Anterior cruciate ligament injury: Difference between revisions

From Wikipedia, the free encyclopedia
Browse history interactively
← Previous editNext edit →
Content deleted Content added
VisualWikitext
UCSFMS3T (talk | contribs)
50 edits
Added notable cases
UCSFMS3T (talk | contribs)
50 edits
Re-organized section for better flow; added more up-to-date references
Line 93: Line 93:


==Prevention==
==Prevention==
Interest in reducing non-contact ACL injury has been intense and the observed, increased liability of the female sex in some sports has added to this. The International Olympic Committee, after a comprehensive review of preventive strategies, has stated that injury prevention programs have a measurable effect on reducing injuries, and that applies particularly to women.<ref>{{cite journal | title=Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement |author1=P Renstrom |author2=A Ljungqvist |author3=E Arendt |author4=B Beynnon |author5=T Fukubayashi |author6=W Garrett |author7=T Georgoulis |author8=T E Hewett |author9=R Johnson |author10=T Krosshaug |author11=B Mandelbaum |author12=L Micheli |author13=G Myklebust |author14=E Roos |author15=H Roos |author16=P Schamasch |author17=S Shultz |author18=S Werner |author19=E Wojtys |author20=L Engebretsen | date=June 2008 | journal=Br J Sports Med | volume=42 | issue = 6 | pages=394–412 | pmc=3920910 | doi=10.1136/bjsm.2008.048934 | pmid=18539658}}</ref> Further, paying attention to the balance of strength between hamstrings and quadriceps will help prevent the ACL from being overpowered by over-emphasized quadriceps strength. It is also stressed that landing forces should be reduced together with emphasizing proper landing technique. It has been previously reported that landing on the heel, rather than forefoot with progressive transfer of weight to the heel, is potentially injurious to the ACL because of the hyperextension forces created. The closer the knee is to full extension, the more likely this is to occur.<ref name=Boden>{{cite journal | title=Non-contact ACL Injuries: Mechanisms and Risk Factors |vauthors=Boden BP, Sheehan FT, Torg JS, Hewett TE | date=Sep 2010 | journal=J Am Acad Orthop Surg | volume=18 | issue = 9 | pages=520–27 | pmc=3625971 | pmid=20810933}}</ref>
Interest in reducing non-contact ACL injury has been intense. The International Olympic Committee, after a comprehensive review of preventive strategies, has stated that injury prevention programs have a measurable effect on reducing injuries.<ref>{{cite journal | title=Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement |author1=P Renstrom |author2=A Ljungqvist |author3=E Arendt |author4=B Beynnon |author5=T Fukubayashi |author6=W Garrett |author7=T Georgoulis |author8=T E Hewett |author9=R Johnson |author10=T Krosshaug |author11=B Mandelbaum |author12=L Micheli |author13=G Myklebust |author14=E Roos |author15=H Roos |author16=P Schamasch |author17=S Shultz |author18=S Werner |author19=E Wojtys |author20=L Engebretsen | date=June 2008 | journal=Br J Sports Med | volume=42 | issue = 6 | pages=394–412 | pmc=3920910 | doi=10.1136/bjsm.2008.048934 | pmid=18539658}}</ref> These programs are especially important in female athletes who bear higher incidence of ACL injury than male athletes, and also in children and adolescents who are at high risk for a second ACL tear.<ref>{{Cite journal|last=Lang|first=Pamela J|last2=Sugimoto|first2=Dai|last3=Micheli|first3=Lyle J|date=2017-06-12|title=Prevention, treatment, and rehabilitation of anterior cruciate ligament injuries in children|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5476725/|journal=Open Access Journal of Sports Medicine|volume=8|pages=133–141|doi=10.2147/OAJSM.S133940|issn=1179-1543|pmc=PMC5476725|pmid=28652828}}</ref>


Researchers have found that female athletes often land with the knees relatively straight and collapsing inwards towards each other, with most of their bodyweight on a single foot and their upper body tilting to one side; these four factors increase the likelihood of ACL tear.<ref name="Boden">{{cite journal|vauthors=Boden BP, Sheehan FT, Torg JS, Hewett TE|date=Sep 2010|title=Non-contact ACL Injuries: Mechanisms and Risk Factors|journal=J Am Acad Orthop Surg|volume=18|issue=9|pages=520–27|pmc=3625971|pmid=20810933}}</ref> <ref>{{Cite journal|last=Hewett|first=Timothy E.|last2=Ford|first2=Kevin R.|last3=Hoogenboom|first3=Barbara J.|last4=Myer|first4=Gregory D.|date=2010-12|title=UNDERSTANDING AND PREVENTING ACL INJURIES: CURRENT BIOMECHANICAL AND EPIDEMIOLOGIC CONSIDERATIONS - UPDATE 2010|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096145/|journal=North American Journal of Sports Physical Therapy : NAJSPT|volume=5|issue=4|pages=234–251|issn=1558-6162|pmc=PMC3096145|pmid=21655382}}</ref> There is evidence that engaging in neuromuscular training (NMT) to counter those factors and emphasize proper landing technique can reduce risk of ACL injury, particularly in young female athletes.<ref>{{Cite journal|last=Myer|first=Gregory D.|last2=Sugimoto|first2=Dai|last3=Thomas|first3=Staci|last4=Hewett|first4=Timothy E.|date=2013-1|title=The Influence of Age on the M Effectiveness of Neuromuscular Training to Reduce Anterior Cruciate Ligament Injury in Female Athletes|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4160039/|journal=The American journal of sports medicine|volume=41|issue=1|pages=203–215|doi=10.1177/0363546512460637|issn=0363-5465|pmc=PMC4160039|pmid=23048042}}</ref><ref>{{Cite book|url=https://www.researchgate.net/publication/277311741_Neuromuscular_training_injury_prevention_strategies_in_youth_sport_A_systematic_review_and_meta-analysis|title=Neuromuscular training injury prevention strategies in youth sport: A systematic review and meta-analysis|last=Emery|first=Carolyn|last2=Roy|first2=Thierry-Olivier|last3=Whittaker|first3=Jackie|last4=Nettel-Aguirre|first4=Alberto|last5=van Mechelen|first5=Willem|date=2015-04-01|volume=49}}</ref>
Accordingly, it is generally recommended that injury prevention programs stress these principles.


==Treatment==
==Treatment==

Revision as of 19:31, 21 March 2018

Anterior cruciate ligament injury
Diagram of the right knee
SpecialtyOrthopedics
SymptomsA "pop" with pain, knee instability, swelling of knee[1]
CausesNon-contact injury, contact injury[2]
Risk factorsAthletes, female[1]
Diagnostic methodPhysical exam, MRI[1]
PreventionNeuromuscular training,[3] core strengthening[4]
TreatmentBraces, physical therapy, surgery[1]
Frequencyc. 200,000 per year (US)[2]

Anterior cruciate ligament injury is when the anterior cruciate ligament (ACL) is either stretched, partially torn, or completely torn.[1] The most common injury is a complete tear.[1] Symptoms include pain, a popping sound during injury, instability of the knee, and joint swelling.[1] Swelling generally appears within a couple of hours.[2] In approximately 50% of cases, other structures of the knee such as surrounding ligaments, cartilage, or meniscus are damaged.[1]

The underlying mechanism often involves a rapid change in direction, sudden stop, landing after a jump, or direct contact to the knee.[1] It is more common in athletes, particularly those who participate in alpine skiing, soccer, football, or basketball.[1][5] Diagnosis is typically made by physical examination and is sometimes supported by magnetic resonance imaging (MRI).[1]

Prevention is by neuromuscular training and core strengthening.[3][4] Treatment recommendations depend on desired level of activity. In those with low levels of future activity, nonsurgical management including bracing and physiotherapy may be sufficient.[1] In those with high activity levels, surgical repair via arthroscopic anterior cruciate ligament reconstruction is often recommended.[1] Surgery, if recommended, is generally not performed until the initial inflammation from the injury has resolved.[1]

About 200,000 people are affected per year in the United States.[2] In some sports, females have a higher risk of ACL injury, while in others, both sexes are equally affected.[5] Many people with a complete tear who do not receive surgery are unable to play sports, and may develop osteoarthritis.[2]

Signs and symptoms

An individual may feel or hear a "pop" in their knee during a twisting movement[6] or rapid deceleration, followed by an inability to continue participation in the sport and early swelling from hemarthrosis. This combination is said to indicate a 90% probability of ACL rupture.[7]

An individual may experience instability in the knee once they resume walking and other activities, and they may feel their knee is "giving out". Loss of full range of motion, and discomfort along the joint line are also common symptoms of an ACL injury.[8]

Risk factors

ACL tear.

ACL injury most commonly occurs when an individual stops suddenly or plants his or her foot hard into the ground (cutting). ACL injury also has been linked to heavy or stiff-legged landing; the knee rotating while landing, especially when the knee is in an unnatural position. The ACL is responsible for providing stability in knee rotation, as it prevents the tibia from shifting in front of the femur.[2]

Many ACL injuries occur when an athlete lands flat on their heels. This movement directs the forces directly up the tibia into the knee, while the straight-knee position places the anterior femoral condyle on the back-slanted portion of the tibia. The resultant forward slide of the tibia relative to the femur is restrained primarily by the now-vulnerable ACL.

ACL injuries also can be caused by direct contact or trauma, such as in a motor vehicle collision or from a tackle in football. A severe form of ACL injury caused by direct contact is called the "unhappy triad," also known as the "terrible triad," or "O'Donoghue's triad." The "unhappy triad" involves injury of the anterior cruciate ligament, the medial collateral ligament, and the medial meniscus.[9]

Sex-related differences

Women in sports such as association football, basketball, and tennis are significantly more prone to ACL injuries than men. The discrepancy has been attributed to gender differences in anatomy, general muscular strength, reaction time of muscle contraction and coordination, and training techniques.

Gender differences in ACL injury rates become evident when specific sports are compared.[10] A review of NCAA data has found relative rates of injury per 1000 athlete exposures as follows:

  • Men's basketball 0.07, women's basketball 0.23
  • Men's lacrosse 0.12, women's lacrosse 0.17
  • Men's football 0.09, women's football 0.28

The highest rate of ACL injury in women occurred in gymnastics, with a rate of injury per 1000 athlete exposures of 0.33 Of the four sports with the highest ACL injury rates, three were women's – gymnastics, basketball and soccer.[11]

According to recent studies, female athletes are two to eight times more likely to strain their anterior cruciate ligament (ACL) in sports that involve cutting and jumping as compared to men who play the same particular sports (soccer, basketball, and volleyball).[12] Differences between males and females identified as potential causes are the active muscular protection of the knee joint, the greater Q angle putting more medial torque on the knee joint, relative ligament laxity caused by differences in hormonal activity from estrogen and relaxin, intercondylar notch dimensions, and muscular strength.[12][13]

Hormonal and anatomic differences

Before puberty, there is no observed difference in frequency of ACL tears between the sexes. Changes in sex hormone levels, specifically elevated levels of estrogen and relaxin in females during the menstrual cycle, have been hypothesized as causing predisposition of ACL ruptures. This is because they may increase joint laxity and extensibility of the soft tissues surrounding the knee joint.[12] Additionally, female pelvises widen during puberty through the influence of sex hormones. This wider pelvis requires the femur to angle toward the knees. This angle towards the knee is referred to as the Q angle. The average Q angle for men is 14 degrees and the average for women is 17 degrees. Steps can be taken to reduce this Q angle, such as using orthotics.[14] The relatively wider female hip and widened Q angle may lead to an increased likelihood of ACL tears in women.

ACL, muscular stiffness, and strength

During puberty, sex hormones also affect the remodeled shape of soft tissues throughout the body. The tissue remodeling results in female ACLs that are smaller and will fail (i.e. tear) at lower loading forces, and differences in ligament and muscular stiffness between men and women. Women’s knees are less stiff than men’s during muscle activation. Force applied to a less stiff knee is more likely to result in ACL tears.[15]

In addition, the quadriceps femoris muscle is an antagonist to the ACL. According to a study done on female athletes at the University of Michigan, 31% of female athletes recruited the quadriceps femoris muscle first as compared to 17% in males. Because of the elevated contraction of the quadriceps femoris muscle during physical activity, an increased strain is placed onto the ACL due to the "tibial translation anteriorly".[16]

Ligament dominance

The increased risk of anterior cruciate ligament injury among female athletes is best predicted by the motion and loading of the knee during performance situations.[17] The ligament dominance theory suggests that females typically perform athletic movements with greater knee valgus angles. A greater amount of stress is placed on the ACL in these situations because there is high activation of the quadriceps muscles despite limited knee flexion, limited hip flexion, greater hip adduction, and a large knee adductor moment.[18][19] Additionally, females typically land with their tibia rotated internally or externally.[20] As a result of increased knee valgus stress, ground reaction forces are greater and laterally directed.[21]

Quadriceps dominance

Ligament dominance is observed when there is excessive movement in the frontal plane to accommodate limited movement in the sagittal plane. This is caused by weakness in the hamstring muscles or reliance on the strength of the quadriceps muscles.[19] This quadriceps dominance theory identifies when the hamstring muscles are notably weaker than the quadriceps muscles. As a result, knee stability in performance situations depends on the quadriceps due to a discrepancy in the pattern in recruiting quadriceps and hamstring muscles.[22]

Trunk and leg dominance

Other theories used to explain the increased risk of ACL injury among female athletes include the trunk dominance and leg dominance theories. Trunk dominance suggests that males typically exhibit greater control of the trunk in performance situations as evidenced by greater activation of the internal oblique muscle. Leg dominance suggests that females exhibit greater kinematic leg asymmetry in knee valgus angles, hip abduction, and ankle abduction in performance situations.[18]

Right knee, front, showing interior ligaments Left knee, behind, showing interior ligaments

Diagnosis

Manual tests

The pivot-shift test, anterior drawer test, and Lachman test are used during the clinical examination of suspected ACL injury. The Lachman test is recognized by most authorities as the most reliable and sensitive test, and usually superior to the anterior drawer test.[23]

An ACL tear can present with a popping sound heard after impact, swelling after a couple of hours, severe pain when bending the knee, and buckling or locking of the knee during movement.

Though clinical examination in experienced hands can be accurate, the diagnosis is usually confirmed by using an arthrometer or MRI, which have greatly lessened the need for diagnostic arthroscopy and which have a higher accuracy than clinical examination. It may also permit visualization of other structures which may have been coincidentally involved, such as a meniscus, or collateral ligament, or posterolateral corner of the knee joint.

Laximetry

Laximetry is a reliable technique for diagnosing a torn anterior cruciate ligament.[24]

MRI scan

Anterior cruciate ligament tear seen on MRI. T1 left, right PDW.

MRI is perhaps the most used technique for diagnosing the state of the ACL but it is not always the most reliable technique. In some cases the ACL cannot be seen because of the blood surrounding it.

Prevention

Interest in reducing non-contact ACL injury has been intense. The International Olympic Committee, after a comprehensive review of preventive strategies, has stated that injury prevention programs have a measurable effect on reducing injuries.[25] These programs are especially important in female athletes who bear higher incidence of ACL injury than male athletes, and also in children and adolescents who are at high risk for a second ACL tear.[26]

Researchers have found that female athletes often land with the knees relatively straight and collapsing inwards towards each other, with most of their bodyweight on a single foot and their upper body tilting to one side; these four factors increase the likelihood of ACL tear.[27] [28] There is evidence that engaging in neuromuscular training (NMT) to counter those factors and emphasize proper landing technique can reduce risk of ACL injury, particularly in young female athletes.[29][30]

Treatment

The term for non-surgical treatment for ACL rupture is "conservative management", and it often includes physical therapy and using a knee brace. Instability associated with ACL deficiency increases the risk of other knee injuries such as a torn meniscus, so sports with cutting and twisting motions are problematic and surgery is often recommended in those circumstances.

Patients who have suffered an ACL injury should be evaluated for other injuries that often occur in combination with an ACL tear and include cartilage/meniscus injuries, bone bruises, PCL tears, posterolateral injuries and collateral ligament injuries. When a combination injury occurs, surgical treatment is usually advised.[2]

Conservative

A torn ACL is less likely to restrict the movement of the knee. Not repairing tears to the ACL can sometimes cause damage to the cartilage inside the knee because with the torn ACL, the tibia and femur bone are more likely to rub against each other. Immediately after a tear of the ACL, the person should rest the knee, ice it every 15 to 20 minutes, provide compression on the knee, and then elevate it above the heart; this process helps decrease the swelling and reduce the pain. The form of treatment is determined based on the severity of the tear on the ligament. Small tears in the ACL may require only several months of rehab in order to strengthen the surrounding muscles, the hamstring and the quadriceps, so that these muscles can compensate for the torn ligament. Falls associated with knee instability may require the use of a specific brace to stabilize the knee. Women are more likely to experience falls associated with the knee giving way. Sudden falls can be associated with further complications such as fractures and head injury.

Surgery

Main article: Anterior cruciate ligament reconstruction

If surgery is decided upon, either because obvious instability interferes with activities of daily living, or because the knee is subject to repeated, severe, provocative maneuvers, such as the case of the competitive athlete involved in cutting and rapid deceleration etc., then several issues need to be decided upon.

  • Timing. Immediate repair is usually avoided and initial swelling and inflammatory reaction allowed to subside.
  • Choice of graft material, autograft or allograft.
  • Choice of anterior cruciate ligament augmentation, patellar tendon or hamstring tendon.[31]

These issues are fully explored in anterior cruciate ligament reconstruction.

Epidemiology

There are around 200,000 ACL tears each year in the United States, with over 100,000 ACL reconstruction surgeries per year. Over 95% of ACL reconstructions are performed in the outpatient setting. The most common procedures performed during ACL reconstruction are partial meniscectomy and chondroplasty.[32]

Special populations

Young athletes

High school athletes are at increased risk for ACL tears when compared to non-athletes. This risk increases with certain types of sports. Among high school girls, the sport with the highest risk of ACL tear is soccer, followed by basketball and lacrosse. The highest risk sport for boys was basketball, followed by lacrosse and soccer.[33] Children and young athletes may benefit from early surgical reconstruction after ACL injury. Young athletes who have early surgical reconstruction of their torn ACL are more likely to return to their previous level of athletic ability when compared to those who underwent delayed surgery or nonoperative treatment. They are also less likely to experience instability in their knee if they undergo early surgery.[34]

Notable Cases

References

  1. ^ a b c d e f g h i j k l m n "Anterior Cruciate Ligament (ACL) Injuries-OrthoInfo - AAOS". orthoinfo.aaos.org. March 2014. Archived from the original on 5 July 2017. Retrieved 30 June 2017. {{cite web}}: Unknown parameter |deadurl= ignored (|url-status= suggested) (help)
  2. ^ a b c d e f g "ACL Injury: Does It Require Surgery?-OrthoInfo - AAOS". orthoinfo.aaos.org. September 2009. Archived from the original on 22 June 2017. Retrieved 30 June 2017. {{cite web}}: Unknown parameter |deadurl= ignored (|url-status= suggested) (help)
  3. ^ a b Hewett, T. E.; Ford, K. R.; Myer, G. D. (2006). "Anterior cruciate ligament injuries in female athletes: Part 2, a meta-analysis of neuromuscular interventions aimed at injury prevention". Am J Sports Med. 34 (3): 490–8. doi:10.1177/0363546505282619. PMID 16382007.
  4. ^ a b Sugimoto D, Myer GD, Foss KD, Hewett TE. "Specific exercise effects of preventive neuromuscular training intervention on anterior cruciate ligament injury risk reduction in young females: meta-analysis and subgroup analysis". Br J Sports Med. 49: 282–9. doi:10.1136/bjsports-2014-093461. PMID 25452612.
  5. ^ a b Prodromos CC, Han Y, Rogowski J, Joyce B, Shi K (Dec 2007). "A meta-analysis of the incidence of anterior cruciate ligament tears as a function of gender, sport, and a knee injury-reduction regimen". Arthroscopy. 23 (12): 1320–25. doi:10.1016/j.arthro.2007.07.003. PMID 18063176.
  6. ^ "ACL Reconstruction Sydney NSW | ACL Injury Treatment Sydney NSW". Dr Stephen Rimmer | Sydney Orthopedic Knee Surgeon. 2016-10-16. Archived from the original on 2016-11-17. Retrieved 2016-11-17. {{cite news}}: Unknown parameter |deadurl= ignored (|url-status= suggested) (help)
  7. ^ Bytomski J, Moorman C (2010). Oxford American Handbook of Sports Medicine. Oxford American Handbook of Medicine Series (First ed.). Oxford, New York: Oxford University Press. p. 290. ISBN 9780195372199.
  8. ^ "Anterior Cruciate Ligament (ACL) Injuries-OrthoInfo - AAOS". orthoinfo.aaos.org. Retrieved 2017-10-24.
  9. ^ O'donoghue, D. H. (1950-10-01). "Surgical treatment of fresh injuries to the major ligaments of the knee". The Journal of Bone and Joint Surgery. American Volume. 32 A (4): 721–738. ISSN 0021-9355. PMID 14784482.
  10. ^ Mountcastle, S. B.; et al. (October 2007). "Gender differences in anterior cruciate ligament injury vary with activity: epidemiology of anterior cruciate ligament injuries in a young, athletic population". Am J Sports Med. 35 (10): 1635–42. doi:10.1177/0363546507302917. PMID 17519438.
  11. ^ Hootman, J. M.; Dick, R.; Agel, J. (Apr–Jun 2007). "Epidemiology of Collegiate Injuries for 15 Sports: Summary and Recommendations for Injury Prevention Initiatives". J Athl Train. 42 (2): 311–19. PMC 1941297. PMID 17710181.
  12. ^ a b c Faryniarz, Deborah A.; et al. (2006). "Quantitation of Estrogen Receptors and Relaxin Binding in Human Anterior Cruciate Ligament Fibroblasts". In Vitro Cellular & Developmental Biology Animal. 42 (7): 176–181. JSTOR 4295693.
  13. ^ Wojyts, Edward M.; et al. (2003). "Gender differences in muscular protection of the knee in torsion in size-matched athletes". Journal of Bone and Joint Surgery. 85 (5): 782. PMID 12728025.
  14. ^ McLean SG, Huang X, van den Bogert AJ (2005). "Association between lower extremity posture at contact and peak when the tibia moves too far forward implications for ACL injury". Clin Biomech (Bristol, Avon). 20 (8): 863–70. doi:10.1016/j.clinbiomech.2005.05.007. PMID 16005555.
  15. ^ Slauterbeck, JR; Hickox JR; Beynnon B; Hardy DM (2006). "Anterior Cruciate Ligament Biology andIts Relationship to Injury Forces". Orthop Clin N Am. 37: 585–591. doi:10.1016/j.ocl.2006.09.001.
  16. ^ Biondino, Robert (November 1999). "Anterior Cruciate Ligament Injuries in Female Athletes". Connecticut Medicine. 63 (11): 657–660. PMID 10589146.
  17. ^ Hewett T. E.; Myer G. D.; Ford K. R.; Heidt R. S.; Colosimo A. J.; McLean S. G.; den Bogert A. J.; Paterno M. V.; Succop P. (2005). "Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study". The American Journal of Sports Medicine. 33 (4): 492–501. doi:10.1177/0363546504269591.
  18. ^ a b Pappas E.; Carpes F. P. (2012). "Lower extremity kinematic asymmetry in male and female athletes performing jump-landing tasks". Journal of Science and Medicine in Sport. 15 (1): 87–92. doi:10.1016/j.jsams.2011.07.008.
  19. ^ a b Pollard C. D.; Sigward S. M.; Powers C. M. (2010). "Limited hip and knee flexion during landing is associated with increased frontal plane knee motion and moments". Clinical Biomechanics. 25 (2): 142–146. doi:10.1016/j.clinbiomech.2009.10.005.
  20. ^ Nagano Y.; Ida H.; Akai M.; Fukubayashi T. (2007). "Gender differences in knee kinematics and muscle activity during single limb drop landing". The Knee. 14 (3): 218–223. doi:10.1016/j.knee.2006.11.008.
  21. ^ Sigward S. M.; Powers C. M. (2007). "Loading characteristics of females exhibiting excessive valgus moments during cutting". Clinical Biomechanics. 22 (7): 827–833. doi:10.1016/j.clinbiomech.2007.04.003.
  22. ^ Ford, K. R.; Myer, G. D.; Hewett, T. E. (2003). "Valgus knee motion during landing in high school female and male basketball players". Medicine and Science in Sports and Exercise. 31 (10): 1745–1750. PMID 14523314.
  23. ^ van Eck CF, van den Bekerom MP, Fu FH, Poolman RW, Kerkhoffs GM (Aug 2013). "Methods to diagnose acute anterior cruciate ligament rupture: a meta-analysis of physical examinations with and without anaesthesia". Knee Surg Sports Traumatol Arthrosc. 21 (8): 1895–903. doi:10.1007/s00167-012-2250-9. PMID 23085822.
  24. ^ Rohman, Eric M.; Macalena, Jeffrey A. (2016-03-16). "Anterior cruciate ligament assessment using arthrometry and stress imaging". Current Reviews in Musculoskeletal Medicine. 9 (2): 130–138. doi:10.1007/s12178-016-9331-1. ISSN 1935-973X. PMC 4896874. PMID 26984335.
  25. ^ P Renstrom; A Ljungqvist; E Arendt; B Beynnon; T Fukubayashi; W Garrett; T Georgoulis; T E Hewett; R Johnson; T Krosshaug; B Mandelbaum; L Micheli; G Myklebust; E Roos; H Roos; P Schamasch; S Shultz; S Werner; E Wojtys; L Engebretsen (June 2008). "Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement". Br J Sports Med. 42 (6): 394–412. doi:10.1136/bjsm.2008.048934. PMC 3920910. PMID 18539658.
  26. ^ Lang, Pamela J; Sugimoto, Dai; Micheli, Lyle J (2017-06-12). "Prevention, treatment, and rehabilitation of anterior cruciate ligament injuries in children". Open Access Journal of Sports Medicine. 8: 133–141. doi:10.2147/OAJSM.S133940. ISSN 1179-1543. PMC 5476725. PMID 28652828.{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link)
  27. ^ Boden BP, Sheehan FT, Torg JS, Hewett TE (Sep 2010). "Non-contact ACL Injuries: Mechanisms and Risk Factors". J Am Acad Orthop Surg. 18 (9): 520–27. PMC 3625971. PMID 20810933.
  28. ^ Hewett, Timothy E.; Ford, Kevin R.; Hoogenboom, Barbara J.; Myer, Gregory D. (2010-12). "UNDERSTANDING AND PREVENTING ACL INJURIES: CURRENT BIOMECHANICAL AND EPIDEMIOLOGIC CONSIDERATIONS - UPDATE 2010". North American Journal of Sports Physical Therapy : NAJSPT. 5 (4): 234–251. ISSN 1558-6162. PMC 3096145. PMID 21655382. {{cite journal}}: Check date values in: |date= (help)CS1 maint: PMC format (link)
  29. ^ Myer, Gregory D.; Sugimoto, Dai; Thomas, Staci; Hewett, Timothy E. (2013-1). "The Influence of Age on the M Effectiveness of Neuromuscular Training to Reduce Anterior Cruciate Ligament Injury in Female Athletes". The American journal of sports medicine. 41 (1): 203–215. doi:10.1177/0363546512460637. ISSN 0363-5465. PMC 4160039. PMID 23048042. {{cite journal}}: Check date values in: |date= (help)CS1 maint: PMC format (link)
  30. ^ Emery, Carolyn; Roy, Thierry-Olivier; Whittaker, Jackie; Nettel-Aguirre, Alberto; van Mechelen, Willem (2015-04-01). Neuromuscular training injury prevention strategies in youth sport: A systematic review and meta-analysis. Vol. 49.
  31. ^ Mohtadi, NG; Chan, DS; Dainty, KN; Whelan, DB (Sep 7, 2011). "Patellar tendon versus hamstring tendon autograft for anterior cruciate ligament rupture in adults". Cochrane Database of Systematic Reviews. 9 (9): CD005960. doi:10.1002/14651858.CD005960.pub2. PMID 21901700.
  32. ^ Mall, Nathan A.; Chalmers, Peter N.; Moric, Mario; Tanaka, Miho J.; Cole, Brian J.; Bach, Bernard R.; Paletta, George A. (2014-10-01). "Incidence and trends of anterior cruciate ligament reconstruction in the United States". The American Journal of Sports Medicine. 42 (10): 2363–2370. doi:10.1177/0363546514542796. ISSN 1552-3365. PMID 25086064.
  33. ^ Gornitzky, Alex L.; Lott, Ariana; Yellin, Joseph L.; Fabricant, Peter D.; Lawrence, J. Todd; Ganley, Theodore J. (2016-10-01). "Sport-Specific Yearly Risk and Incidence of Anterior Cruciate Ligament Tears in High School Athletes: A Systematic Review and Meta-analysis". The American Journal of Sports Medicine. 44 (10): 2716–2723. doi:10.1177/0363546515617742. ISSN 1552-3365. PMID 26657853.
  34. ^ Ramski, David E.; Kanj, Wajdi W.; Franklin, Corinna C.; Baldwin, Keith D.; Ganley, Theodore J. (2014-11-01). "Anterior cruciate ligament tears in children and adolescents: a meta-analysis of nonoperative versus operative treatment". The American Journal of Sports Medicine. 42 (11): 2769–2776. doi:10.1177/0363546513510889. ISSN 1552-3365. PMID 24305648.
  35. ^ Conway, Tyler. "Timeline of Derrick Rose's Journey from Knee Injury to NBA Return". Bleacher Report. Retrieved 2018-03-21.
  36. ^ "Adrian Peterson leads way in ACL recovery in NFL". USA TODAY. Retrieved 2018-03-21.
  37. ^ "Gale Sayers - Suffers Serious Knee Injury". sports.jrank.org. Retrieved 2018-03-21.
Retrieved from "https://en.wikipedia.org/w/index.php?title=Anterior_cruciate_ligament_injury&oldid=831683446"