Anterior Cruciate Ligament Syndrome




Abstract


Anterior cruciate ligament syndrome is characterized by pain in the anterior aspect of the knee joint. It is usually the result of trauma to the anterior cruciate ligament from sudden deceleration secondary to planting of the affected lower extremity while extreme twisting or hyperextension forces are placed on the knee, typically during snow skiing accidents, football, and basketball injuries. Unlike many other painful knee syndromes, anterior cruciate ligament syndrome occurs significantly more frequently in female patients. Patients with anterior cruciate ligament syndrome present with pain over the anterior knee joint and increased pain on passive valgus stress and range of motion of the knee. Activity makes the pain worse, whereas rest and heat provide some relief. The pain is constant and is characterized as aching; it may interfere with sleep. Patients with injury to the anterior cruciate ligament may complain of a sudden popping of the affected knee at the time of acute injury, as well as a sensation that the knee wants to give way or slip backward. Coexistent bursitis, tendinitis, arthritis, or internal derangement of the knee may confuse the clinical picture after trauma to the knee joint. The menisci of the knee are often injured when the patient sustains knee trauma severe enough to disrupt the anterior cruciate ligament.




Keywords

anterior cruciate ligament syndrome, anterior cruciate ligament, anterior cruciate ligament tear, anterior cruciate ligament strain, magnetic resonance imaging, knee pain, sports injury, skiing injury, Lachman test, flexion-rotation drawer test

 


ICD-10 CODE S83.509A




Keywords

anterior cruciate ligament syndrome, anterior cruciate ligament, anterior cruciate ligament tear, anterior cruciate ligament strain, magnetic resonance imaging, knee pain, sports injury, skiing injury, Lachman test, flexion-rotation drawer test

 


ICD-10 CODE S83.509A




The Clinical Syndrome


Anterior cruciate ligament syndrome is characterized by pain in the anterior aspect of the knee joint. It is usually the result of trauma to the anterior cruciate ligament from sudden deceleration secondary to planting of the affected lower extremity while extreme twisting or hyperextension forces are placed on the knee, typically during snow skiing accidents, football, and basketball injuries ( Fig. 109.1 ). Unlike many other painful knee syndromes, anterior cruciate ligament syndrome occurs significantly more frequently in female patients.




FIG 109.1


Patients with anterior cruciate ligament syndrome present with anterior knee pain and pain that increases with valgus stress applied to the knee.


The anterior cruciate ligament controls the amount of anterior movement or translation of the tibia relative to the femur, as well as providing important proprioceptive information regarding the position of the knee. This ligament is made up of dense fibroelastic fibers that run from the posteromedial surface of the lateral condyle of the distal femur through the intercondylar notch to the anterior surface of the tibia ( Fig. 109.2 ). The anterior cruciate ligament is innervated by the posterior branch of the posterior tibial nerve. The ligament is susceptible to sprain or partial or complete tear.




FIG 109.2


Normal magnetic resonance imaging anatomy of the cruciate ligaments. A, Sagittal fast spin-echo proton density (FSE PD)–weighted image shows streaky areas of isointense signal within a normal anterior cruciate ligament (ACL). Note the straight anterior border of the ACL (arrow), which is parallel to Blumensaat’s line. B, Sagittal fat-saturated FSE PD–weighted image shows the dark signal intensity of the posterior cruciate ligament (PCL), which has a posterior convex configuration (arrows). C and D, Contiguous coronal fat-saturated FSE PD–weighted images of a normal ACL and PCL. Note the dark signal intensity of the PCL (arrowhead) and relatively high signal intensity of the ACL near its tibial insertion. The anteromedial and posterolateral bundles of the ACL are visualized (arrows).

(From Kam CK, Chee DW, Peh WC. Magnetic resonance imaging of cruciate ligament injuries of the knee. Can Assoc Radiol J. 2010;61(2):80–89.)




Signs and Symptoms


Patients with anterior cruciate ligament syndrome present with pain over the anterior knee joint and increased pain on passive valgus stress and range of motion of the knee. Activity makes the pain worse, whereas rest and heat provide some relief. The pain is constant and is characterized as aching; it may interfere with sleep. Patients with injury to the anterior cruciate ligament may complain of a sudden popping of the affected knee at the time of acute injury, as well as a sensation that the knee wants to give way or slip backward. Coexistent bursitis, tendinitis, arthritis, or internal derangement of the knee may confuse the clinical picture after trauma to the knee joint. The menisci of the knee are often injured when the patient sustains knee trauma severe enough to disrupt the anterior cruciate ligament.


On physical examination, patients with injury to the anterior cruciate ligament exhibit tenderness to palpation of the anterior knee. If the ligament is avulsed from its bony insertions, tenderness may be localized to the site of insertion, whereas patients suffering from strain of the ligament have more diffuse tenderness. Patients with severe injury to the ligament may exhibit joint laxity when anterior stress is placed on the affected knee. This maneuver is best accomplished by performing an anterior drawer test for anterior cruciate ligament integrity ( Fig. 109.3 ). Other tests to assess the integrity of the anterior cruciate ligament include the flexion-rotation anterior drawer test and the Lachman test.


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Sep 9, 2019 | Posted by in PAIN MEDICINE | Comments Off on Anterior Cruciate Ligament Syndrome

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