REVIEW PAPER
Anterior cruciate ligament injury: from biomechanism to complications of reconstruction – an overview
1
Collegium Medicum, Jan Kochanowski University, Kielce, Poland
2
Department of Physiology and Pathophysiology, Division of Pathophysiology, Wroclaw Medical University, Wroclaw, Poland
3
Department of Orthopedics and Traumatology, Collegium Medicum, Jan Kochanowski University, Kielce, Poland
4
Department of Orthopedics and Traumatology, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
Submission date: 2023-12-30
Acceptance date: 2024-10-27
Publication date: 2025-09-17
Corresponding author
Jakub Bulski
Jakub Bulski Collegium Medicum Jan Kochanowski University Kielce, Poland
Jakub Bulski Collegium Medicum Jan Kochanowski University Kielce, Poland
Medical Studies 2025;41(4):330-336
KEYWORDS
knee jointanterior cruciate ligament injuriesanterior cruciate ligament reconstructionarthroscopycomplications
TOPICS
ABSTRACT
The aim of this study was to review the literature in order to present indications for anterior cruciate ligament (ACL) reconstruction surgery, the techniques of its performance, and potential complications. Indications for performing ACL reconstruction (ACLR) include knee instability and episodes of giving way, accompanying meniscal injuries, multi-ligament knee injuries, and the desire to return to a high level of physical activity, even among patients over 40 years of age. There are two main types of grafts: autografts and allografts. In the autograft group, the transplant material is most commonly taken from the hamstring tendons, quadriceps tendon, and patellar tendon. For a better understanding of the surgical procedure, this study includes photos from the ACLR surgery using hamstring tendons. The most common complication after ACLR is graft damage resulting from another knee injury. Among additional complications following ACLR, notable issues include arthrofibrosis, graft displacements, septic arthritis, and saphenous nerve injury.
REFERENCES (53)
1.
Saavedra MÁ, Navarro-Zarza JE, Villaseñor-Ovies P, Canoso JJ, Vargas A, Chiapas-Gasca K, Hernández-Díaz C, Kalish RA. Clinical anatomy of the knee. Reumatol Clin. 2012; 8: 39-45.
2.
Stępniewski A. Analysis of structural, geometrical and static of knee-joint mechanism. Acta Mech Autom. 2010; 4: 80-85.
3.
Gupton M, Munjal A, Terreberry RR. Anatomy, Hinge Joints. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Nov 27]. Available from: http://www.ncbi.nlm.nih.gov/bo....
4.
Pinskerova V, Vavrik P. Knee anatomy and biomechanics and its relevance to knee replacement. In: Personalized Hip and Knee Joint Replacement [Internet]. Rivière C, Vendittoli PA, editors. Cham (CH): Springer; 2020.
5.
Murray MM. Optimizing outcomes of ACL surgery – is autograft reconstruction the only reasonable option? J Orthop Res. 2021; 39: 1843-1850.
6.
Evans J, Nielson J. Anterior cruciate ligament knee injury. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing 2023.
7.
Wang LJ, Zeng N, Yan ZP, Li JT, Ni GX. Post-traumatic osteoarthritis following ACL injury. Arthritis Res. Ther 2020; 22: 57.
8.
Hsu H, Siwiec RM. Knee arthroplasty. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.
10.
Gupton M, Imonugo O, Black AC, Launico MV, Terreberry RR. Anatomy, bony pelvis and lower limb, knee. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing 2023.
11.
Cox CF, Graefe SB, Black AC, Bordoni B. Anatomy, bony pelvis and lower limb: knee posterior cruciate ligament. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.
12.
Smith CW, Jansen KE. In-Memory Integration Of Existing Software Components For Parallel Adaptive Unstructured Mesh Workflows: Phasta 3D Dam Break [Internet]. Zenodo; 2017 [cited 2023 Oct 17]. Available from: https://zenodo.org/record/3457....
13.
Cox CF, Sinkler MA, Black AC, Launico MV, Hubbard JB. Anatomy, bony pelvis and lower limb, knee patella. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.
14.
Pritchett JW. Bicruciate total knee replacement. In: Personalized Hip and Knee Joint Replacement. Rivière C, Vendittoli PA, editors. Cham (CH): Springer 2020.
15.
Ecklund K. Sports-related injuries of the pediatric musculoskeleton: lower extremity. In: Hodler J, Kubik-Huch RA, von Schulthess GK, editors. Musculoskeletal Diseases 2021-2024: Diagnostic Imaging. Cham (CH): Springer; 2021.
16.
Yoo H, Marappa-Ganeshan R. Anatomy, bony pelvis and lower limb, knee anterior cruciate ligament. In: Stat- Pearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.
17.
Sanders TL, Pareek A, Kremers HM, Bryan AJ, Levy BA, Stuart MJ, Dahm DL, Krych AJ. Long-term follow-up of isolated ACL tears treated without ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2017; 25: 493-500.
18.
Eriksson K, von Essen C, Jönhagen S, Barenius B. No risk of arthrofibrosis after acute anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2018; 26: 2875-2882.
19.
Freshman RD, Truong NM, Cevallos N, Lansdown DA, Feeley BT, Ma CB, Zhang AL. Delayed ACL reconstruction increases rates of concomitant procedures and risk of subsequent surgery. Knee Surg Sports Traumatol Arthrosc 2023; 31: 2897-2905.
20.
Arliani GG, Astur D da C, Kanas M, Kaleka CC, Cohen M. Anterior cruciate ligament injury: treatment and rehabilitation. Current perspectives and trends. Rev Bras Ortop 2015; 47: 191-196.
21.
Diermeier TA, Rothrauff BB, Engebretsen L, Lynch A, Svantesson E, Hamrin Senorski EA, Meredith SJ, Rauer T, Ayeni OR, Paterno M, Xerogeanes JW, Fu FH, Karlsson J, Musahl V. Treatment after ACL injury: Panther Symposium ACL Treatment Consensus Group. Br J Sports Med 2021; 55: 14-22.
22.
Levy BA, Dajani KA, Whelan DB, Stannard JP, Fanelli GC, Stuart MJ, Boyd JL, MacDonald PA, Marx RG. Decision making in the multiligament-injured knee: an evidence-based systematic review. Arthroscopy 2009; 25: 430-438.
23.
Buyukdogan K, Laidlaw MS, Miller MD. Surgical management of the multiple-ligament knee injury. Arthrosc Tech 2018; 7: 147-164.
24.
Ishibashi Y, Adachi N, Koga H, Kondo E, Kuroda R, Mae T, Uchio Y. Japanese Orthopaedic Association (JOA) clinical practice guidelines on the management of anterior cruciate ligament injury – secondary publication. J Orthop Sci 2020; 25: 6-45.
25.
Reijman M, Eggerding V, van Es E, van Arkel E, van den Brand I, van Linge J, Zijl J, Waarsing E, Bierma-Zeinstra S, Meuffels D. Early surgical reconstruction versus rehabilitation with elective delayed reconstruction for patients with anterior cruciate ligament rupture: COMPARE randomised controlled trial. BMJ 2021; 372: 375.
26.
Sommerfeldt M, Raheem A, Whittaker J, Hui C, Otto D. Recurrent instability episodes and meniscal or cartilage damage after anterior cruciate ligament injury: a systematic review. Orthop J Sports Med 2018; 6: 2325967118786507.
27.
Cinque ME, Chahla J, Moatshe G, DePhillipo NN, Kennedy NI, Godin JA, LaPrade RF. Outcomes and complication rates after primary anterior cruciate ligament reconstruction are similar in younger and older patients. Orthop J Sports Med 2017; 5: 2325967117729659.
28.
Wierer G, Runer A, Hoser C, Herbst E, Gföller P, Fink C. Acute ACL reconstruction in patients over 40 years of age. Knee Surg Sports Traumatol Arthrosc 2017; 25: 1528-1534.
29.
Alomar AZ, Nasser ASB, Kumar A, Kumar M, Das S, Mittal S. Hamstring graft diameter above 7 mm has a lower risk of failure following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2022; 30: 288-297.
30.
Dai W, Leng X, Wang J, Cheng J, Hu X, Ao Y. Quadriceps tendon autograft versus bone-patellar tendon-bone and hamstring tendon autografts for anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Am J Sports Med 2022; 50: 3425-3439.
31.
Mouarbes D, Menetrey J, Marot V, Courtot L, Berard E, Cavaignac E. Anterior cruciate ligament reconstruction: a systematic review and meta-analysis of outcomes for quadriceps tendon autograft versus bone-patellar tendon-bone and hamstring-tendon autografts. Am J Sports Med 2019; 47: 3531-3540.
32.
Chen W, Li H, Chen Y, Jiang F, Wu Y, Chen S. Bone–patellar tendon–bone autografts versus hamstring autografts using the same suspensory fixations in acl reconstruction: a systematic review and meta-analysis. Orthop J Sports Med 2019; 7: 2325967119885314.
33.
Hoge CG, Matar RN, Khalil LS, Buchan JA, Johnson CM, Grawe BM. Outcomes following anterior cruciate ligament reconstruction with patellar tendon vs hamstring autografts: a systematic review of randomized controlled trials with a mean follow-up of 15 years. Arch Bone Jt Surg 2022; 10: 311-319.
34.
Buerba RA, Boden SA, Lesniak B. Graft selection in contemporary anterior cruciate ligament reconstruction. JAAOS Glob Res Rev 2021; 5: e21.00230.
35.
Krupa S, Reichert P. Factors influencing the choice of graft type in ACL reconstruction: Allograft vs autograft. Adv Clin Exp Med 2020; 29: 1145-1151.
36.
Dhillon J, Kraeutler MJ, Belk JW, McCarty EC, McCul- loch PC, Scillia AJ. Autograft and nonirradiated allograft for anterior cruciate ligament reconstruction demonstrate similar clinical outcomes and graft failure rates: an updated systematic review. Arthrosc Sports Med Rehabil 2022; 4: 1513-1521.
37.
Chang MJ, Choi YS, Shin JH, Yoon TH, Kim TW, Chang CB, Kang SB. Comparison of failure rates and functional outcomes between hamstring autografts and hybrid grafts in anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Orthop Traumatol Surg Res 2023; 109: 103499.
38.
Fan D, Ma J, Zhang L. Patellar tendon versus artificial grafts in anterior cruciate ligament reconstruction: a systematic review and meta-analysis. J Orthop Surg Res 2021; 16: 478.
39.
Costa GG, Perelli S, Grassi A, Russo A, Zaffagnini S, Monllau JC. Minimizing the risk of graft failure after anterior cruciate ligament reconstruction in athletes. A narrative review of the current evidence. J Exp Orthop 2022; 9: 26.
40.
Diquattro E, Jahnke S, Traina F, Perdisa F, Becker R, Kopf S. ACL surgery: reasons for failure and management. EFORT Open Rev 2023; 8: 319-330.
41.
Kulczycka P, Larbi A, Malghem J, Thienpont E, Vande Berg B, Lecouvet F. Imaging ACL reconstructions and their complications. Diagn Interv Imaging 2015; 96: 11-19.
42.
Samitier G, Marcano AI, Alentorn-Geli E, Cugat R, Far- mer KW, Moser MW. Failure of anterior cruciate ligament reconstruction. Arch Bone Jt Surg 2015; 3: 220-240.
43.
Noailles T, Chalopin A, Boissard M, Lopes R, Bouguen- nec N, Hardy A. Incidence and risk factors for cyclops syndrome after anterior cruciate ligament reconstruction: a systematic literature review. Orthop Traumatol Surg Res 2019; 105: 1401-1405.
44.
Oh D, Lee AD, Smith A. Symptomatic tibial tunnel ganglion cyst presenting four years following an ACL hamstring autograft reconstruction: a case report of a rare complication of ACL surgery. J Can Chiropr Assoc 2022; 66: 293-299.
45.
Vaishya R, Esin Issa A, Agarwal AK, Vijay V. Anterior cruciate ligament ganglion cyst and mucoid degeneration: a review. Cureus. 2017; 9: 1682.
46.
Carlos Monllau J, Perelli S, Costa GG. Anterior cruciate ligament failure and management. EFORT Open Rev. 2023; 8: 231-244.
47.
Tjoumakaris FP, Herz-Brown AL, Legath-Bowers A, Sennett BJ, Bernstein J. Complications in brief: anterior cruciate ligament reconstruction. Clin Orthop Relat Res. 2012; 470: 630-636.
48.
Chen N, Wang C, Li D, Jiang Y, Ao Y. Effect of joint infection after arthroscopic single-bundle ACL reconstruction with autologous hamstring tendon: a retrospective matched MRI Study. Orthop J Sports Med. 2022; 10: 23259671221125493.
49.
Komnos GA, Chalatsis G, Mitrousias V, Hantes ME. Postoperative infection after anterior cruciate ligament reconstruction: prevention and management. Microorganisms. 2022; 10: 2349.
50.
Matava M, Evans T, Wright R, Shively R. Septic arthritis of the knee following anterior cruciate ligament reconstruction: results of a survey of sports medicine fellowship directors. Arthroscopy. 1998; 14: 717-725.
51.
Sun L, Zhang L, Wang K, Wang W, Tian M. Fungal osteomyelitis after arthroscopic anterior cruciate ligament reconstruction: a case report with review of the literature. Knee. 2012; 19: 728-731.
52.
Viola R, Marzano N, Vianello R. An unusual epidemic of staphylococcus-negative infections involving anterior cruciate ligament reconstruction with salvage of the graft and function. Arthroscopy. 2000; 16: 173-177.
53.
Somanathan A, Tandon A, Yang L. Review of magnetic resonance imaging features of complications after anterior cruciate ligament reconstruction. smedj. 2019; 60: 63-68.
Share
RELATED ARTICLE
| eISSN: | 2300-6722 |
| ISSN: | 1899-1874 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
