The anterior cruciate ligament (ACL)

by Rakib Raihan SEO Consultant

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 also referred to as the cranial cruciate ligament.

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.


Non Operative Treatment of the ACL


The ACL can be treated non operatively with strengthening and rehabilitation and occasionally injections when the ACL is not completely torn and the knee is still stable or if the patient is low demand and not doing cutting and pivoting sports. The mainstay of ACL non-operative treatment is strengthening of the muscles around the knee, especially the hamstrings. Focused physical therapy supervised by your knee doctor is a great way to accomplish this.


ACL Surgery


Anterior cruciate ligament (ACL) surgery is a complex surgery that requires expertise in the field of sports medicine. Many factors should be considered when discussing surgery including the athletes level of competition, age, previous knee injury, other injuries sustained, leg alignment, and graft choice. Occasionally, we can stimulate the bodies natural ability to heal the native ligament, called a “healing response” surgery. More commonly the ligament needs to be replaced by a graft, either your own tissue or from a cadaver. Your graft choice can be confusing, please ask your doctor for an explanation of graft selection



Rehabilitation is crucial to any ACL surgery. Your ACL surgery will take 6 to 9 months for complete recovery and return to sports. Revision ACL surgery will often take 9 months to more than a year. During this time, your doctor should guide you through the rehabilitation process. The early rehab, usually lasting 6 weeks, will focus on maintaining full knee motion and preventing scar tissue. The second phase of rehab will then be directed towards regaining your strength. Finally, your doctor will return the athlete sport specific rehab before returning the athlete to competition.


If your doctor recommends surgery for your ACL, he may prescribe rehab before surgery as many studies have shown that having good motion before your surgery will benefit you after surgery. The ACL is quite commonly injured in athletes of varying sports. These situations are often remedied by surgery followed by several months of physical therapy.


A 2010 Los Angeles Times review of two 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 18 to 35, though, patients who underwent early surgery followed by rehabilitation fared no better than those who had rehabilitative therapy and a later surgery.


The first report focused on children and the timing of an ACL reconstruction. ACL injuries in children 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 focused on adults. It found no significant statistical difference in performance and pain outcomes for patients who receive early ACL reconstruction vs. those who receive physical therapy with an option for later surgery. This would suggest that many patients without instability, buckling or giving way after a course of rehabilitation can be managed non-operatively. However, the study points to the need for more extensive research, was limited to outcomes after 2 years, and did not involve patients who were serious athletes. 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. The randomized control study was originally published in the New England Journal of Medicine.

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