The anterior cruciate ligament problem.

The management of the acutely injured anterior cruciate ligament (ACL) was evaluated by a survey of 58 orthopedic surgeons in North America. The ACL is the most frequently totally torn ligament in the knee. Diagnosis may be made with a combination of tests: anterior drawer, Lachman, and pivot shift. If the patient is unable to relax because of pain or fear, examination under anesthesia, and possibly arthroscopy, should be performed. The manner in which the patient is treated for the ligamentous deficiency depends on the physician's perception of the natural history of the ACL deficient knees, the biomechanical necessity of the ligament, and the physician's ability to repair or reconstruct the ligament. Treatment can be surgical or nonsurgical. The method depends on the patient and his or her life-style. Since the ACL is vital to normal knee function, surgical intervention is advisable in the majority of cases of acute disruption in patients less than 40 years of age. Patients with chronic instability of the ligament, should be treated initially with a program of rehabilitation and, possibly, a reconstruction if the knee has not responded after at least six months. All knee surgeons should continuously review the literature and, as necessary, revise the treatment regimens for their patients.