Summary
The complete tear of the anterior cruciate ligament initiates the clinical syndrome represented by continued functional disability. The precise degree of functional disability is highly debated. Agreement is elusive due to the lack of uniform and scientific meth-odology. An historical review and analysis of functional and subjective rating systems is reported, and the strengths of previous systems are identified. A subjective and functional rating system is proposed in which 6 activity levels are related to pain, swelling, giving-way and overall activity. This is important because of the marked dependence of the functional disability of the anterior cruciate insufficient knee on the activity level of the patient. Thus, activity levels must be rigorously and comprehensively defined.
In addition, we propose the utilisation of a risk factor checklist, based on the statistics drawn from our previous articles, to identify those patients at significant risk for future joint arthrosis. Risk factors are grouped under the categories of activity level, symptoms, clinical laxity, meniscal damage, lower limb alignment, tibiofemoral crepitus, patellofe-moral factors, rehabilitation and patient compliance.
Thirdly, we examine controversial aspects of the anterior cruciate ligament syndrome existing in the literature today and demonstrate why contrasting opinions are not mutually exclusive.
Finally we propose our treatment guidelines for management of the acute and chronic anterior cruciate ligament insufficient knee.
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References
Arnold, J.A.; Coker, T.P.; Heaton, L.M.; Park, J.P. and Harris, W.D.: Natural history of anterior cruciate tears. American Journal of Sports Medicine 7: 305–313 (1979).
Butler, D.L.; Noyes, F.R. and Grood, E.S.: Ligamentous restraints to anterior-posterior drawer in the human knee. A biochemical study. Journal of Bone and Joint Surgery 62A: 259–270 (1980).
Chick, R.R. and Jackson, D.W.: Tears of the anterior cruciate ligament in young athletes. Journal of Bone and Joint Surgery 60A: 970–973(1979).
Clancy, W.: Anterior cruciate ligament reconstruction using one-third of the patellar ligament, augmented by extra-articular tendon transfers. Journal of Bone and Joint Surgery 64A: 352–359(1982).
Ellison, A.E.: The pathogenesis and treatment of anterolateral rotatory instability. Clinical Orthopaedics and Related Research 147: 51–55(1980).
Fairbank, T.J.: Knee joint changes after meniscectomy. Journal of Bone and Joint Surgery 30B(4): 664–670 (1948).
Feagin Jr, J. A.: The syndrome of the torn anterior cruciate liga-ment. Orthopedic Clinics of North America 10: 81–90 (1979).
Feagin, J.A. and Blake, P.W.: Post-operative evaluation and result recording in the anterior cruciate ligament reconstructed knee. Clinical Orthopaedics and Related Research 172: 143–147(1983).
Fetto, J.F. and Marshall, J.L.: The natural history and diagnosis of anterior cruciate ligament insufficiency. Clinical Orthopaedics and Related Research 147: 29–38 (1980).
Giove, T.P.; Sayers, J.M.; Kent, B.E.; Sanford, T.L. and Garrick, J.G.: Non-operative treatment of the torn anterior cruciate ligament. Journal of Bone and Joint Surgery 65A: 184–192 (1983).
Grood, E.S.; Noyes, F.R.; Butler, D.L. and Suntay, W.J.: Liga-mentous and capsular restraints preventing straight medial and lateral laxity in intact human cadaver knees. Journal of Bone and Joint Surgery 63A: 1257–1269 (1981).
Hughston, J.C.; Andrews, J.R.; Cross, M.J. and Moschi, A.: Classification of knee ligament instabilities. I. The medial com-partment and cruciate ligaments. Journal of Bone and Joint Surgery 58A: 159–172(1976).
Hughston, J.C. and Barrett, G.R.: Acute anteromedial rotatory instability. Long term results of surgical repair. Journal of Bone and Joint Surgery 65A: 145–153 (1983).
Jacobsen, K.: Osteoarthrosis following insufficiency of the cruciate ligaments in man. Acta Orthopaedica Scandinavica 48: 520–526 (1977).
Jensen, J.E.; Slocum, D.B.; Larson, R.L.; James, S.L. and Singer, K.M.: Reconstruction procedures for anterior cruciate ligament insufficiency: A computer analysis of clinical results. American Journal of Sports Medicine 11: 240–248 (1983).
Kennedy, J.C; Roth, J.H.; Mendenhall, H.B. and Sanford, J.B.: Intra-articular replacement in the anterior cruciate ligament deficient knee. American Journal of Sports Medicine 8: 1–8 (1980).
Kennedy, J.C; Weinberg, H.W. and Wilson, A.S.: The anatomy and function of the anterior cruciate ligament. As determined by clinical and morphological studies. Journal of Bone and Joint Surgery 56A: 223–235 (1974).
Larson, R.L.: Combined instabilities of the knee. Clinical Ortho-paedics and Related Research 147: 68–75 (1980).
Marshall, J.L. and Rubin, R.M.: Knee ligament injuries. A diag-nostic and therapeutic approach. Orthopedic Clinics of North America 8: 641–668 (1977).
Marshall, J.L.; Rubin, R.M.; Wang, J.B.; Fetto, J.F. and Arnozky, S.P.: The anterior cruciate ligament. The diagnosis and treatment of its injuries and their serious prognostic impli-cations. Orthopaedic Review 7: 35–46 (1978).
McDaniel Jr, W.J. and Dameron Jr, T.B.: Untreated ruptures of the anterior cruciate ligament. A follow-up study. Journal of Bone and Joint Surgery 62A: 696–705 (1980).
Noyes, F.R.; Bassett, R.W.; Grood, E.S. and Butler, D.L.: Ar-throscopy in acute traumatic hemarthrosis of the knee. In-cidence of anterior cruciate tears and other injuries. Journal of Bone and Joint Surgery 62A: 687–695 (1980a).
Noyes, F.R.; Butler, D.L.; Paulos, L.E. and Grood, E.S.: Intra-articular cruciate reconstruction: I. Perspectives on graft strength, vascularization and immediate motion after replace-ment. Clinical Orthopaedics and Related Research 172: 71–77 (1983c).
Noyes, F.R.; DeLucas, J.L. and Torvik, P.J.: Biomechanics of an-terior cruciate ligament failure: An analysis of strain-rate sen-sitivity and mechanisms of failure in primates. Journal of Bone and Joint Surgery 56A: 236–253 (1974).
Noyes, F.R.; Grood, E.S.; Butler, D.L. and Paulos, L.E.: Clinical biomechanics of the knee-ligament restraints and functional stability; in Funk Jr (Ed) The American Academy of Ortho-paedic Surgeons: Symposium on the Athlete’s Knee; Surgical Repair and Reconstruction, pp. 1–35. (CV. Mosby, St Louis 1980b).
Noyes, F.R.; Matthews, D.S.; Mooar, P.A. and Grood, E.S.: The symptomatic anterior cruciate deficient knee. Part II: The re-sults of rehabilitation, activity modification, and counselling on functional disability. Journal of Bone and Joint Surgery 65A: 163–174 (1983b).
Noyes, F.R. and McGinniss, G.H.: Reflections on the controversy associated with treating the knee with anterior cruciate laxity. (Submitted for publication, Clinical Orthopaedics and Related Research 1984).
Noyes, F.R.; McGinniss, G.H. and Grood, E.S.: The variable functional disability of the anterior cruciate deficient knee. (Submitted for publication, Orthopedic Clinics of North America 1984).
Noyes, F.R.; Mooar, P.A.; Matthews, D.S. and Butler, D.L.: The symptomatic anterior cruciate-deficient knee. Part I: The long term functional disability in athletically active individuals. Journal of Bone and Joint Surgery 65A: 154–162 (1983a).
Paulos, L.; Noyes, F.R.; Grood, E.S. and Butler, D.L.: Knee rehabilitation after anterior cruciate ligament reconstruction and repair. American Journal of Sports Medicine 9: 140–149 (1981).
Warren, R.F. and Marshall, J.L.: Injuries of the anterior cruciate and medial collateral ligaments of the knee. A long term fol-low-up of 86 cases — Part II. Clinical Orthopaedics and Related Research 136: 198–211 (1978).
Youmans, W.T.: The so-called ‘isolated anterior cruciate ligament tear or anterior cruciate ligament syndrome’: A report of 32 cases with some observations on treatment and its effect on results. American Journal of Sports Medicine 6: 26–30 (1978).
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Noyes, F.R., McGinniss, G.H. & Mooar, L.A. Functional Disability in the Anterior Cruciate Insufficient Knee Syndrome Review of Knee Rating Systems and Projected Risk Factors in Determining Treatment. Sports Medicine 1, 278–302 (1984). https://doi.org/10.2165/00007256-198401040-00004
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DOI: https://doi.org/10.2165/00007256-198401040-00004