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Document Title: Beynnon-AJSM-Oct05.shtml
Article Title: Clinical Sports Medicine Update: Treatment of Anterior Cruciate Ligament Injuries, Part I
Authors: Bruce D. Beynnon, PhD, Robert J. Johnson, MD, Joseph A. Abate, MD, Braden C. Fleming, PhD and Claude E. Nichols, MD
Publication: American Journal of Sports Medicine, Baltimore, Maryland
Date: October 2005
Volume 33, pages 1579-1602
Keywords: anterior cruciate ligament, knee, reconstruction, menisci, articular cartilage, bone-bruising, concomitant injuries, posterolateral corner (PLC), posterolateral structures, female athlete ACL, multi-ligament reconstruction, hamstring, quadriceps, patellar-tendon autograft, allograft.
(Reference-denoting numbers appear in the same font and point size as the document text. As with all Knee Library documents, this article is provided in full-text form. This article has no figures.)
Comments: This article provides a very comprehensive overview (with a staggering 307 references) of ACL injuries and related aspects (including bone-bruising, meniscal damage, and concomitant ligamenous injuries). It also delves into risk factors (such as being a female athlete) and confounding factors (such as being someone with open growth plates [i.e. a child]). Beynnon et al. do a superb job of tying together all the various issues that must be considered when making decisions (e.g. to pursue surgery or not, and if so, what operations to do) pertinent to knee conditions, and they note the many interdependencies and complexities inherent in knee injuries (e.g. if the knee harbours damage to the posterolateral structures in addition to a torn ACL, then merely reconstructing the ACL is almost guaranteed to result in failure). The authors also provide interesting comparisons between the various options for ACL reconstruction, and they note that because ACL injuries rarely occur in isolation (i.e. concomitant injuries are very common), the eventual long-term outcome of any ACL treatment varies from person to person. They note that over 100,000 ACL reconstructions are performed annually in the United States alone (which works out to roughly 2000 of these surgeries each week).
Part 2, which follows directly from this article, can be found here.
ABSTRACT
Anterior cruciate ligament injuries are common among athletes. Although the true natural history remains unclear, anterior cruciate ligament injuries are functionally disabling; they predispose the knee to subsequent injuries and the early onset of osteoarthritis. This article, the first in a 2-part series, was initiated with the use of the PubMed database and a comprehensive search of articles that appeared between January 1994 to the present, using the keywords anterior cruciate ligament. A total of 3810 citations were identified and reviewed to determine the current state of knowledge about the treatment of these injuries. Articles pertaining to the biomechanical behavior of the anterior cruciate ligament, the prevalence of anterior cruciate ligament injury, the natural history of the anterior cruciate ligament–deficient knee, injuries associated with anterior cruciate ligament disruption, risk factors for anterior cruciate ligament injury, indications for treatment of anterior cruciate ligament injuries, and nonoperative and operative treatments were obtained, reviewed, and served as the basis for part I. Part II, to be presented in another issue of this journal, includes technical aspects of anterior cruciate ligament surgery, bone tunnel widening, graft healing, rehabilitation after reconstruction, and the effect of sex, age, and activity level on the outcome of surgery. Our approach was to build on prior reviews and to provide an overview of the literature for each of the before-mentioned areas of study by summarizing the highest level of scientific evidence available. For the areas that required a descriptive approach to research, we focused on the prospective studies that were available; for the areas that required an experimental approach, we focused on the prospective, randomized controlled trials and, when necessary, the highest level of evidence available. We were surprised to learn that considerable advances have been made during the past decade regarding the treatment of this devastating injury.
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