Anterior cruciate‐injured knees: a review of evaluation methods and treatment regimens

Functional scores, activity scores, objective clinical findings and results after arthrometric measurements performed by the same examiner give valuable information when evaluating results after treatment of anterior cruciate ligament (ACL) injuries. Patient relaxation is of considerable importance during the arthrometric examination and the results between different measuring devices cannot be compared directly. The difference in anterior laxity between the injured and uninjured knee is the most important information when arthrometric measurements are to be presented. In the acute phase, if surgery is indicated, augmentation‐reconstruction with use of autologous material is the method of choice. The operation should be postponed until the knee has a full range of motion and when the effusion has subsided. Reconstruction using autologous patellar tendon bone‐tendon‐bone grafts and fixation techniques with use of interference‐screws in both recent and old injuries, permitting early knee rehabilitation, seem to be methods of choice. In selected cases hamstring tendons should be used as grafts. Adequate notchplasty should always be considered. Both modern miniarthrotomy techniques or arthroscopically assisted reconstruction procedures minimize postoperative morbidity and facilitate knee rehabilitation. Future prospective randomized studies comparing these two methods, with special reference to aspects of postoperative rehabilitation and long‐term results concerning function and stability, will certainly be valuable. Extra‐articular stabilization procedures do not function in the long‐term and these methods cannot be recommended as the only surgical procedure. There is as yet no true prosthetic ACL implant that has proven long‐lasting satisfactory results. Most long‐term reports about reconstruction of the ACL with synthetic materials have presented a high rate of failures. Augmentation techniques in which a synthetic material is combined with autologous tissue seem to give positive results, and resorbable materials may be a future solution. Use of allografts, either fresh‐frozen or freeze‐dried, are interesting techniques but must be considered developmental. Allograft techniques may enhance knee rehabilitation and minimize anterior knee pain, provided that the grafts are prepared properly and no viral infection is transmitted. Patient selection for either conservative or operative treatment is of greatest importance for good results. Each case should be treated individually, and in the future hopefully there will be better objective methods for selecting the right patient for the right method.