Anterior cruciate ligament injury - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Anterior cruciate ligament injury is typified by a sudden, painful, audible pop noise. The patient is typically unable to return to the ongoing sporting activity, and presents with joint instability, and rapid development of an effusion (hemarthrosis).
Often tender at lateral femoral condyle, lateral tibial plateau, and tibiofemoral joint lines.
A positive Lachman test is most accurate right after the injury and the pivot shift test is more useful in subacute or chronic cases.
History and physical exam usually provide an accurate diagnosis.
X-rays obtained to rule out avulsion fractures or other related conditions, but do not directly identify ACL injury. Magnetic resonance imaging delineates ACL tears, along with associated injury to the menisci and other structures.

T1-weighted MRI showing ACL tear

From the personal collection of Philip H. Cohen

Quick Reference

History & Exam
- Key Factors
- Other Factors
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Diagnostics Tests
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Treatment Options
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Definition

Epidemiology

Etiology

Pathophysiology

Images

T1-weighted MRI showing ACL tear
Lachman maneuver
Anterior and posterior drawer test starting position
Varus and valgus stability testing
T2-weighted MRI showing bone bruise, effusion, and flattening of sulcus terminalis
Pivot start
Pivot finish
External rotation recurvatum test
McMurray flexion in valgus
McMurray flexion varus
McMurray external varus
McMurray external valgus
Patellar apprehension test

Citations

Key Articles

Arundale AJH, Bizzini M, Giordano A, et al. Exercise-Based Knee and Anterior Cruciate Ligament Injury Prevention. J Orthop Sports Phys Ther. 2018 Sep;48(9):A1-A42.[Abstract][Full Text]
American Academy of Orthopaedic Surgeons. Management of anterior cruciate ligament injuries: evidence-based clinical practice guideline. Aug 2022 [internet publication].[Full Text]
Padua DA, DiStefano LJ, Hewett TE, et al. National Athletic Trainers' Association Position Statement: Prevention of Anterior Cruciate Ligament Injury. J Athl Train. 2018 Jan;53(1):5-19.[Abstract][Full Text]
van Melick N, van Cingel RE, Brooijmans F, et al. Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus. Br J Sports Med. 2016 Dec;50(24):1506-15.[Abstract][Full Text]

Referenced Articles

1. Boden BP, Dean GS, Feagin JA, et al. Mechanisms of anterior cruciate ligament injury. Orthopedics. 2000;23:573-58.[Abstract]
2. Ettlinger CF, Johnson RJ, Shealy JE. A method to help reduce the risk of serious knee sprains incurred in alpine skiing. Am J Sports Med. 1995;23:531-37.[Abstract]
3. Butler DL, Noyes FR, Grood ES. Ligamentous restraints to anterior-posterior drawer in the human knee: a biomechanical study. J Bone Joint Surg Am. 1980;62:259-70.[Abstract]
4. Noyes FR, Mooar LA, Moorman CT, et al. Partial tears of the anterior cruciate ligament: progression to complete ligament deficiency. J Bone Joint Surg Br. 1989;71:825-33.[Abstract][Full Text]
5. Hong SH, Choi JY, Lee GK, et al. Grading of anterior cruciate ligament injury: diagnostic efficacy of oblique coronal magnetic resonance imaging of the knee. J Comput Assist Tomogr. 2003;27:814-9.[Abstract]
6. Kocher MS, Mandiga R, Klingele K, et al. Anterior cruciate ligament injury versus tibial spine fracture in the skeletally immature knee: a comparison of skeletal maturation and notch width index. J Pediatr Orthop. 2004;24:185-8.[Abstract]
7. Paletta GA Jr. Special considerations: anterior cruciate ligament reconstruction in the skeletally immature. Orthop Clin North Am. 2003;34:65-77.[Abstract]
8. Accousti WK, Willis RB. Tibial eminence fractures. Orthop Clin North Am. 2003;34:365-75.[Abstract]
9. Weitzel PP, Richmond JC, Altman GH, et al. Future direction of the treatment of ACL ruptures. Orthop Clin North Am. 2002;33:653-61.[Abstract]
10. Agel J, Rockwood T, Klossner D. Collegiate ACL Injury Rates Across 15 Sports: National Collegiate Athletic Association Injury Surveillance System Data Update (2004-2005 Through 2012-2013). Clin J Sport Med. 2016 Nov;26(6):518-23.[Abstract][Full Text]
11. Hootman JM, Dick R, Agel J. Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives. J Athl Train. 2007 Apr-Jun;42(2):311-9.[Abstract][Full Text]
12. Mihata LC, Beutler AI, Boden BP. Comparing the incidence of anterior cruciate ligament injury in collegiate lacrosse, soccer, and basketball players. Am J Sports Med. 2006;34:899-904.[Abstract]
13. Agel J, Arendt EA, Bershadsky B. Anterior cruciate ligament injury in National Collegiate Athletic Association basketball and soccer: a 13 year review. Am J Sports Med. 2005;33:524-30.[Abstract]
14. Myer GD, Ford KR, Hewett TE. Methodological approaches and rationale for training to prevent anterior cruciate ligament injuries in female athletes. Scand J Med Sci Sports. 2004;14:275-85.[Abstract]
15. Giugliano DN, Solomon JL. ACL tears in female athletes. Phys Med Rehabil Clin N Am. 2007;18:417-38. [Abstract]
16. Ireland ML, Ott SM. Special concerns of the female athlete. Clin Sports Med. 2004;23:281-98.[Abstract]
17. Krosshaug T, Nakamae A, Boden BP, et al. Mechanisms of anterior cruciate ligament injury in basketball: video analysis of 39 cases. Am J Sports Med. 2007;35:359-67.[Abstract]
18. Trojian TH, Collins S. The anterior cruciate ligament tear rate varies by race in professional women's basketball. Am J Sports Med. 2006;34:895-8.[Abstract]
19. Slauterbeck JR, Hickox JR, Beynnon B, et al. Anterior cruciate ligament biology and its relationship to injury forces. Orthop Clin North Am. 2006;37:585-91.[Abstract]
20. Fleming BC, Renstrom PA, Beynnon BD, et al. The effect of weightbearing and external loading on anterior cruciate ligament strain. J Biomech. 2001;34:163-70.[Abstract]
21. Crain EH, Fithian DC, Paxton EW, et al. Variation in anterior cruciate ligament scar pattern: does the scar pattern affect anterior laxity in anterior cruciate ligament-deficient knees? Arthroscopy. 2005;21:19-24.[Abstract]
22. Warren RF, Marshall JL. Injuries of the anterior cruciate and medial collateral ligaments of the knee. A retrospective analysis of clinical records - part I. Clin Orthop Relat Res. 1978;136:191-7.[Abstract]
23. Fauno P, Wulff Jakobsen B. Mechanism of anterior cruciate ligament injuries in soccer. Int J Sports Med. 2006;27:75-9.[Abstract]
24. Griffin LY, Agel J, Albohm MJ, et al. Noncontact anterior cruciate ligament injuries: risk factors and prevention strategies. J Am Acad Orthop Surg. 2000;8:141-50.[Abstract]
25. Yu B, Garrett WE. Mechanisms of non-contact ACL injuries. Br J Sports Med. 2007;41(suppl 1):i47-i51.[Abstract]
26. Hewett TE, Myer GD, Ford KR. Anterior cruciate ligament injuries in female athletes: Part 1, mechanisms and risk factors. Am J Sports Med. 2006;34:299-311.[Abstract]
27. Hewett TE, Zazulak BT, Myer GD, et al. A review of electromyographic activation levels, timing differences, and increased anterior cruciate ligament injury incidence in female athletes. Br J Sports Med. 2005;39:347-50.[Abstract][Full Text]
28. Faude O, Junge A, Kindermann W, et al. Risk factors for injuries in elite female soccer players. Br J Sports Med. 2006;40:785-90.[Abstract][Full Text]
29. McConkey JP. Anterior cruciate ligament rupture in skiing: a new mechanism of injury. Am J Sports Med. 1986;14:160-4.[Abstract]
30. Giza E, Mithofer K, Farrell L, et al. Injuries in women's professional soccer. Br J Sports Med. 2005;39:212-6.[Abstract][Full Text]
31. Pope RP. Injury surveillance and systematic investigation identify a rubber matting hazard for anterior cruciate ligament rupture on an obstacle course. Mil Med. 2002;167:359-62.[Abstract]
32. Orchard JW, Chivers I, Aldous D, et al. Rye grass is associated with fewer non-contact anterior cruciate ligament injuries than bermuda grass. Br J Sports Med. 2005;39:704-9.[Abstract][Full Text]
33. Orchard J, Seward H, McGivern J, et al. Rainfall, evaporation and the risk of non-contact anterior cruciate ligament injury in the Australian Football League. Med J Australia. 1999;170:304-6.[Abstract]
34. Orchard J. Is there a relationship between ground and climatic conditions and injuries in football? Sports Med. 2002;32:419-32.[Abstract]
35. Orchard J, Seward H, McGivern J, Hood S. Intrinsic and extrinsic risk factors for anterior cruciate ligament injury in Australian footballers. Am J Sports Med. 2001;29:196-200.[Abstract]
36. Chappell JD, Herman DC, Knight BS, et al. Effect of fatigue on knee kinetics and kinematics in stop-jump tasks. Am J Sports Med. 2005;33:1022-9.[Abstract]
37. McLean SG, Felin RE, Suedekum N, et al. Impact of fatigue on gender-based high-risk landing strategies. Med Sci Sports Exerc. 2007;39:502-14.[Abstract]
38. Koyanagi M, Shino K, Yoshimoto Y, et al. Effects of changes in skiing posture on the kinetics of the knee joint. Knee Surg Sports Traumatol Arthrosc. 2006;14:88-93.[Abstract]
39. Giza E, Micheli LJ. Soccer injuries. Med Sport Sci. 2005;49:140-69.[Abstract]
40. Yoo JH, Lim BO, Ha M, et al. A meta-analysis of the effect of neuromuscular training on the prevention of the anterior cruciate ligament injury in female athletes. Knee Surg Sports Traumatol Arthrosc. 2010;18:824-30.[Abstract]
41. Arundale AJH, Bizzini M, Giordano A, et al. Exercise-Based Knee and Anterior Cruciate Ligament Injury Prevention. J Orthop Sports Phys Ther. 2018 Sep;48(9):A1-A42.[Abstract][Full Text]
42. American Academy of Orthopaedic Surgeons. Management of anterior cruciate ligament injuries: evidence-based clinical practice guideline. Aug 2022 [internet publication].[Full Text]
43. Sadoghi P, von Keudell A, Vavken P. Effectiveness of anterior cruciate ligament injury prevention training programs. J Bone Joint Surg Am. 2012;94:769-76.[Abstract]
44. Padua DA, DiStefano LJ, Hewett TE, et al. National Athletic Trainers' Association Position Statement: Prevention of Anterior Cruciate Ligament Injury. J Athl Train. 2018 Jan;53(1):5-19.[Abstract][Full Text]
45. Shelbourne KD, Rowdon GA. Anterior cruciate ligament injury: the competitive athlete. Sports Med. 1994;17:132-40.[Abstract]
46. Maffulli N, Binfield PM, King JB, et al. Acute haemarthrosis of the knee in athletes: a prospective study of 106 cases. J Bone Joint Surg Br. 1993;75:945-9.[Abstract][Full Text]
47. Ostrowski JA. Accuracy of 3 diagnostic tests for anterior cruciate ligament tears. J Athl Train. 2006;41:120-1.[Abstract][Full Text]
48. Benjaminse A, Gokeler A, van der Schans CP. Clinical diagnosis of an anterior cruciate ligament rupture: a meta-analysis. J Orthop Sports Phys Ther. 2006;36:267-88.[Abstract]
49. Solomon DH, Simel DL, Bates DW, et al. The rational clinical examination. Does this patient have a torn meniscus or ligament of the knee? Value of the physical examination. JAMA. 2001;286:1610-20.[Abstract]
50. Kocher MS, Steadman JR, Briggs KK, et al. Relationships between objective assessment of ligament stability and subjective assessment of symptoms and function after anterior cruciate ligament reconstruction. Am J Sports Med. 2004;32:629-34.[Abstract]
51. Stiell IG, Wells GA, McDowell I, et al. Use of radiography in acute knee injuries: need for clinical decision rules. Acad Emerg Med. 1995 Nov;2(11):966-73.[Abstract][Full Text]
52. Expert Panel on Musculoskeletal Imaging, Taljanovic MS, Chang EY, et al. ACR appropriateness criteria® acute trauma to the knee. J Am Coll Radiol. 2020 May;17(5s):S12-S25.[Abstract][Full Text]
53. Davis DS, Post WR. Segond fracture: lateral capsular ligament avulsion. J Orthop Sports Phys Ther. 1997;25:103-6.[Abstract]
54. Thomas S, Pullagura M, Robinson E, et al. The value of magnetic resonance imaging in our current management of ACL and meniscal injuries. Knee Surg Sports Traumatol Arthrosc. 2007;15:533-6.[Abstract]
55. Bining J, Andrews G, Forster BB. The ABCs of the anterior cruciate ligament: a primer for magnetic resonance imaging assessment of the normal, injured and surgically repaired anterior cruciate ligament. Br J Sports Med. 2009;43:856-62.[Abstract]
56. Chang CB, Seong SC, Kim TK. Preoperative magnetic resonance assessment of patellar tendon dimensions for graft selection in anterior cruciate ligament reconstruction. Am J Sports Med. 2009;37:376-82.[Abstract]
57. Shea MA, Coppola GW. Knee pain, swelling and instability. Phys Sportsmed. 2003;31:31-3.
58. Emparanza JI, Aginaga JR. Validation of the Ottawa knee rules. Ann Emerg Med. 2001;38:364-8.[Abstract]
59. Ballmer PM, Jakob RP. The non operative treatment of isolated complete tears of the medial collateral ligament of the knee: a prospective study. Arch Orthop Trauma Surg. 1988;107:273-6.[Abstract]
60. St Pierre P, Miller MD. Posterior cruciate ligament injuries. Clin Sports Med. 1999;18:199-221.[Abstract]
61. Quarles JD, Hosey RG. Medial and lateral collateral injuries: prognosis and treatment. Prim Care. 2004;31:957-75.[Abstract]
62. Fowler PJ, Lubliner JA. The predictive value of five clinical signs in the evaluation of meniscal pathology. Arthroscopy. 1989;5:184-6.[Abstract]
63. Karachalios T, Hantes M, Zibis AH, et al. Diagnostic accuracy of a new clinical test (the Thessaly test) for early detection of meniscal tears. J Bone Joint Surg Am. 2005;87:955-62.[Abstract]
64. Fox MG. MR imaging of the meniscus: review, current trends, and clinical implications. Magn Reson Imaging Clin N Am. 2007;15:103-23.[Abstract]
65. Sims WF, Jacobson KE. The posteromedial corner of the knee: medial-sided injury patterns revisited. Am J Sports Med. 2004;32:337-45.[Abstract]
66. Boden BP, Pearsall AW, Garrett WE Jr, et al. Patellofemoral instability: evaluation and management. J Am Acad Orthop Surg. 1997;5:47-57.[Abstract]
67. Elias DA, White LM. Imaging of patellofemoral disorders. Clin Radiol. 2004;59:543-57.[Abstract]
68. Failla MJ, Arundale AJ, Logerstedt DS, et al. Controversies in knee rehabilitation: anterior cruciate ligament injury. Clin Sports Med. 2015;34:301-12.[Abstract]
69. Saka T. Principles of postoperative anterior cruciate ligament rehabilitation. World J Orthop. 2014;5:450-9.[Abstract]
70. Strehl A, Eggli S. The value of conservative treatment in ruptures of the anterior cruciate ligament (ACL). J Trauma. 2007;62:1159-62.[Abstract]
71. Beynnon BD, Johnson RJ, Abate JA, et al. Treatment of anterior cruciate ligament injuries, part I. Am J Sports Med. 2005;33:1579-602.[Abstract]
72. Frobell RB, Roos EM, Roos HP, et al. A randomized trial of treatment for acute anterior cruciate ligament tears. N Engl J Med. 2010;363:331-42. [Erratum in: N Engl J Med. 2010;363:893.][Abstract][Full Text]
73. Frobell RB, Roos HP, Roos EM, et al. Treatment for acute anterior cruciate ligament tear: five year outcome of randomised trial. BMJ. 2013;346:f232.[Abstract][Full Text]
74. Monk AP, Davies LJ, Hopewell S, et al. Surgical versus conservative interventions for treating anterior cruciate ligament injuries. Cochrane Database Syst Rev. 2016 Apr 3;4:CD011166.[Abstract][Full Text]
75. Legnani C, Terzaghi C, Borgo E, et al. Management of anterior cruciate ligament rupture in patients aged 40 years and older. J Orthop Traumatol. 2011;12:177-84.[Abstract][Full Text]
76. Andersson D, Samuelsson K, Karlsson J. Treatment of anterior cruciate ligament injuries with special reference to surgical technique and rehabilitation: an assessment of randomized controlled trials. Arthroscopy. 2009;25:653-85.[Abstract]
77. Mohtadi NG, Chan DS, Dainty KN, et al. Patellar tendon versus hamstring tendon autograft for anterior cruciate ligament rupture in adults. Cochrane Database Syst Rev. 2011;(9):CD005960.[Abstract]
78. Webster KE, Feller JA, Hartnett N, et al. Comparison of patellar tendon and hamstring tendon anterior cruciate ligament reconstruction: a 15-year follow-up of a randomized controlled trial. Am J Sports Med. 2016;44:83-90.[Abstract]
79. Mohtadi N, Chan D, Barber R, et al. A randomized clinical trial comparing patellar tendon, hamstring tendon, and double-bundle ACL reconstructions: patient-reported and clinical outcomes at a minimal 2-year follow-up. Clin J Sports Med. 2015;25:321-31.[Abstract][Full Text]
80. Lubowitz JH, Elson WS, Guttmann D. Part II: arthroscopic treatment of tibial plateau fractures: intercondylar eminence avulsion fractures. Arthroscopy. 2005;21:86-92.[Abstract]
81. Hiemstra LA, Veale K, Sasyniuk T. Knee immobilization in the immediate post-operative period following ACL reconstruction. Clin J Sport Med. 2006;16:199-202.[Abstract]
82. Harilainen A, Sandelin J. Post-operative use of knee brace in bone-tendon-bone patellar tendon anterior cruciate ligament reconstruction: 5-year follow-up results of a randomized prospective study. Scand J Med Sci Sports. 2006;16:14-8.[Abstract]
83. Shelbourne KD, Klotz C. What I have learned about the ACL: utilizing a progressive rehabilitation scheme to achieve total knee symmetry after anterior cruciate ligament reconstruction. J Orthop Sci. 2006;11:318-25.[Abstract]
84. Daniel DM, Stone ML, Dobson BE, et al. Fate of the ACL-injured patient: a prospective outcome study. Am J Sports Med. 1994;22:632-44.[Abstract]
85. Shelbourne KD, Gray T. Anterior cruciate ligament reconstruction with autogenous patellar tendon graft followed by accelerated rehabilitation: a two to nine year follow-up. Am J Sports Med. 1997;25:786-95.[Abstract]
86. Roi GS, Creta D, Nanni G, et al. Return to official Italian First Division soccer games within 90 days after anterior cruciate ligament reconstruction: a case report. J Orthop Sports Phys Ther. 2005;35:52-61.[Abstract]
87. Kvist J. Rehabilitation following anterior cruciate ligament injury: current recommendations for sports participation. Sports Med. 2004;34:269-80.[Abstract]
88. Gobbi A, Francisco R. Factors affecting return to sports after anterior cruciate ligament reconstruction with patellar tendon and hamstring graft: a prospective clinical investigation. Knee Surg Sports Traumatol Arthrosc. 2006;14:1021-8.[Abstract]
89. van Melick N, van Cingel RE, Brooijmans F, et al. Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus. Br J Sports Med. 2016 Dec;50(24):1506-15.[Abstract][Full Text]
90. Ardern CL, Webster KE, Taylor NF, et al. Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med. 2011;45:596-606.[Abstract]
91. Salmon L, Russell V, Musgrove T, et al. Incidence and risk factors for graft rupture and contralateral rupture after anterior cruciate ligament reconstruction. Arthroscopy. 2005;21:948-57.[Abstract]
92. Murray MM, Spindler KP, Devin C, et al. Use of a collagen-platelet rich plasma scaffold to stimulate healing of a central defect in the canine ACL. J Orthop Res. 2006;24:820-30.[Abstract]
93. Vavken P, Sadoghi P, Murray MM. The effect of platelet concentrates on graft maturation and graft-bone interface healing in anterior cruciate ligament reconstruction in human patients: a systematic review of controlled trials. Arthroscopy. 2011;27:1573-83.[Abstract][Full Text]
94. Moraes VY, Lenza M, Tamaoki MJ, et al. Platelet-rich therapies for musculoskeletal soft tissue injuries. Cochrane Database Syst Rev. 2014;(4):CD010071.[Abstract][Full Text]
95. Meaney Murray M, Rice K, Wright RJ, et al. The effect of selected growth factors on human anterior cruciate ligament cell interactions with a three-dimensional collagen-GAG scaffold. J Orthop Res. 2003;21:238-44.[Abstract]
96. Murray MM, Bennett R, Zhang X, et al. Cell outgrowth from the human ACL in vitro: regional variation and response to TGF-beta1. J Orthop Res. 2002;20:875-80.[Abstract]
97. Kondo E, Yasuda K, Yamanaka M, et al. Effects of administration of exogenous growth factors on biomechanical properties of the elongation-type anterior cruciate ligament injury with partial laceration. Am J Sports Med. 2005;33:188-96.[Abstract]
98. Murray MM, Fleming BC, Badger GJ, et al. Bridge-Enhanced Anterior Cruciate Ligament Repair Is Not Inferior to Autograft Anterior Cruciate Ligament Reconstruction at 2 Years: Results of a Prospective Randomized Clinical Trial. Am J Sports Med. 2020 May;48(6):1305-15.[Abstract][Full Text]
99. DiFelice GS, Villegas C, Taylor S. Anterior cruciate ligament preservation: early results of a novel arthroscopic technique for suture anchor primary anterior cruciate ligament repair. Arthroscopy. 2015;31:2162-71.[Abstract]
100. Karaaslan F, Karaoğlu S, Yurdakul E. Reducing intra-articular hemarthrosis after arthroscopic anterior cruciate ligament reconstruction by the administration of intravenous tranexamic acid: a prospective, randomized controlled trial. Am J Sports Med. 2015;43:2720-6.[Abstract]
101. National Institute for Health and Care Excellence. LARS for reconstructing damaged intra-articular cruciate knee ligaments. May 2015 [internet publication].[Abstract][Full Text]
102. Ardern CL, Ekås GR, Grindem H, et al. 2018 International Olympic Committee consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries. Br J Sports Med. 2018 Apr;52(7):422-38.[Abstract][Full Text]
103. Hawkins RJ, Misamore GW, Merritt TR. Followup of the acute nonoperated isolated anterior cruciate ligament tear. Am J Sports Med. 1986;14:205-10.[Abstract]
104. Keene GC, Bickerstaff D, Rae PJ, et al. The natural history of meniscal tears in anterior cruciate ligament insufficiency. Am J Sports Med. 1993;21:672-79.[Abstract]
105. Bellabarba C, Bush-Joseph CA, Bach BR Jr. Patterns of meniscal injury in the anterior cruciate-deficient knee: a review of the literature. Am J Orthop. 1997;26:18-23.[Abstract]
106. Paul JJ, Spindler KP, Andrish JT, et al. Jumping versus nonjumping anterior cruciate ligament injuries: a comparison of pathology. Clin J Sport Med. 2003;13:1-5.[Abstract]
107. Millett PJ, Willis AA, Warren RF. Associated injuries in pediatric and adolescent anterior cruciate ligament tears: does a delay in treatment increase the risk of meniscal tear? Arthroscopy. 2002;18:955-9.[Abstract]
108. Mandalia V, Fogg AJ, Chari R, et al. Bone bruising of the knee. Clin Radiol. 2005;60:627-36.[Abstract]
109. Shelbourne KD, Haro MS, Gray T. Knee dislocation with lateral side injury: results of an en masse surgical repair technique of the lateral side. Am J Sports Med. 2007;35:1105-16.[Abstract]
110. Brophy RH, Zeltser D, Wright RW, et al. Anterior cruciate ligament reconstruction and concomitant articular cartilage injury: incidence and treatment. Arthroscopy. 2010;26:112-20.[Abstract]
111. Bowers AL, Spindler KP, McCarty EC, et al. Height, weight, and BMI predict intra-articular injuries observed during ACL reconstruction: evaluation of 456 cases from a prospective ACL database. Clin J Sport Med. 2005;15:9-13.[Abstract]
112. Williams GN, Buchanan TS, Barrance PJ, et al. Quadriceps weakness, atrophy, and activation failure in predicted non-copers after anterior cruciate ligament injury. Am J Sports Med. 2005;33:402-7.[Abstract]
113. Murakami H, Shinomiya N, Kikuchi T, et al. Upregulated expression of inducible nitric oxide synthase plays a key role in early apoptosis after anterior cruciate ligament injury. J Orthop Res. 2006;24:1521-34.[Abstract]
114. Tiderius CJ, Olsson LE, Nyquist F, et al. Cartilage glycosaminoglycan loss in the acute phase after an anterior cruciate ligament injury: delayed gadolinium-enhanced magnetic resonance imaging of cartilage and synovial fluid analysis. Arthritis Rheum. 2005;52:120-7.[Abstract][Full Text]
115. Silvers HJ, Mandelbaum BR. Prevention of anterior cruciate ligament injury in the female athlete. Br J Sports Med. 2007;41(suppl 1):i52-9.[Abstract]
116. Hewett TE, Ford KR, Myer GD. Anterior cruciate ligament injuries in female athletes: Part 2, a meta-analysis of neuromuscular interventions aimed at injury prevention. Am J Sports Med. 2006;34:490-8.[Abstract]
117. Stevenson JH, Beattie CS, Schwartz JB, et al. Assessing the effectiveness of neuromuscular training programs in reducing the incidence of anterior cruciate ligament injuries in female athletes: a systematic review. Am J Sports Med. 2015;43:482-90.[Abstract]
118. Grindstaff TL, Hammill RR, Tuzson AE, et al. Neuromuscular control training programs and noncontact anterior cruciate ligament injury rates in female athletes: a numbers-needed-to-treat analysis. J Athl Train. 2006;41:450-6.[Abstract][Full Text]
119. Wright RW, Fetzer GB. Bracing after ACL reconstruction: a systematic review. Clin Orthop Rel Res. 2007;455:162-8.[Abstract]
120. Najibi S, Albright JP. The use of knee braces, part 1: prophylactic knee braces in contact sports. Am J Sports Med. 2005;33:602-11.[Abstract]