The Los Angeles Times. Archived from the original on July 28, 2010. Retrieved 2010-07-23. 
  5. ^ "ACL Tears: To reconstruct or not, and if so, when?". howardluksmd.com. Retrieved 2010-07-23. 
  6. ^ Frobell, Richard B.; Roos, Ewa M.; Roos, Harald P.; Ranstam, Jonas; Lohmander, L. Stefan (2010). "A Randomized Trial of Treatment for Acute Anterior Crut Tears". New England Journal of Medicine. 363 (4): 331–342. doi:10.1056/NEJMoa0907797. PMID 20660401. 
  7. ^ "ACL Injuries in Women". Retrieved December 12, 2012. 

External links[edit]

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