From the Guidelines
Individuals with a genetic predisposition to ACL tears should prioritize comprehensive prevention strategies, including neuromuscular training programs and strengthening exercises, and if an ACL tear occurs, treatment options should be tailored to the individual's needs, with surgical reconstruction typically recommended for younger, active individuals and those with complete tears, as supported by the most recent study 1.
Prevention Strategies
- Neuromuscular training programs to improve proprioception and joint stability
- Strengthening exercises targeting the quadriceps, hamstrings, and hip muscles
- Prevention programs like the FIFA 11+ or PEP (Prevent Injury and Enhance Performance) performed 2-3 times weekly
Treatment Options
- Surgical reconstruction using autografts (patellar tendon or hamstring tendons) or allografts for younger, active individuals and those with complete tears
- Non-surgical management focusing on physical therapy to restore strength and stability for less active individuals or those with partial tears
Post-Treatment Rehabilitation
- Typically lasting 6-9 months with progressive strengthening, range of motion exercises, and sport-specific training before return to activity
- Rehabilitation protocol should be based on progression criteria, with time since surgery considered necessary but not sufficient for progression unless coupled with objective physical and psychological criteria, as recommended by 1
Key Considerations
- Genetic component affects collagen composition and hormone receptors, influencing tissue strength and healing capacity
- Consistent prevention efforts are particularly important for individuals with a genetic predisposition to ACL tears
- Early screening with family history assessment and potentially genetic testing can identify those needing more intensive prevention efforts, as suggested by 1
From the Research
Prevention and Treatment Options for ACL Tears
- Prevention of ACL tears in individuals with a genetic disposition to ACL injuries is crucial, as having a family history of ACL injury increases the odds of injury across all outcomes 2.
- Studies have shown that familial predisposition to ACL injury is a significant risk factor, with those having a family history of ACL injury having a 2.5 times greater odds for sustaining a primary ACL injury 2.
- Anatomic and neuromuscular risk factors, such as female sex and specific measures of bony geometry of the knee joint, also contribute to the increased risk of ACL injury 3, 4.
- Treatment options for ACL tears include ACL reconstruction using autografts, such as patellar tendon or hamstring tendon autografts 5, 6.
- The selection of graft, surgical technique, and rehabilitation program can affect the severity of pain that patients experience after ACL reconstruction 5.
- Hamstring tendon autografts appear to cause less postoperative donor-site morbidity and anterior knee problems than patellar tendon autografts 5.
Rehabilitation and Recovery
- Rehabilitation programs should aim to regain full range of motion and strength after ACL reconstruction to avoid future anterior knee problems 5.
- Varying knee joint angles and effort levels for graft site rehabilitation may need to be considered to target specific regions of the patellar tendon 6.
- Accelerating quadriceps strengthening to enhance strain distribution across the patellar tendon may be beneficial for optimizing postsurgery rehabilitation 6.
Genetic Disposition and Risk Factors
- Having a family history of ACL injury increases the odds of subsequent ACL injury, including graft ruptures and contralateral ACL injuries 2.
- The odds of sustaining a primary ACL injury are similar for males and females with a family history of ACL injury 2.
- Anatomic and neuromuscular risk factors, such as female sex and specific measures of bony geometry of the knee joint, contribute to the increased risk of ACL injury 3, 4.