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ACL Tears

The ACL, anterior cruciate ligament, originates on the medial tibial articular surface and travels posteriorly where it inserts on the lateral femoral condyle and functions to provide rotational stability and resistance of anterior tibial translation, varus and valgus stress. 

ACL injuries compromise 40-50% of all ligamentous knee injuries in sports and occur more commonly in sports such as skiing, soccer, basketball and football. Most ACL injuries occur due to noncontact mechanisms, primarily during landing, pivoting or deceleration. When the ACL is injured, many patients report a popping sensation followed by immediate pain, instability and a severe knee effusion within two to twelve hours. Surrounding structures such as the MCL, lateral and medial meniscus may also be injured simultaneously. More rarely, chondral surfaces, posterolateral corner structures or fractures may also occur at the time of injury. 

While ACL reconstruction surgery is recommended for most athletes, less active individuals may also elect for non-operative management with physical therapy. There is a risk of meniscal and chondral injuries with cutting or pivoting in nonoperatively managed ACL tears. 

There are several different types of tendon autograft and allograft selections that may be recommended for ACL reconstruction surgeries. The decision on graft selection involves many patient specific factors that will be taken into consideration by your surgeon. The most common tendon autografts that are used are bone- patella  tendon - bone (BPTB) and hamstring tendon grafts, but quadricep tendon graft may be used as well. In patients who are active and place high demands on their knees, a BPTB tendon is often recommended. Allograft tendons may be recommended in patients who place lower demands on their knees or for patient preference. 

Depending on graft selection and any additional injuries, patients should expect to be partial weight bearing in a brace, with range of motion restrictions and a rigorous physical therapy program following surgery. While every patient progresses differently, most patients are running on a treadmill around 3 months and consideration of return to sport around 8-9 months following surgery. 

ACL Injuries in Female Athletes

Research shows that females have an enhanced risk of noncontact ACL injuries. Several studies have suggested this to be multifactorial. Anatomical, hormonal and biomechanical factors in females increase the incidence of noncontact ACL injuries. 

 

Because 75-85% of noncontact ACL injuries occur upon landing from a jump or abruptly stopping or pivoting, the importance of neuromuscular strengthening is crucial to prevention of ACL injuries in both males and females. Females specifically tend to have an imbalance in quadricep and hamstring muscle strength, therefore contributing to one of the many factors that increases females risk of ACL injuries. 

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