ACL Injury Prevention and Treatment

Mayo Clinic sports medicine researchers in anterior cruciate ligament (ACL) injury prevention and treatment work to identify athletes at risk of ACL injury, then take the appropriate steps for prevention. Physicians treat people with ACL injuries using the latest surgical techniques and rehabilitation strategies to optimize return to sport and minimize the risk of future injury.

Faculty members collaborating on research related to ACL injury prevention and treatment include:

• Christopher L. Camp, M.D.
• Nancy M. Cummings, M.D.
• Diane L. Dahm, M.D.
• Aaron J. Krych, M.D.
• Daniel B. F. Saris, M.D., Ph.D.
• David B. Soma, M.D.
• Michael J. Stuart, M.D.

Research highlights

Review a complete list of publications on ACL injury by Mayo Clinic sports medicine researchers. Here are the highlights:

• All-inside and complete tibial tunnel ACL reconstruction techniques using hamstring autograft successfully restore knee stability and patient function.

  Desai VS, Anderson GR, Wu IT, Levy BA, Dahm DL, Camp CL, Krych AJ, Stuart MJ. Anterior cruciate ligament reconstruction with hamstring autograft: A matched cohort comparison of the all-inside and complete tibial tunnel techniques. The Journal of Orthopaedic Sports Medicine. Jan. 8, 2019.

• Surgical fixation of a tibial eminence fracture has more joint laxity and higher risk of arthrofibrosis but no difference in the rate of subsequent ACL injury compared with ACL reconstruction.

  Melugin HP, Desai VS, Camp CL, Milbrandt TA, Dahm DL, Levy BA, Stuart MJ, Krych AJ. Do tibial eminence fractures and anterior cruciate ligament tears have similar outcomes? Orthopaedic Journal of Sports Medicine. Dec. 7, 2018.

• Tibial slope has the potential to influence ACL strain during landing, especially when large abduction moments are present at the knee.

  Bates NA, Mejia Jaramillo MC, Vargas M, McPherson AL, Schilaty ND, Nagelli CV, Krych AJ, Hewett TE. External loads associated with anterior cruciate ligament injuries increase the correlation between tibial slope and ligament strain during in vitro simulations of in vivo landings. Clinical Biomechanics. 2019;61:84.

• There is a need to develop dynamic proprioception tests and outline future directions for research into the senses of joint position, movement, tension and force.

  Nagai T, Schilaty ND, Strauss JD, Crowley EM, Hewett TE. Analysis of lower extremity proprioception for anterior cruciate ligament injury prevention: Current opinion. Sports Medicine. 2018;48:1303.

• Long-term overall clinical success rate for pediatric and adolescent meniscal tear repair in the setting of concomitant ACL reconstruction is 72%.

  Tagliero AJ, Desai VS, Kennedy NI, Camp CL, Stuart MJ, Levy BA, Dahm DL, Krych AJ. Seventeen-year follow-up after meniscal repair with concomitant anterior cruciate ligament reconstruction in a pediatric and adolescent population. The American Journal of Sports Medicine. 2018;46:3361.

• Information from a health care database regarding diagnosis, treatment and outcomes for ACL tears is more accurate when verified with medical chart review.

  Sanders TL, Pareek A, Desai VS, Hewett TE, Levy BA, Stuart MJ, Dahm DL, Krych AJ. Low accuracy of diagnostic codes to identify anterior cruciate ligament tear in orthopaedic database research. The American Journal of Sports Medicine. 2018;46:2894.

• Self-reported symptoms and function with psychological readiness to return to sports after ACL reconstruction surgery.

  Webster KE, Nagelli CV, Hewett TE, Feller JA. Factors associated with psychological readiness to return to sport after anterior cruciate ligament reconstruction surgery. The American Journal of Sports Medicine. 2018;46:1545.

• ACL injury prevention programs reduce the risk of ACL injuries by half in all athletes and the risk of noncontact ACL injuries by two-thirds in female athletes.

  Webster KE, Hewett TE. Meta-analysis of meta-analyses of anterior cruciate ligament injury reduction training programs. Journal of Orthopaedic Research. 2018;36:2696.

• Mechanical impact simulator examines independent mechanical variables, treatment techniques and preventive interventions during athletic tasks leading up to and including an ACL injury.

  Bates NA, Schilaty ND, Nagelli CV, Krych AJ, Hewett TE. Validation of noncontact anterior cruciate ligament tears produced by a mechanical impact simulator against the clinical presentation of injury. The American Journal of Sports Medicine. 2018;46:2113.

• Preoperative physiologic passive knee hyperextension of 5 degrees or more is present in one-third of ACL revision reconstruction patients and predisposes to a two times greater risk of graft failure.

  Cooper DE, Dunn WR, Huston LJ, Haas AK, Spindler KP, Allen CR, Anderson AF, DeBerardino TM, Lantz BBA, Mann B, Stuart MJ, Albright JP, Amendola AN, Andrish JT, Annunziata CC, Arciero RA, Bach BR Jr, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Butler V, Campbell JD, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, Dahm DL, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ Jr, Gecha SR, Giffin JR, Hame SL, Hannafin JA, Harner CD, Harris NL Jr, Hechtman KS, Hershman EB, Hoellrich RG, Hosea TM, Johnson DC, Johnson TS, Jones MH, Kaeding CC, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP II, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O'Neill DF, Owens BD, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Slauterbeck JR, Smith MV, Spang JT, Svoboda SJ, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS Jr, Wolcott ML, Wolf BR, York JJ, Wright RW. Physiologic preoperative knee hyperextension is a predictor of failure in an anterior cruciate ligament revision cohort: A report from the MARS group. The American Journal of Sports Medicine. 2018;46:2836.

• A Segond's fracture in ACL reconstruction does not affect pivot-shift test results, graft failure rates or activity levels.

  Melugin HP, Johnson NR, Wu IT, Levy BA, Stuart MJ, Krych AJ. Is treatment of segond fracture necessary with combined anterior cruciate ligament reconstruction? The American Journal of Sports Medicine. 2018;46:832.

• The knee abduction moment increases strain to the ACL under clinically representative loading, and sex-based differences may contribute to female predisposition to ACL injury.

  Schilaty ND, Bates NA, Nagelli C, Krych AJ, Hewett TE. Sex-based differences in knee kinetics with anterior cruciate ligament strain on cadaveric impact simulations. Orthopaedic Journal of Sports Medicine. March 15, 2018.