Management of Anterior Cruciate Ligament Injuries
Publication Date: August 22, 2022
Last Updated: August 30, 2022
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)
312070
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)
312070
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)
312070
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)
312070
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)
312070
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)
312070
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)
312070
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)
312070
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)
312070
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)
312070
MENISCAL REPAIR
In patients with ACL tear and meniscal tear, meniscal preservation should be considered to optimize joint health and function. (L)
312070
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)
312070
PROPHYLACTIC KNEE BRACING
Prophylactic bracing is not a preferred option to prevent ACL injury. (L)
312070
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)
312070
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)
312070
Recommendation Grading
Abbreviations
- ACL: Anterior Cruciate Ligament
- BTB: Bone Patellar Bone
Overview
Title
Management of Anterior Cruciate Ligament Injuries
Authoring Organization
American Academy of Orthopaedic Surgeons
Publication Month/Year
August 22, 2022
Last Updated Month/Year
August 29, 2024
Supplemental Implementation Tools
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
Supplemental Methodology Resources
Methodology
Number of Source Documents
342
Literature Search Start Date
June 6, 2020
Literature Search End Date
August 27, 2021