Anterior Cruciate Ligament (ACL) Injuries
Written and edited by Aruna Seneviratne, M.D.
Several ligaments stabilize the human knee. They are the Anterior Cruciate Ligament (ACL), the Posterior Cruciate Ligament (PCL), the Medial Collateral Ligament (MCL), the Lateral Collateral Ligament (LCL), and the Posterolateral Corner Complex (PLC). Injury to the ACL is can lead to instability of the knee. Injuries to the ACL can occur in isolation or in combination with other injuries – usually ACL, LCL, and PLC injuries. Meniscal tears can also occur concurrently. These injuries typically occur during participation in sports that involve lateral movements such as soccer, skiing, football, etc. Women have a 5-7 fold increased risk of ACL ruptures and it is hypothesized that its due to anatomic variations, neuromuscular control mechanisms, and other factors. Hormonal differences have been largely disputed through rigorous scientific study, including a study published by Dr. Seneviratne investigating the influence of estrogen on ACL tenocyte function ( Seneviratne AM, Attia E, Williams RJ, Rodeo SA, Hannafin J. “The Effect of Estrogen on Ovine Anterior Cruciate Ligament Fibroblasts: Cell Proliferation and Collagen Synthesis.” American Journal of Sports Medicine, November 2003).
Biology: Why does it occur?
Common Diagnostic Techniques
Depends on a variety of factors including patient age, activity level, degree of instability etc. Older patients are usually treated non-operatively with physical therapy. Athletes who play high demand sports such as basketball, soccer, football, and skiing, require surgical reconstruction of the ACL. Dr. Seneviratne will carefully evaluate each patient and recommend the optimum course of treatment.
For hamstring ACL reconstructions – 4-13%
For allograft (cadaver tissue) ACL reconstructions – about 20%