ACL (anterior cruciate ligament) disruption is associated with high-performance athletes as a consequence of fall from heights, shard change of direction, or direct knee collision, but it may also concern anyone involved in sports, or even the general population, as a result of an accident. It is one of the most serious and most frequent knee injuries, often with a long recovery period.

The most recent data from the American Academy of Orthopedic Surgeons  indicate that about 200,000 Americans, each year, suffer a rupture of the anterior cruciate ligament, with more than half of them resorting to  surgical treatment. The anatomical, hormonal and genetic differences between the two sexes render women more vulnerable, while recent studies in the United States have reported an increase of incidences among children and adolescents practicing sports. The second ACL contralateral reinjury rate is 15%.

The anterior cruciate, along with the posterior cruciate, the medial collateral and the lateral collateral ligaments, are basic knee stabilizers. Their primary role is to prevent the tibia from sliding forward in relation to the thigh - in fact, it provides 90% stability to the knee. It diagonally crosses the joint and connects the posterior part of the femoral base with the upper part of the tibia. 90% of it consists of type I collagen fibrils, and 10% of it of type II collagen fibrils.
Unlike degenerative knee changes, the rupture of the anterior cruciate ligament is acute, and is almost always attributed to a specific incident (e.g. a car accident) or an injury. The statistics, which emerged from the studying of athletes’ videos, indicate that 70% of the injuries are due to a non contact mechanism, and usually occur during an abrupt deceleration or landing to the ground. In these cases, the knee is almost in a straight and steady position while the athlete is trying to make rotating motions, such as the pivot movement in basketball. The rupture (partial or total) is caused as the ligament - despite its high endurance - stretches beyond normal and is torn.
Most people who have suffered a rupture of the anterior cruciate ligament describe that they heard a “popping” or “cracking” sound, and then their foot went off or got stuck. Deep pain and swelling in the knee are the first signs, and, depending on the damage, the knee joint range of motion is limited and instability is observed.

The diagnosis is mainly made through the guiding of the clinical picture, which will show how stable and functional the knee is. A supporting, yet very important role in detecting the concomitant knee lesions (tear of a meniscus, cartilage lesions) is that of an MRI. The evolution of the diagnostic imaging  techniques and hence the better visualization of the knee pathology, has resulted, in recent years, in proving that the rupture of the anterior cruciate ligament does not have to be complete. In cases of a partial rupture, a precise history and a thorough examination shall indicate the correct recovery, and the necessity or non-necessity of a surgery. Nowadays, the specialized techniques which have been developed enable surgeons to restore, through arthroscopic surgery, only the broken part of the ligament, and keep the healthy one intact.
However, in cases of a complete rupture, always taking the patient’s age, sex, occupation and sport into account (and given that the anterior cruciate ligament is not self-healed and its functioning is not restored), surgical treatment is, usually, a one-way solution. The doctor will use an autograft (a tendon from the patient themselves or an artificial one) to replace the ligament, in order for the knee to become stable and functional again.
The period of return to sports activities depends and starts to be risk-free for the graft, usually after 6 months

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