The anterior cruciate ligament

Abstract

The anterior cruciate ligament (ACL) is the most common surgically treated ligament rupture in the adult knee. Disruption of the ACL has important consequences for knee kinematics, activities of daily living, return to sport and progression to symptomatic knee osteoarthritis in later life. While reconstructive procedures have good evidence for improving symptoms following ACL rupture, there is no strong evidence that reconstruction prevents osteoarthritis and selection of patients for reconstruction should be made on the basis of their clinical picture. Several controversies persist regarding surgical technique, including the use of single- or double-bundle techniques, the method of fixation and the selection of appropriate graft material. In this chapter, we discuss the natural history of ACL rupture, the evidence base for surgical interventions and the long-term outcomes of ACL reconstruction.