ACL Introduction

The 'ACL', or anterior cruciate ligament, has become a household word in the '90's. Most athletes have heard about or know someone who has had an injury to the anterior cruciate ligament of the knee. The following discussion is meant to provide all the information that you need to know about the ACL. It will also help you to make an informed decision on the best management of the injury to the anterior cruciate ligament.

The anterior cruciate ligament is the main stabilizer of the knee for athletic pivotal activities. One of the first definitive monographs on the ACL was written by Ivor Palmer in the 1920's. He advocated early surgical repair by suturing the ligament, and thus set the stage for the aggressive surgical approach by the Swedish surgeons. Ultimately suture repair was found to have a high failure rate in athletes. Jones, Erickson, and Macintosh all advocated reconstruction of the ACL with the patellar tendon, rather than repair, and thus began the modern phase of treatment.

In 1973, when I first started practice, the torn anterior cruciate ligament often ended the athlete's career. Now, they routinely return to play as early as 4 months and certainly by the next season. We have gained considerable experience in the surgical treatment of ACL injuries, but have made little impact in the prevention of the injury, especially in downhill skiing.

The operative treatment has evolved from open procedures performed in hospital with post-op casting, to arthroscopically performed outpatient procedures with early weight bearing and splint immobilization. The pain control has also improved considerably. This has lessened the morbidity of the operation, and, extended the operative option to the recreational and older athlete.

The injury to the anterior cruciate ligament has become one of the most common athletic injuries.