RISKS, RECONSTRUCTION AND LONG-TERM EFFECTS OF ACL TEARS

Risks, Reconstruction and Long-Term Effects of ACL Tears

Matthew Nickell, Mackenzie Tucker, Kayla Mollendor, Brianna Meeks, Ibro Soumah,

Nathan Swartzbaugh

SES-331

Dr. Smith

04/30/2021
RISKS, RECONSTRUCTION AND LONG-TERM EFFECTS OF ACL TEARS

Abstract

Our group explored a common knee injury, anterior cruciate ligament (ACL) tears. Bioengineers

and researchers have explored the dynamic function of the ACL via the foundations of

biomechanics and related topics. The cruciate ligament of interest is found inside of the knee and

can tear, also known as a grade 3 sprain, occurs when the ligament is partially or fully torn into

two (OrthoInfo, n.d.). This causes the knee to become unstable. While the ACL tears can be

partial, this is very rare and more likely to be a complete tear. Our group found ACL tears of

interest and explored peer-reviewed literature to learn more. ACL tears are explained in more

detail as well as their risk factors, long-term effects of tears, and how reconstruction may play a

role. Specifically, we were exploring the research question: What are the risk factors for an ACL

tear, long-term effects of a subject who has torn an ACL, and how does reconstruction play a

role? A deeper understanding of this topic has the potential to impact applied settings such as

coaching, physical education, physical therapy, personal health, and other professions. A

synthesis of all 15 articles is provided.

RISKS, RECONSTRUCTION AND LONG-TERM EFFECTS OF ACL TEARS

1) Ferretti, A., Monaco, E., & Vadalà, A. (2013). Rotatory instability of the knee after acl tear

and reconstruction. Journal of Orthopaedics and Traumatology, 15(2), 75-79.

doi:10.1007/s10195-013-0254-y

Source summary:

These authors suggest that although surgical techniques have advanced throughout the

years, there is still a need to further investigate the long-lasting outcomes after surgery (Ferretti

et al., 2013). Namely - there is still instability in the rotary after common surgeries. In this article

the authors describe the surgical differences between each of the different types of surgical styles

to replace and repair ACL tears. For example, they look at anatomical positioning of the original

ACL compared to the different surgical repairs done to ACLs. They try to find factors on which

is most like the original ACL and which of the following techniques are the most beneficial.

Ferretti and colleagues (2013) states, “All modern ACL techniques nowadays are good and can

get people back to their original lifestyle.” They begin by describing the original ACL and its

comparison of rotatory instability with that of a reconstructed ACL surgery. Overall, I would

say this article was very helpful in understanding the anatomy and purposes of the ACL joint and

provides a very basic insight to other ACL options in the case of an injury.
RISKS, RECONSTRUCTION AND LONG-TERM EFFECTS OF ACL TEARS

2) Hollman, J. H., Deusinger, R. H., Dillen, L. R., & Matava, M. J. (2002). Knee joint

movements in subjects without knee pathology and subjects with injured anterior cruciate

ligaments. Physical Therapy, 82(10), 960-972. doi:10.1093/ptj/82.10.960

Source summary:

The purpose of this article was to find the differences in the motions of the knee and

whether a person with one or more ACL injuries (e.g., tears) had a different motion then those

without motions (Hollman et al., 2002). For methods, the authors did multiple tests on all

subjects in the study including “weight bearing and non-weight bearing movements.” The results

of the survey were interesting as it showed that in both of the tests done the weight bearing and

non-weight bearing tests showed that the knees with injured ACLs have more gliding

movements then the knees without ACL injuries. Holloman and colleagues (2002) state, “in the

absence of increased hamstring muscle activity, anterior tibial displacement is not reduced in

knees with injured ACLs during WB movement.” This simply means that even with the ACL

injuries (e.g, tears) that the subjects would not notice long term effects in weight bearing

movements, however, there is a difference in the movements. People with ACL injuries will use

more gliding knee movements while knees without will experience more of a surface rolling

movement due to the tightness of the hamstring muscles.

RISKS, RECONSTRUCTION AND LONG-TERM EFFECTS OF ACL TEARS

3) Mardani-Kivi, M., Mobarakeh, M. K., Keyhani, S., Ebrahim-zadeh, M., & Azari, Z. (2019).

Contralateral and siblings’ knees are at higher risk of ACL tear for patients with a

positive history of ACL tear. Knee Surgery, Sports Traumatology, Arthroscopy, 28(2),

622-628. doi:10.1007/s00167-019-05781-z

Source summary:

For our 3rd article, Mardani-Kivi and associates (2019) showed us “underlying factors

that contribute to ACL tears.” This article looks to find ways to predict and prevent an ACL

injury, before it occurs by using medical history, age, and gender. In this study it is found that

women are almost 3 times as likely to rupture an ACL as men. It also finds that the younger

someone is the more likely it is to happen to them. This makes sense since younger people

usually take more risks, are more active, etc. Their study also shows that someone who has

suffered an ACL rupture is more likely to suffer another knee injury on the same or different

knee then someone who hasn't suffered an ACL rupture. Whilte this article doesn’t speak too

explicitly to the long-term effects of ACL tears, it provides a good overview of a previous injury

being a predictive factor of a future injury. Overall, we believe this information is both

interesting and useful to answer the question of what the risk factors of ACL injuries are and

predicting if it will happen again.

RISKS, RECONSTRUCTION AND LONG-TERM EFFECTS OF ACL TEARS

4) Kilcoyne, K. G., Dickens, J. F., Haniuk, E., Cameron, K. L., & Owens, B. D. (2012).

Epidemiology of meniscal injury associated with ACL tears in young athletes.

Orthopedics (Thorofare, N.J.), 35(3), 208-212. https://doi.org/10.3928/01477447-

20120222-07

Sources Summary:

The purpose of this study was to see how the meniscus of the knee affects how ACL tears

happen with young athletes that play sports. This study showed that athletes with a minor

meniscal injury would be six-teen to eighty-two percent more likely to have a particle however,

those with a major meniscal injury would be ninety-six percent more likely to have an ACL tear

at some point during their sporting career. The methods included examining ten consecutive

graduating students from the United States Military Academy from 1994-2003. New ACL tears

were diagnosed after taking a look at the students previous medical history and multiple exams.

It was stated in the article that the authors started seeing a very interesting pattern in their studys

when it came to which sex suffered these ACL injuries and which sports it happened frequently

in. The authors stated in the article that female high school soccer players were less likely to

have a meniscal injury than the male athletes who play soccer and the injury was caused without

any contact. When looking at when contact is involved the authors stated in the article that

female high school basketball players are more likely to have a meniscal injury playing

basketball that involved some type contact then a male basketball player. After looking at 10,419

cadets of the academy, 352 of them would undergo ACL reconstruction surgery and fifty-two

percent of those patients had a meniscal tear in the past. After a long look at the results, wrestling

and volleyball were the two sports that had the highest number of muscle tears, football and

soccer being the second most. It’s hard to determine if female athletes have a tendency of getting
RISKS, RECONSTRUCTION AND LONG-TERM EFFECTS OF ACL TEARS

meniscal injuries which then led to ACL reconstruction more than male athletes but this study

was a step in the right direction to find the answer because it always seems to be more common

in athletes around the world that at some point in their career they have a knee injury which

resulted in a ACL repair or reconstruction.

RISKS, RECONSTRUCTION AND LONG-TERM EFFECTS OF ACL TEARS

5) Gornitzky, A. L., Lott, A., Yellin, J. L., Fabricant, P. D., Lawrence, J. T., & Ganley, T. J.

(2016). Sport-specific yearly risk and incidence of anterior cruciate ligament tears in high

school athletes: A systematic review and meta-analysis. The American Journal of Sports

Medicine, 44(10), 2716-2723. https://doi.org/10.1177/0363546515617742

Sources Summary:

In this article the purpose was to really look at which sports and which sex is mostly

effected with ACL tears, espcially in high school where it happens pretty commonly. In the

article it states that over half of all high school student body populations play at least some type

of sport. However, when looking at ACL tears, it was stated that female athletes are the most

common sex to have a ACL surgy when playing high school sports, particularly the age of

seven-teen is where the authors sees the most ACL reconstruction happen in young women. The

authors state that the reason for most of these ACL tears happen because of young athletes

participating in year round athletic activities and training with very little rest time to heal body

from competition. The authors stated that out of ten studies that reported ACL injuries, nine

varsity sports were the most common factors which were: 1) football, 2) field hockey, 3)

basketball, 4) soccer, 5) lacrosse, 6) baseball, 7) softball, 8) wrestling, and 9) volleyball. The

methods used for this study was a series of three controlled trials which included PubMed,

EMBASE, and Cochrane Central Register. The authors stated in the article that these controlled

trials were used to find all articles reporting ACL tears at the high school level across all sports.

The author would also state that a meta analysis would be used in order to find which sport and

which sex had the most ACL injurys and incidents. When looking at the graphs at the end of

their research, the data that was collected the researchers could see that a lot of the athletes get a

lot of exposure to tearing their ACL because it sometimes four days of practice, and one game a
RISKS, RECONSTRUCTION AND LONG-TERM EFFECTS OF ACL TEARS

week with two days of rest for a ten week long season, some sports have two to three games a

week with two too three practices a week. The author stated that boys football had the most ACL

tears and girls soccer had the highest numbers of exposure to tearing their ACL in high school

athletics. We now see a shift from girls soccer being the most common sport for ACL tears to

male sports, however, female athletes are 1.6 more likely to tear their ACL due to high exposure.

It’s safe to say that anybody that plays a sport can tear their ACL at any given point in time so

being able to get a good amount of rest, reducing exposure and proper training athletes could

reduce their chance significantly.

RISKS, RECONSTRUCTION AND LONG-TERM EFFECTS OF ACL TEARS

6) Meyer, S. E., Yamato, T. P., & Saragiotto, B. T. (2017). Knee injury and ACL tear prevention

programmes (PEDro synthesis). British Journal of Sports Medicine, 51(15), 1161-1162.

https://doi.org/10.1136/bjsports-2016-097232

Source Summary:

In this particular article it talks about which programs are the best to help prevent the

tear of anybody's ACL. It’s inevitable that an ACL can’t tear just because someone does these

exercise programs but it does help reduce the chances. As stated in the article, it showed that in

almost all sports 10 to 25% of all injuries are revolved around the knee. It also talked about how

any sport that requires athletes to do a lot of jumping, cutting, pivoting are at a really high risk of

tearing their ACL then those who play sports and don’t require as much demand out of the knee.

The main focus of the study in the article was to see how neuromuscular and

proprioceptive acted in order to help prevent ACL tears and other knee injuries in athletes.

Twenty-four studies were conducted in order to see if the two programs would help reduce the

risks of ACL injuries and other knee related injuries to athletes. The methods that were used to

conduct this study was a series of finding articles from PubMed, MEDLINE/EMBASE,

CINAHL, Cochrane Central Register of Controlled Trials and Web of Science in order to find

which methods of therapy would help prevent knee injuries and ACL tears. The author would

state that incidence rate ratio where used to find the effects of each treatment. A meta-analysis

was also used for the random effect portion of the models as the author would state. The author

would also state that a meta-regression was also used in the study to help find the effects of

multiple training strategies to find the characteristics of the training strategies for the incidence

rate ratio. The last method used for this study was a simple subgroup analysis that would be used

in order to find out how many non-contact knee injuries were reported to help with their studies
RISKS, RECONSTRUCTION AND LONG-TERM EFFECTS OF ACL TEARS

as the author would state. The article stated that the first nine-teen trials of this study showed

that the neuromuscular and proprioceptive program helped reduce knee related injuries and ACL

tears by twenty-seven percent than any other knee prevention program. Although the study

mostly focused on the female athletes some male athletes took part in the study and they also had

a significant change as well as most of them would reduce their chance of getting a knee injury

or ACL tear from doing the program. It also stated in the article that athletes are more likely to

get some kind of knee injury when they are in season verus when they doing pre-season activities

only because the pre-season activities are less demanding on the athlete's knee during this time.

Finally in the article it stated that more health professional and athletic trainers should consider

doing the neuromuscular and proprioceptive program in order to help reduce the chances of

athletes getting some type of knee related injury and possibly tearing of an athletes ACL.
RISKS, RECONSTRUCTION AND LONG-TERM EFFECTS OF ACL TEARS

7) Evangelopoulos, D., Kohl, S., Schwienbacher, S., Gantenbein, B., Exadaktylos, A., & Ahmad,

S. (2015). Collagen application reduces complication rates of mid-substance ACL tears

treated with dynamic intraligamentary stabilization. Knee Surgery, Sports Traumatology,

Arthroscopy, 25(8), 2414-2419. doi: 10.1007/s00167-015-3838-7

https://link.springer.com/article/10.1007/s00167-015-3838-7

Source Analysis:

This article (Evangelopoulous et al., 2015) talks about Collagen and how it can help

complications with ACL tears that were treated with dynamic intraligamentary stabilization. This

method is typically used in acute ACL tears. This study consisted of two groups: a) 23

individuals, and b) 33 individuals. Group A was given the collagen and Group B was the control

group. Both groups had an ACL repair using the “dynamic intraligamentary stabilization using

the Ligamys™ device”. Methods included an evaluation of participants before the operation and

then they were evaluated again 24 month post operation to see if there was a change in their

mobility and range of motion. In group B 6 patients suffered a rerupture and 11 people

developed extension loss. In group A only 2 patients suffered extension loss. It was found that

the application of a collagen membrane to the surface of the ACL reduced incidence of extension

loss and re-ruptures.

RISKS, RECONSTRUCTION AND LONG-TERM EFFECTS OF ACL TEARS

8) Ng, A., Griffith, J., Hung, E., Law, K., & Yung, P. (2012). MRI diagnosis of ACL bundle

tears: value of oblique axial imaging. Skeletal Radiology, 42(2), 209-217. doi:

10.1007/s00256-012-1372-y

https://link.springer.com/article/10.1007/s00256-012-1372-y

Source Analysis:

This article investigated the accuracy of oblique axial intermediate weighting MR

imaging in diagnosing partial thickness ACL bundle tears. The study had 61 subjects all with

suspected ACL or meniscus tears between September 2009 and January 2011. The study used

two different methods to diagnose the participants: 1) standard orthogonal sequences and 2)

standard orthogonal sequences plus oblique axial intermediate weighted imaging (MRI). The

conclusion of the study was that adding the oblique axial imaging to standard MR imaging

improves the accuracy of diagnosis towards ACL partial tears and individual bundle tears.
RISKS, RECONSTRUCTION AND LONG-TERM EFFECTS OF ACL TEARS

9) Hettler, J., & Myklebust, G. (2013). Avoiding the Failed ACL: How to Prevent ACL Tears

Before They Occur. Revision ACL Reconstruction, 11-22. doi: 10.1007/978-1-4614-

0766-9_2

https://link.springer.com/chapter/10.1007/978-1-4614-0766-9_2

Source Analysis:

This article talks about ACL tears and ACL tear prevention. In the article it talks about

how some of the youngest athletes to have an ACL tear are six years old. Most ACL tears

happen during sport related activities. However, they can also happen due to traumatic injuries,

contact injuries, or even everyday movements like jumping and pivoting (non-contact injury). It

was found that female athletes are six times more likely than men to get ACL tears due to a non-

contact injury. Most studies research what happens after the ACL injury and not how to prevent

one. The method used in this study was an analysis of previous studies on ACL injury

prevention. There were seven studies in total all conducted between 1999 and 2008. The data

included 12,000 athletes. Overall, it was concluded that a prevention program can help reduce

the risk of an ACL injury by 71%. It was also found that the most effective ways to help prevent

ACL injuries are strength training, stretching, plyometrics, and sport-specific training.
RISKS, RECONSTRUCTION AND LONG-TERM EFFECTS OF ACL TEARS

10) Trigsted, S. M., Cook, D. B., Pickett, K. A., Cadmus-Bertram, L., Dunn, W. R., & Bell, D.

R. (2018). Greater fear of reinjury is related to stiffened jump-landing biomechanics and

muscle activation in women after ACL reconstruction. Knee Surgery, Sports

Traumatology, Arthroscopy, 26(12), 3682-3689.

doi:http://dx.doi.org.unco.idm.oclc.org/10.1007/s00167-018-4950-2

Source Analysis:

In this article, the authors researched the effects of ACL tears and how the fear of

reinjury affect women athletes (Trigsted et al., 2018). This article explored the connection

between the fear of reinjury and performance. The methods used in order to assess the research

question, a cross-sectional design, in which 36 women were accessed and accompanied with

complete data sets that could then be properly diagnosed. The research and data found that fear

of reinjury of the ACL impacted performance, specifically movement patterns. This study found

that one specific effect of tearing the ACL (fear of tearing it again), had direct effects on

movement patterns. Results found that movement patterns in the sagittal and transverse planes

were stiffened, while there was greater motion in the frontal plane. In conclusion, the article

states that fear of reinjury due to previous injury of the ACL lowered the peak knee, hip and

trunk flexion but in turn increased the peak hip adduction during the jump landing.
RISKS, RECONSTRUCTION AND LONG-TERM EFFECTS OF ACL TEARS

11) Sarraf, K. M., Sadri, A., Thevendran, G., & Vedi, V. (2011). Approaching the ruptured

anterior cruciate ligament. Emergency Medicine Journal : EMJ, 28(8), 644.

doi:http://dx.doi.org.unco.idm.oclc.org/10.1136/emj.2009.085522

Source Analysis:

In this article, the authors attempt to understand ACL injuries, their lasting effects, and

possible reinjury on different anatomical sections of the knee. In the beginning this article covers

the basic anatomy of the ACL and defines it as an intra-articular, extrasynovial ligament found

inside the knee joint (Sarraf et al., 2011). Additionally, the article covers the functions of the

ACL along with the mechanics of an injury to the ACL. The methods used for this research

experiment, consisted of a combination of information that was found in other research papers

that had already taken place. This specific research paper identified a total of 143 papers and

only selected 39 of them in order to tackle the original question at hand. As the article goes on it

is made clear that the main focus of the research is geared to effects after an ACL tear if a proper

diagnosis is not conducted. An ACL tear can often come along with other injuries, which can be

missed by a doctor if they are not careful and can cause lasting damage/effects on athletes. One

common effect of a missed diagnosis as stated by the article is reinjury of the ACL. In

conclusion, this article finds and presents the topic of lasting effects on athletes due to ACL tear,

to be mainly due to a missed diagnostic which can lead to more long term effects. For example,

reinjury will happen which then leads to decline in joint functioning due to a hasten of

progression of joint arthrosis.

RISKS, RECONSTRUCTION AND LONG-TERM EFFECTS OF ACL TEARS

12) Fu, F. H., Bennett, C. H., Ma, C. B., Menetrey, J., & Lattermann, C. (2000). Current Trends

in Anterior Cruciate Ligament Reconstruction: Part II. Operative Procedures and Clinical

Correlations. The American Journal of Sports Medicine, 28(1), 124–130.

https://doi.org/10.1177/03635465000280010801

Source Analysis:

When looking at the long and short term effects on an ACL injury, it is important to

understand the healing process. In this article, the authors explore the current trends of the ACL

healing process or better known as reconstruction (Fu et al., 2000). The methods of this study

consisted of looking into multiple clinical studies that assess short term and long term effects.

More specifically this article references clinical studies that have five year and seven year follow

ups in order to address the question at hand more fully. Authors discuss the biology of an injured

ACL, as well as the anatomy and strength of the specified ligament. The authors also discuss the

biomechanical reconstruction of a torn ACL. This article conducts multiple studies that are

specifically geared to different techniques of reconstruction and if the techniques are successful

in the reconstruction. Success was defined as getting the reconstruction to be similar as possible

to the ACL’s original state. In conclusion, the reconstructed areas show ability to adapt to

mechanical demands, but they never reach the structural identity of either the original tendon

tissue or the ACL.

RISKS, RECONSTRUCTION AND LONG-TERM EFFECTS OF ACL TEARS

13) Ueno R., Navacchia A., Bates N.A., Schilaty N.D., Krych A.J., & Hewett T.E. (2020).

Analysis of Internal Knee Forces Allows for the Prediction of Rupture Events in a

Clinically Relevant Model of Anterior Cruciate Ligament Injuries. Orthop J Sports Med.

8(1). doi:10.1177/2325967119893758

Summary Analysis:

This paper is a more recent publication that is trying to advance the biomechanical factors

that are used in an impact simulator to better understand ACL injuries (Ueno et al., 2020). In the

background section the authors highlight how important it is to understand risk factors for ACL

injuries and how they are likely to reoccur within two years of the first injury. They suggest that

prevention is key and should be studied more in the future. Previous work in this type of impact

simulation has used tibial shear forces, knee abduction movement, and internal tibial rotation.

These authors are attempting to better understand internal movements and forces beyond these

previously used variables in the simulation. The authors used frozen cadaveric knees in the

impact simulator using a 6-axis local recorder. The simulation was looking at drop-landing

movements. The cadaver knees were between the ages of 14 and 50, with no previous injuries or

bone issues. Using 30 cadaveric knees, they authors ran1083 trials, with 30 ACL injuries

occurring. The results suggest that there is a significant correlation between the studied

movements and the addition of internal knee factors (i.e., internal knee adduction movement and

lateral tibial force). The authors also noted that posterior tibial force declined after the ACL

injury. These results suggest that internal movements should be included in simulations to better

our understanding of ACL injuries and the understanding of movement and force changes after

an injury.
RISKS, RECONSTRUCTION AND LONG-TERM EFFECTS OF ACL TEARS

14) Hewett, T. E., Myer, G. D., Ford, K. R., Heidt Jr, R. S., Colosimo, A. J., McLean, S. G., ... &

Succop, P. (2005). Biomechanical measures of neuromuscular control and valgus loading

of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective

study. The American journal of sports medicine, 33(4), 492-501.

Summary Analysis:

This paper specially addressed a major risk factor for ACL injuries: Gender. Previous

research suggests that women are 4-6 times more likely to have an ACL tear than male athletes.

They (Hewett et al., 2004) stated that, “Most ACL injuries in female athletes occur during a

noncontact episode, typically during deceleration, lateral pivoting, or landing tasks that are often

associated with high external knee joint loads'' (p. 493). This paper used a cohort study design

utilizing a sample of 205 female athletes in the sports of soccer, basketball and volleyball

(Hewett et al., 2004). The research study was examining how knee position loading, knee joint

load, and muscular control may be a differentiator among women who do and do not have an

ACL tear. They collected data using a 3D biomechanical analysis before the season started. The

authors explored knee motions and knee loading during jump and landing tasks (i.e., a drop

vertical jump). The authors measured the movement and joint angles during the jump-landing

tasks then, later, compared these movements between participants (those who did experience an

ACL tear and those who did not). The results suggest that knee motion and knee loading during

landing are key variables that predict the ACL tears. Specifically, the authors identified dynamic

valgus and high abduction loads as risk factors. The authors provided specific measurements and

differences between the female athletes. A major takeaway from this is that female athletes

should avoid and be cautious around specific movements: excessive valgus alignment at landing,

cutting or decelerating. This paper suggests that athletes should take part in preventative
RISKS, RECONSTRUCTION AND LONG-TERM EFFECTS OF ACL TEARS

programs to reduce the risk. This paper won an award and seemed to be a pivoting point in the

biomechanical literature and understanding of why females vs. males are more likely to get an

ACL injury.
RISKS, RECONSTRUCTION AND LONG-TERM EFFECTS OF ACL TEARS

15) Pappas, E., Pappas, E., Zampeli, F., Zampeli, F., Xergia, S., Xergia, S., Georgoulis, A., &

Georgoulis, A. (2013). Lessons learned from the last 20 years of ACL-related in vivo-

biomechanics research of the knee joint. Knee Surgery, Sports Traumatology,

Arthroscopy : Official Journal of the ESSKA, 21(4), 755–766.

Summary Analysis:

This piece focuses on that general inferences that can be drawn from the advanced in

biomechanics field regarding ACL prevention, surgery, and the study of knee motion (Pappas et

al., 2013). The authors describe the biomechanical function of an ACL, and how its role in axial

rotation and knee flexing is key in various day to day activities and athletics. This is a review

paper, therefore the methods include how the authors found and selected previously published

articles. They authors (Pappas et al., 2013) stated, “A PubMed search on ‘knee biomechanics’

yielded 7,473 articles in the last 20 years (1992–2011) which represents a more than fourfold

increase in publications compared to the previous 20 years” (p. 755). The authors used the

publications impact factor and the topics of the publications as selection criteria into the study.

The results suggest that one of the biggest factors related to optimal tibial rotation, post injury, is

the success of reconstructive surgeries. Other themes that authors pointed out include that there

are specific movements related to the likelihood of tearing one’s ACL. Further, the authors

discuss common ways to collect data in studies (e.g., kinetic data via the use of force transducers,

or electromyography). The authors talk about how early biomechanical literature on ACLs

considered a deficiency in the use of quadriceps as a risk factor, but how over the years the

evidence suggests that this is not really a common risk factor. Regarding surgeries, the authors

highlight a debate across ACL biomechanics researchers surrounding the timing and safety of

exercises after an ACL tear. Across multiple studies, it seems that poor trunk control, excessive
RISKS, RECONSTRUCTION AND LONG-TERM EFFECTS OF ACL TEARS

force and leg asymmetric, and excessive knee valgus are biomechanical risk factors. Overall, this

review suggests that ACL risk factors can be focused on to prevent injury, and prevention

programs are a practical and low-cost way to prevent those injuries. Further, the lack of tibial

rotation after reconstruction predisposes people to further poor outcomes.

RISKS, RECONSTRUCTION AND LONG-TERM EFFECTS OF ACL TEARS

Synthesis

Peer-reviewed articles on ACL tears were explored by our group members. The literature

search targeted articles about 1) the risks of an ACL tear, 2) the long-term effects of an ACL

tear, and 3) how reconstruction plays a role. While this is not an exhaustive search of the

expansive body of literature on ACL risks, reconstructions, and long-term effects, it provides an

insight into the complex issues surrounding the ACL and its injuries. Major themes were derived

from the articles, with an overall theme being the concern of reinjury and the movement of an

injured knee. Below is a synthesis of articles, organized around the three main parts of our

research question.

There appears to be some consensus in the field of biomechanics and its focus on ACL

tears, risk factors, surgery and long-term effects. The field has solidified around the role the ACL

plays in movement, rotation and force (e.g., Pappas et al., 2013). However, there is still some

debate around the best surgical technique that could be generalized across all cases of ACL tears.

Most of the articles discussed an ACL in terms of its anatomical structure and other parts of the

body it can influence. There was a difference in methodological approaches across the articles.

For example, some articles used archival data sets while others used medical machinery.

Additionally, experimental intervention was varied between the studies. Some were purely

observational while others included surgical procedures on the ACL. Although all articles were

about ACLs, their primary research questions slightly varied. For example, some spoke directly

to surgery and reconstruction, while others spoke to risk factors. Overall, results suggest that

there should be individualized approaches to prevention care to mitigate risks, individualized

approaches to surgery for that person’s ACL tear, and further, an individualized approach to

long-term care and healing.

RISKS, RECONSTRUCTION AND LONG-TERM EFFECTS OF ACL TEARS

Risks

The articles that provide information about risk factors included gender and kinetic

factors. Across most of the articles, there was at least a mention of gender differences in the

likelihood of experiencing an ACL tear, even if the primary research question wasn’t about

gender differences. When it comes to specific kinetic factors, across genders, poor trunk control,

excessive force and leg asymmetric, and excessive knee valgus are biomechanical risk factors

that seem to be involved across the literature. Finally, most authors noted that once one ACL

injury occurs, another is highly likely.

Reconstructions

Reconstruction of the ACL is not always necessary after injury, but is often a part of the

healing process for ACL tears. The authors suggest that reconstructed ACLS and knees are able

to meet the mechanical demands of the knee. However, there is some debate across the authors

about the best approach to surgery. Overall, this represents a debate in the field. This represents

the complexity of what goes into an ACL tear. Across multiple authors, there seems to be some

consensus that surgery and a healing plan should be individualized to each individual person

with an ACL injury.

Long-term Effects

Lasting effects of an ACL tear can include new or different injuries in the future. Across

a handful of articles, authors suggest that once there is an injury on an ACL, there is a high

likelihood of another in the future. Importantly, correctly diagnosing the injury is critical to the

future of the ACL health and long-term health outcomes. For example, misdiagnosis could lead

to a higher likelihood of reinjury and a decline in joint functioning.

Practical Implications
RISKS, RECONSTRUCTION AND LONG-TERM EFFECTS OF ACL TEARS

The major themes across these 15 articles have the possibility to be applied across many

settings. Notably, most authors suggest an individualized prevention, survey, and healing plan.

For example, coaches should be aware of the risks and long-term effects of ACL tears to help

their athletes in a preventative fashion for their first ACL tear. Further, based on the findings of

these articles, they should also be aware of the connection between one ACL tear and the

increased risk of a future injury. Physical Therapists would need to know that a proper diagnosis

is key in understanding a healing process, and be able to have confidence in the diagnosis they

receive regarding a patient with an ACL injury. Finally, a synthesis across these articles could be

applied to personal care, in terms of knowing what the risk factors are for an ACL injury, one

could be more cautious and make logical data-based decisions in their physical health and

physical activities.
RISKS, RECONSTRUCTION AND LONG-TERM EFFECTS OF ACL TEARS

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