Last updated August 30, 2022

Management of Anterior Cruciate Ligament Injuries

Recommendations

HISTORY AND PHYSICAL

A relevant history should be obtained, and a focused musculoskeletal exam of the lower extremities should be performed when assessing for an ACL injury. (S)
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SURGERY TIMING

When surgical treatment is indicated for an acute isolated ACL tear, early reconstruction is preferred because the risk of additional cartilage and meniscal injury starts to increase within 3 months. (S)
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SINGLE OR DOUBLE BUNDLE RECONSTRUCTION

In patients undergoing intraarticular ACL reconstruction single or double bundle techniques can be considered because measured outcomes are similar. (S)
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AUTOGRAFT VS ALLOGRAFT

When performing an ACL reconstruction, surgeons should consider autograft over allograft to improve patient outcomes and decrease ACL graft failure rate, particularly in young and/or active patients. (S)
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AUTOGRAFT SOURCE

When performing an ACL reconstruction with autograft for skeletally mature patients, surgeons may favor BTB to reduce the risk of graft failure or infection, or hamstring to reduce the risk of anterior or kneeling pain. (M)
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ACL TRAINING PROGRAMS

Training programs designed to prevent injury can be used to reduce the risk of primary ACL injuries in athletes participating in high-risk sports. (M)
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ANTEROLATERAL LIGAMENT / LATERAL EXTRAARTICULAR TENODESIS

ALL Reconstruction / LET could be considered when performing hamstring autograft reconstruction in select patients to reduce graft failure and improve short-term function, although long-term outcomes are yet unclear. (M)
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REPAIR VS. RECONSTRUCTION

ACL tears indicated for surgery should be treated with ACL reconstruction rather than repair because of the lower risk of revision surgery. (S)
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ASPIRATION OF THE KNEE

In the absence of reliable evidence, it is the opinion of the workgroup that physicians may consider aspirating painful, tense effusions after knee injury. (C)
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ACL SURGICAL RECONSTRUCTION

ACL reconstruction can be considered in order to lower the risk of future meniscus pathology or procedures, particularly in younger and/or more active patients. ACL reconstruction may be considered to improve long term pain and function. (L)
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MENISCAL REPAIR

In patients with ACL tear and meniscal tear, meniscal preservation should be considered to optimize joint health and function. (L)
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COMBINED ACL / MCL TEAR

In patients with combined ACL and MCL tears, non-operative treatment of the MCL injury results in good patient outcomes, although operative treatment of the MCL may be considered in select cases. (L)
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PROPHYLACTIC KNEE BRACING

Prophylactic bracing is not a preferred option to prevent ACL injury. (L)
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RETURN TO SPORT

Functional evaluation, such as the hop test, may be considered as one factor to determine return to sport after ACL reconstruction. (L)
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RETURN TO ACTIVITY FUNCTIONAL BRACING

Functional knee braces are not recommended for routine use in patients who have received isolated primary ACL reconstruction, as they confer no clinical benefit. (L)
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Recommendation Grading

Abbreviations

  • ACL: Anterior Cruciate Ligament
  • BTB: Bone Patellar Bone

Overview

Title

Management of Anterior Cruciate Ligament Injuries

Authoring Organization

Publication Month/Year

August 22, 2022

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Target Provider Population

Orthpaedic surgeons, emergency medicine physicians and other allied providers

Inclusion Criteria

Male, Female, Adolescent, Adult, Child

Health Care Settings

Ambulatory, Emergency care, Outpatient, Operating and recovery room

Intended Users

Athletics coaching, nurse, nurse practitioner, occupational therapist, physical therapist, physician, physician assistant

Scope

Assessment and screening, Treatment, Management, Prevention, Rehabilitation

Diseases/Conditions (MeSH)

D016118 - Anterior Cruciate Ligament

Keywords

ACL injury, Anterior Cruciate Ligament

Source Citation

American Academy of Orthopaedic Surgeons Management of Anterior Cruciate Ligament Injurie EvidenceBased Clinical Practice Guidline. www.aaos.org/aclcpg Published 08/22/2022 View background materials via the ACL CPG eAppendix 1 View data summaries via the ACL CPG eAppendix 2

Methodology

Number of Source Documents
342
Literature Search Start Date
June 6, 2020
Literature Search End Date
August 27, 2021