| Ligament: Anterior cruciate ligament | ||
|---|---|---|
| Diagram of the right knee. (Anterior cruciate ligament labeled at center left.) | ||
| Latin | ligamentum cruciatum anterius | |
| Gray's | subject #93 342 | |
| From | lateral condyle of the femur | |
| To | intercondyloid eminence of the tibia | |
| Dorlands/Elsevier | l_09/12492099 | |
The anterior cruciate ligament (ACL) is a cruciate ligament which is one of the four major ligaments of the human knee. In the quadruped stifle (analogous to the knee), based on its anatomical position, it is referred to as the cranial cruciate ligament.[1]
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 ACL attaches in front of the intercondyloid eminence of the tibia, being blended with the anterior horn of the medial meniscus. These attachments allow it to resist anterior translation and medial rotation of the tibia, in relation to the femur.
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A 2010 Los Angeles Times review[2] of two seemingly conflicting 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. For adults under 35, though, patients who underwent early surgery followed by rehab fared no better than those who had rehab therapy and a later surgery.
The first report focused on children and the timing of an ACL reconstruction. ACL injuries in children, according to orthopedic surgeon Howard Luks, MD,[3] 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.
The second study noted in the L.A. Times piece[2] focused on adults and questioned whether an ACL reconstruction was necessary when an MRI-is not merely an existing tear; many patients without instability, buckling or giving way after a course of rehabilitation can be managed non-operatively. 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, and may want to consider an early reconstruction to minimize the risk of developing common associated injuries. "You can change your knee to suit your lifestyle," says Dr. Howard Luks, "or change your lifestyle to suit your knee."
The randomized control study was also reviewed by the New York Times.[4]
The randomized control study was originally published in the New England Journal of Medicine.[5]
On Tuesday, September 13, 2011, an online article by Jim Dryden, Associate Director of Broadcast Services of the Washington University in St. Louis Newsroom Record, reviewed a Washington University School of Medicine study; the examination "looked at why second ACL surgeries often fail":
"Sports medicine specialists at Washington University School of Medicine in St. Louis are leading a national study analyzing why a second surgery to reconstruct a tear in the knee's anterior cruciate ligament (ACL) carries a high risk of bad outcomes.
More than 200,000 ACL reconstruction surgeries are performed each year in the United States, and 1 percent to 8 percent fail for some reason. Most of those patients then opt to have their knee ligament reconstructed a second time, but the failure rate on those subsequent surgeries is almost 14 percent.
The Washington University group has received a $2.6 million grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (one of the constituent institutes of the NIH, or the National Institutes of Health, which is in turn a part of the Cabinet-level U.S. Department of Health and Human Services, or USDHHS) and is leading dozens of surgeons across the nation in one of the largest orthopedic, multicenter studies ever conducted. The MARS study (Multicenter ACL Revision Study) is comparing surgical techniques and analyzing outcomes for patients undergoing ACL surgery to learn why a subsequent reconstruction is more likely to fail than an initial ACL repair."[6]
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