Cronicon O P EN A C C ESS EC ORTHOPAEDICS

Review Article

ACL Anatomy and it’s Injuries

Pia Accetto*
Department of Physiotherapy, Alma Mater Europaea, Maribor, Slovenia

*Corresponding Author: Pia Accetto, Department of Physiotherapy, Alma Mater Europaea, Maribor, Slovenia.

Received: March 18, 2018; Published: April 10, 2018

Abstract
ACL, known as anterior cruciate ligament, is one of the most common injuries in sport profession. For understanding further ACL
injuries, a good pre-knowledge of knee anatomy has to be understandable. In the knee join further movements are possible: flexion,
extension and rotation. Rotation of a knee joint is possible, when the knee is flexed and stable on the ground. Those rotations are
small. ACL represents one out of two cruciate ligaments, situated in knee. It runs from anterolateral tibial spine to lateral femoral
condyle. ACL can be divided into two parts. The fibre of ACL, which are arising from the lateral side, extends farther dorsally than
the one which comes from the medial side. ACL is important for preventing the tibia moving forward. Beside ACL, there is posterior
cruciate ligament, known as PCL, which prevents tibia for moving backwards. Injuries that can happen for ACL are not graded with
just one grade, which would imply for further surgery. The rupture of ACL, is actually divided into three grades, and for each of them
there are specific insight of what it means. The causes of ACL injuries are some, but most common cause of ACL rupture is combined
knee compression, flexion and internal rotation.

Keywords: ACL; acl Anatomy; Knee Anatomy; acl Injuries; Causes

What does ACL means, where is it situated, what is its anatomy, why is the ACL important, how does it lead to rupture? The answers
will be given in this article. This is about to be a short review of the anatomy ACL, which is important to know for further understanding
of rehabilitation (not mentioned in this article).

http://sportskneetherapy.com/knee-ligaments/what-is-an-acl-pcl/ [1].

Citation: Pia Accetto. “ACL Anatomy and it’s Injuries”. EC Orthopaedics 9.5 (2018): 270-272.
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Short review of knee structure

In knee anatomy we know the following ligaments:

• 2 cruciate ligaments; anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL)
• 2 collateral ligaments; medial collateral ligament, lateral collateral ligament
• Transverse ligament
• Anterior meniscofemoral ligament, posterior meniscofemoral ligament

Knee is composited of three bones, which are: tibia, femur and patella. Besides mentioned ligaments, bones, the meniscus represents
an important role as well [2].

ACL anatomy
ACL, known as anterior cruciate ligament is one out of two cruciate ligaments in knee. Both of them are mainly composed of collagen
fibres with only 10% of elastic fibre. It goes anterolateral from anterior tibial spine to lateral femoral condyle. Attachment of ACL to
anterior tibial spine is stronger than the part of ACL that attaches to lateral femoral condyle. Anatomically ACL can be divided into two
parts: anteromedial band and posterolateral band. Anteromedial band attaches anteromedial to the tibia. Posterolateral band constitute
the rest of the ligament. In extension posterolateral band is taut/strengthened, while anteromedial band is lax. Constant length ratio with
PCL (posterior cruciate ligament) is 5:3, which varies upon individuals. ACL provides around 86% of the restraint to anterior displace-
ment, while PCL provides 94% restraint to posterior displacement of the tibia and femur. There is barely good blood supplies from middle
genicular artery, with a small contribution from the inferior lateral genicular artery. Mechanoreceptors are located around the periphery
where the maximum bending occurs. It is most probable they convey information regarding angular acceleration and may be involved
in reflexes to protect the knee from potential injury [2]. Platzer [3] indicates that the fibers of ACL, arising from the lateral side extends
farther dorsally than those from the medial side. ACL prevents tibia for moving forward, meanwhile posterior cruciate ligament prevents
movement of tibia backwards.

Flexed knee and its rotation

Besides ACL and PCL, the collateral ligaments are also involved, Platzer says [3]. Platzer [3] continues with explanation of functionality
of flexed knee. It is said lateral collateral ligament is completely relaxed, while medial collateral ligament is largely lax, but ACL and PCL
are taut/strengthened. During flexion the slightly rotations are possible. The movement of rotation is supervised by ACL and PCL. Range
of internal rotation is less then external.

ACL injury
Most common ACL injuries, happens in high demand sport discipline such as football, basketball, soccer. Ligament sprains are graded
on three different level, depends on the stage of injury.

Such division is:

• Grade 1 sprain: ligament is mildly/slightly damaged, stretched, but the knee joint is stable
• Grade 2 sprain: ligament stretches to the point where it becomes loose. It refers to partial tear of ligament
• Grade 3 sprain: complete tear of ligament. It is most common. Ligament is split into two pieces. Knee joint is unstable [4].

ACL rupture increases very little in the anterior draw, while PCL in a posterior draw of up to 25 mm [2]. Most frequent causes of ACL
rupture are combined knee compression, flexion and internal rotation. Taking into consideration maximal knee loading happens in re-
sponse of repeated exercises in a short period of time. In professional athletes, ACL injury increases among limited internal axial rotation
of a hip joint [5]. A reason for ACL injury often involves minimal or no contact, which represents ¾ of all ACL injuries. For non-contact ACL

Citation: Pia Accetto. “ACL Anatomy and it’s Injuries”. EC Orthopaedics 9.5 (2018): 270-272.
ACL Anatomy and it’s Injuries

272

injury axial compressive forces are critical. Interesting fact is female athlete gets from two to eight time greater rate of injuries than men.
Further factors for causing ACL injuries are: impingement, quadriceps contraction, hamstring compression, axial forces [6].

Further suggestions
Since the ACL is one of the most talkative topic, especially in sport, I suggest to dig into the different researches. I wrote this short,
understandable article for people to understand what it means, when the doctor says, your ACL has been injured and so they know where
is it situated. There is so musch to discover on its field, and as I said, my article is just a one percent of everything that there is happening
with the ACL. For each information I pointed out, there are further explanations and also to confirm the literature researches on its topic
are needed [7-9].

Conclusion
ACL plays a very important role in sport. For the ones, not being a professional sport person, the rupture of ACL cannot be so devas-
tated. Understanding the knee anatomy is crucial for understanding ACL anatomy and it´s ruptures. Besides anatomy, it is important to
understand the biomechanics of knee. Since the topic of ACL has not been yet very developed, I suggest for doing a lot of researches. With
understanding the basics, there are a lot of different fields that are needed for being researched, such as: reconstruction, rehabilitation,
etc.

Bibliography
1. What is an ACL and PCL?

2. Palastanga Soames. “Anatomy and human movement: structure and function”. PAGEBURST Access, 6th Edition (Physiotherapy Es-
sentials) (2012).

3. Platzer. Color Atlas of Human anatomy Volume 1 Locomotor System (2014).

4. Anterior Cruciate Ligament (ACL) Injuries.

5. Wojtys EM., et al. “New perspectives on ACL injury: On the role of repetitive sub-maximal knee loading in causing ACL fatigue failure”.
Journal of Orthopaedic Research 34.12 (2016): 2059-2068.

6. Barry P Boden., et al. “Non-contact ACL Injuries: Mechanisms and Risk Factors”. Journal of the American Academy of Orthopaedic
Surgeons 18.9 (2010): 520-527.

7. ACL Injury

8. Anterior cruciate ligament tear

9. ACL Injury: Does It Require Surgery?

Volume 9 Issue 5 May 2018

©All rights reserved by Pia Accetto.

Citation: Pia Accetto. “ACL Anatomy and it’s Injuries”. EC Orthopaedics 9.5 (2018): 270-272.