From the Guidelines
For individuals with a family history of ACL tears, a comprehensive prevention approach is recommended, focusing on neuromuscular training programs and proper technique. These individuals should engage in regular preventive exercises including plyometrics, balance training, and strength training with particular emphasis on hamstring and quadriceps development, as suggested by the American Academy of Orthopaedic Surgeons clinical practice guideline summary 1. A structured program like the FIFA 11+ or PEP (Prevent Injury and Enhance Performance) should be performed 2-3 times weekly, especially during pre-season and throughout the competitive season. Proper landing mechanics should be emphasized, teaching athletes to land with knees bent and aligned over the toes. Regular screening for biomechanical risk factors is advised, with correction of issues like dynamic knee valgus through targeted exercises.
Some key points to consider in the management and prevention of ACL tears in individuals with a family history include:
- Appropriate footwear selection and playing surface awareness can reduce risk, while adequate warm-up routines and avoiding fatigue-related training are essential 1.
- If minor ACL injuries occur, prompt RICE (Rest, Ice, Compression, Elevation) treatment and professional evaluation are recommended before returning to activity.
- Rehabilitation after ACL reconstruction should focus on exercise interventions as the mainstay of treatment, with physical therapy modalities used as an adjunct in the early phase of rehabilitation, as outlined in the Aspetar clinical practice guideline on rehabilitation after anterior cruciate ligament reconstruction 1.
- Return to running and return to training/activity are key milestones for rehabilitation after ACLR, although there is no evidence on which progression or discharge criteria should be used 1.
Overall, a comprehensive approach to prevention and management of ACL tears in individuals with a family history is crucial to reduce the risk of injury and optimize outcomes, as supported by the latest clinical practice guidelines 1.
From the Research
Management of ACL Tears
- The management of Anterior Cruciate Ligament (ACL) tears in individuals with a family history of ACL tears involves a combination of conservative management and surgical intervention 2, 3, 4, 5, 6.
- Conservative management includes progressive physical therapy, educating the patient on how to prevent instability, and the use of a hinged knee brace 3.
- Surgical management involves reconstruction of the torn ligament using an autograft or an allograft and ACL repair where the torn ligament is affixed back to the tibia or femur 3.
Prevention of ACL Tears
- Primary prevention of ACL injury includes specific proprioceptive and neuromuscular training exercises to improve knee stability 2.
- Neuromuscular training can reduce the risk of ACL injury in adolescent girls 6.
- Intrinsic risk factors for ACL injury include higher BMI, subtalar joint overpronation, generalized ligamentous laxity, and decreased neuromuscular control of knee motion 6.
Diagnosis of ACL Tears
- The diagnosis of ACL tears is made with a combination of patient's history, clinical examination, and, if appropriate, magnetic resonance imaging 2, 4, 5, 6.
- The Lachman test is the most accurate test for detecting an ACL tear 2.
- Magnetic resonance imaging is the primary study used to diagnose ACL injury in the United States and can also identify concomitant meniscal injury, collateral ligament tear, and bone contusions 2.
Treatment Outcomes
- The choice of management depends on the severity of the injury, other injuries in associated structures, the level of fitness, and the athletic goals of the patient 3, 4, 5.
- Patients who undergo surgery must commit to appropriate rehabilitation for the best outcome 2.
- Long-term sequelae of ACL injury include knee osteoarthritis in up to 90 percent of patients 2.