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Free Paper
Profile of The Anterior Cruciate Ligament Injury from December 2014 – August 2015
in Sanglah General Hospital
I. Background
Human being has a lot of ligaments of their body and has an important function in life. One of the most important ligament of human body is the Anterior Cruciate Ligament ACL.
Nowadays, this ligament become the most important thing to discussion because the etiology and treatment management are still have many controversion. Research study for Anterior
Cruciate Ligament ACL is became increased in the world and made many doctors used their knowledge for done the best treatment.
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Anterior Cruciate Ligament ACL is important for a knee, especially for athletes which they can done for walking, running, jumping, and kicking. Normally, Anterior
Cruciate Ligament ACL can protect for knee joint while a human do the daily activity. After that, it has a good viscoelasticity degree for doing tension and resting without damage
the knee joint and give the good configuration, and it can give the knee can do rotation and translation movement.
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The progression of management of the diagnosis and treatment of the Anterior Cruciate Ligament ACL was begun at the 1970 and 1980. On 1990, the research has
focused to identificate the mechanism of injury, risk factors of injury, treatment of injury, and physical rehabilitation. For the severe Anterior Cruciate Ligament ACL, doctors usually
done the reconstruction surgery and it need high cost for the treatment. So we can said, patient who had Anterior Cruciate Ligament ACL injury will spent many money and give
the emotional, phychological, and economic problems.
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The newest result of the research about Anterior Cruciate Ligament ACL injury are increased everey recent years, it can be occured in women more than in man 2-8:1, more
occured in foot ball and basket ball player, and more frequently occured after adolescent phase.
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II. Anatomy of Anterior Cruciate Ligament
Picture 1. Anatomy of Anterior Cruciate Ligament ACL
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Anterior Cruciate Ligament ACL has 38 mm length and 11 mm width. It has two bundle, they are anteromedial and posterolateral bundle. This classification is based on the its
insertion to the tibia and its function for doing tension when the knee is working. Anterior Cruciate Ligament ACL is attached from lateral intercondylar notch of the posterior lateral
condyle, then pass through the anteromedial aspect of the plateau tibia and attached to the eminentia tibia knee can do extention and flexion motion. The function of the two bundle
are anteromedial bundle is shortening when the knee flexed and the posterolateral bundle is shortening when the knee extended. Two bundle of Anterior Cruciate Ligament ACL is in
pararel position when the knee extended and crossed each other when the knee flexed.
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Anterior Cruciate Ligament ACL consist of type I collagen matrix about 90, type III collagen matrix about 10, elastin 5, proteoglican 1 and water 60. This
ligament has many nerve fibers which had proprioceptif function or mechanoreseptor pain respon. The nerve supply from Anterior Cruciate Ligament ACL is from tibial nerve which
can penetrated the posterior capsule joint and the synovial membrane. This ligament has the blood supply from medial genicular artery branch of poplitea artery which can penetrated
the posterior capsule. The other side, it has the blood supply from medial inferior arteri and lateral genicularartery from the fat tissues.
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Insertion of Anterior Cruciate Ligament ACL to the bone is through the fibrocartilagenous enthesis. This is can divided into four zone, such as
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: First zone is the edge of the Anterior Cruciate Ligament ACL,
Second zone is collagen fibers ligament with fibrocartilage region, Third zone is mineralization of the fibrocartilage
Fourth zone is joined with the bone
Picture 2. Intraoperative Anterior Cruciate Ligament ACL
. A picture of two bundle Anterior Cruciate Ligament ACL
: anteromedial AM dan posterolateral PL. PL bundle is located in posterolateral of the AM bundle and we pushed the AM bundle to
the medial, give the bundle PL is seen more clearly. B and C, picture show the anatomy of LCA foot prints. LM = lateral meniscus, MM = medial malleolus.
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III. Definitive Treatment of Anterior Cruciate Ligament ACL Injury A. Management Non Operative
