ACL RUPTURE
Anatomical overview: The stability of this joint relies mainly on ligaments, which act as strong cords, but a more detailed description is important to understand the mechanisms of rupture and repair solutions.
There are two distinct functional bundles:
• The Anteromedial Bundle (AMB): Insertion at the posterosuperior part of the medial surface of the lateral femoral condyle (notch) and at the anterior and medial intercondylar area of the tibial plateau. • The posterolateral bundle (PLB): Insertion at the anteroinferior part of the medial surface of the lateral femoral condyle and at the anterior and lateral intercondylar area of the tibial plateau.
Characteristics
AMB
PLB
Main role
Anterior translation brake
Rotation brake (Pivot-Shift)
Maximum tension
Knee flexed at approximately 90°
Knee extended at approximately 0°
Main clinical test (but NOT in isolation)
Anterior drawer (if no effusion splinting)
Lachman at 20 and 30° flexion
NB Anterior drawer test is unrealiable especially if the Posterior Cruciate ligament (PCL) is involved.
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