ANTERIOR CRUCIATE LIGAMENT INJURY OVERVIEW The anterior cruciate ligament (ACL) is an important stabilizing ligament in the knee. It is frequently injured by athletes and trauma victims; in the United States alone, there are between 100,000 and 200,000 ACL tears per year. This topic review will discuss the causes, signs and symptoms, diagnostic tests, and treatment options for ACL injuries. WHAT IS THE ANTERIOR CRUCIATE LIAGMENT (ACL)? The knee joint is held tightly together by four ligaments: the inner and outer fan-shaped hinge ligaments (medial and lateral collateral ligaments) and the crossing (cruciate) ligaments, which sit in the middle of the joint (the anterior and posterior cruciate ligaments) (figure 1). The collateral ligaments are firmly attached to the far end of the femur (thigh bone) and the near end of the tibia and fibula (lower leg bones). The ligaments hold the two bones together and prevent side to side motion. The anterior cruciate ligament prevents forward and backward motion. You can partially or completely tear the ligament(s). Other structures can be damaged during an acute ACL injury, including: The meniscus Joint capsule (the tissue that surrounds the joint) Articular cartilage (cartilage that covers the ends of bones where they meet in a joint) The ends of the femur or tibia Other ligaments (medial collateral ligament (MCL), l ateral collateral ligament (LCL), posterior cruciate ligament (PCL)) (figure 2) One common injury is called the athlete's triad, in which the ACL, MCL, and medial meniscus are all torn. CAUSES OF ANTERIOR CRUCIATE LIGAMENT INJURY Non-contact ACL injuries typically occur when a person is running or jumping and then suddenly slows and changes direction (eg, cutting) or pivots in a way that involves rotating or bending the knee sideways. Women appear to be at a higher risk of non-contact ACL injuries than men, although the exact reason for this is not clear [1]. Contact-related ACL injuries usually occur from a direct blow causing hyperextension or when the knee is forced inwards towards the other leg. This is often seen in American football when a player's foot is planted and an opponent strikes him on the outside or front of that thigh. ACL injuries most commonly occur during the following activities: Noncontact sports, such as downhill skiing, gymnastics, and tennis Certain contact sports, including rugby, American football, soccer, and basketball Motor vehicle collisions
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