KNEE INJURIES
The treatment of an anterior cruciate ligament (ACL) injury is planned individually. The line of treatment is not determined solely by an MRI, age, or a single clinical finding. Crucial factors to assess include the functional stability of the knee, the patient's goals, the demands of their sport, and any potential associated injuries.
The anterior cruciate ligament, or ACL, is one of the most important stabilizing ligaments of the knee. It is particularly involved in controlling the front-to-back and rotational movement of the knee.
An anterior cruciate ligament (ACL) injury often occurs in sports during a rapid change of direction, twisting motion, deceleration, or landing from a jump. The injury can also occur in a contact situation, but a large portion of ACL injuries happen without direct contact.
Typical early symptoms include pain, swelling, and a feeling of the knee giving way or buckling.
The diagnosis is based on the symptoms, a clinical examination of the knee, and usually an MRI scan.
An ACL injury is not always just an injury to the anterior cruciate ligament. At the same time, the menisci, cartilage surfaces, and other ligaments are assessed. An ACL injury can be associated with, for example, a meniscus tear, a root or ramp lesion, cartilage damage, or damage to other ligaments.
Associated injuries can have a significant impact on both the choice of treatment line and the long-term prognosis of the knee.
A complete rupture of the anterior cruciate ligament does not automatically mean surgery. On the other hand, it is also not justified to treat all patients conservatively for a predetermined period of time before the treatment decision can be reassessed.
Is the knee able to function stably in the daily life and sports to which the patient wishes to return?
Instability, meaning the knee giving way or slipping out of place, especially during twisting movements, is one of the most important factors influencing the choice of treatment.
However, in the early stages of the injury, it is not always possible to predict with certainty who will develop functional instability. Therefore, the decision is based on an overall risk assessment.
• functional and clinical stability of the knee
• patient's age
• sport and target level
• the amount of change-of-direction and rotational loading
• meniscus and other associated injuries
• anatomical and individual risk factors
• the patient's own goals and treatment wishes
The treatment decision is made based on a risk assessment conducted jointly by the patient and the treating physician.
Open growth plates in a child or adolescent do not alone determine the treatment approach for an anterior cruciate ligament injury.
The openness of the growth plates primarily affects the planning of the surgical technique. If a young athlete has functional instability, a repairable meniscus tear, or the goal of returning to a high-risk pivoting sport, operative treatment may be justified even while growth is still ongoing.
Growth lines affect the surgical technique – they do not solely determine the line of treatment.
Anterior cruciate ligament reconstruction, graft selection, associated injuries, and individualized surgical planning.
Structured rehabilitation and monitoring of functional knee stability.