Anterior cruciate ligament reconstruction: principles of treatment

Overview

This review sets out the current principles of treatment for anterior cruciate ligament injury, with a focus on surgical reconstruction. It is aimed at orthopaedic surgeons, sports physicians and physiotherapists managing patients with ACL rupture.

Patient selection and timing

Not every ACL rupture needs surgery. The decision depends on functional instability, activity level and sporting goals, associated meniscal and cartilage injuries, and the patient's age and preferences. Before reconstruction, the review recommends restoring knee motion and letting acute inflammation settle. For skeletally immature patients, techniques that protect the growth plates are discussed.

Surgical principles

Graft choice is covered in detail, weighing the advantages and drawbacks of hamstring, patellar tendon and quadriceps tendon autografts and of allografts. The review emphasises anatomical tunnel placement to reproduce native ligament function, secure fixation, and treatment of associated injuries, especially repair of the meniscus where feasible. For patients with marked rotational instability or at high risk of re-rupture, extra-articular augmentation procedures are considered.

Rehabilitation and return to sport

Structured rehabilitation is presented as essential to the outcome. Return to sport should be based on objective criteria for strength, function and psychological readiness rather than on time alone, to lower the risk of re-injury.

Implications for practice

Good results depend on individualised decisions, anatomical surgical technique, attention to associated injuries and a criteria-based rehabilitation programme. Long-term follow-up is still needed because of the risk of post-traumatic osteoarthritis.