OPERATIVE TREATMENT OF ANTERIOR CRUCIAL LIGAMENT RUPTURE - INDICATIONS, METHODS, TIME OF INTERVENTION AND REHABILITATION

The indication for operative or conservative treatment of the anterior cruciate ligament remains still difficult. Many years of intensive ba sic and clinical research and a better knowledge of biology, biomechan ics and pathology have not been achieved standards of therapy. Therefo re varying treatment options exist. In this paper we give an overview on the main indications and common treatments. Untreated ruptures of t he ACL result in severe functional impairment. Therefore we find a wid e indication for an operative reconstruction. Patient orientated facto rs (age, activity level, morphotype) and the range of instability are important for the decision-making between operative and conservative t reatment. The time of intervention is determined by the chosen treatme nt. Multidirectional instabilities, ruptures of meniscus or damage of cartilage need an early, isolated injuries of the ACL an early or late r (until 4 weeks) surgical therapy. An anatomical ligament reconstruct ion (so called suture'') is possible only for selected ruptures near t he femoral insertion. Operative treatment needs a special suture techn ic and autologous or allogenous augmentation. In 15 until 25 % of all ACL ruptures good results can be obtained in this way. In all other ty pes of ruptures only a reconstruction using autologous material (lig. patellae, semitendinosous tendon) is recommended. Rehabilitation after ACL ruptures depends on the method of treatment (conservative procedu re, reconstruction material, fixation technique, associated lesions) a nd has to be adapted to the biological healing process. Normally an im mobilisation (cast, orthesis) has no benefit for ligament healing.