Page 14 - Demo

Chapter 112The course of the ACL makes it susceptible to injuries from activities that combine a valgus force with internal rotation of the tibia with respect to the femur. This most commonly occurs with external rotation of the trunk and femur when the foot is firmly planted, for instance during pivoting movements in sports like soccer, handball and basketball.1 Most ACL ruptures are caused by non-contact injuries.1 The incidence of ACL injuries is estimated at 81:100,000.1,9 In recent years the epidemiology of ACL injuries has shifted from traditionally the adolescent population to a higher incidence in the paediatric population, and from a predominantly male group to more female athletes. The highest increase in ACL injuries was seen in girls aged 13-15, at 143%.34Due to parental and social pressure to perform well, children are encouraged to expose themselves to high-intensity training at a prepubertal age. Heightened exposure to pivoting sports enhances the risk of ACL injury. Also, the increased popularity of female football has boosted female participation in that sport. Unfortunately, female sex is associated with increased risk of ACL injury in pivoting sports.1,29All in all, ACL injuries are expected to increase over the coming years; this is already reflected in a rising incidence of ACL reconstructions among adolescents over the past decade.14ACL Reconstruction: A Brief HistorySpontaneous healing of the ACL without surgical treatment is unlikely to occur. The presence of synovial fluid in the knee joint inhibits the formation of a provisional bridge between the two stumps after ACL rupture and thus primary healing is counteracted.8,20 In addition, gravity causes the distal end to descend towards the posterior cruciate ligament, which again is unfavourable for primary healing. Still, a tear of the ACL is not always a reason for surgery. Some patients can manage well in the presence of ACL deficiency. Surgical treatment is indicated if instability of the knee persists despite conservative treatment.19In the early 20th century, repair of the ACL was first described using catgut sutures. In 1903, Mayo-Robson was the first to publish satisfying shortMark Zee.indd 12 03-01-2024 08:55