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                                    [value] => The anterior cruciate ligament (ACL) is a cruciate ligament which is one of the four major ligaments of the human knee. In the quadruped stifle (analogous to the knee), based on its anatomical position, it is referred to as the cranial cruciate ligament.[1] The ACL originates from deep within the notch of the distal femur. Its proximal fibers fan out along the medial wall of the lateral femoral condyle. There are two bundles of the ACL—the anteromedial and the posterolateral, named according to where the bundles insert into the tibial plateau. The ACL attaches in front of the intercondyloid eminence of the tibia, being blended with the anterior horn of the lateral meniscus. These attachments allow it to resist anterior translation and medial rotation of the tibia, in relation to the femur. ACL reconstructive surgery can utilize several different tendons and grafts in place of the torn ACL including the hamstring, patellar tendon, semitendinosus tendon, gracillus tendon, and the plantaris.[2] There is great controversy as to which source produces the strongest, most stable ACL replacement. Many orthopedic surgeons prefer to use tendons and grafts from cadavers; therefore the patient does not have to rehabilitate more than just their ACL. Others prefer to use tendons directly from the patient in order to counteract the potential for an immune system rejection of the cadaver tissue. Furthermore surgeons have the choice between several surgical techniques to fixate the ACL replacement to the femoral bone: staple fixation, tying sutures over buttons, and screw fixation.[3] There are several studies currently testing all the variables involved in ACL reconstructive surgery accounting for the lifestyle, age, and future goals of the ACL reconstruction patients. There are no quantitative results as to which combination of ligament and grafts work best with the different surgical techniques for every individual. A 2010 Los Angeles Times review[4] of two seemingly conflicting medical studies discussed whether ACL reconstruction was advisable. One study found that children under 14 who had ACL reconstruction fared better after early surgery than those who underwent a delayed surgery. For adults under 35, though, patients who underwent early surgery followed by rehab fared no better than those who had rehab therapy and a later surgery. The first report focused on children and the timing of an ACL reconstruction. ACL injuries in children, according to orthopedic surgeon Howard Luks, MD,[5] are a challenge because children have open growth plates in the bottom of the femur or thigh bone and on the top of the tibia or shin. An ACL reconstruction will typically cross the growth plates, posing a theoretical risk of injury to the growth plate, stunting leg growth or causing the leg to grow at an unusual angle. The second study noted in the L.A. Times piece[4] focused on adults and questioned whether an ACL reconstruction was necessary when an MRI-is not merely an existing tear;[clarification needed] many patients without instability, buckling or giving way after a course of rehabilitation can be managed non-operatively. Patients involved in sports requiring significant cutting, pivoting, twisting, or rapid acceleration or deceleration may not be able to participate in these activities without ACL reconstruction, and may want to consider an early reconstruction to minimize the risk of developing common associated injuries. "You can change your knee to suit your lifestyle," says Dr. Howard Luks, "or change your lifestyle to suit your knee."
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                                    [safe_value] => The anterior cruciate ligament (ACL) is a cruciate ligament which is one of the four major ligaments of the human knee. In the quadruped stifle (analogous to the knee), based on its anatomical position, it is referred to as the cranial cruciate ligament.[1] The ACL originates from deep within the notch of the distal femur. Its proximal fibers fan out along the medial wall of the lateral femoral condyle. There are two bundles of the ACL—the anteromedial and the posterolateral, named according to where the bundles insert into the tibial plateau. The ACL attaches in front of the intercondyloid eminence of the tibia, being blended with the anterior horn of the lateral meniscus. These attachments allow it to resist anterior translation and medial rotation of the tibia, in relation to the femur. ACL reconstructive surgery can utilize several different tendons and grafts in place of the torn ACL including the hamstring, patellar tendon, semitendinosus tendon, gracillus tendon, and the plantaris.[2] There is great controversy as to which source produces the strongest, most stable ACL replacement. Many orthopedic surgeons prefer to use tendons and grafts from cadavers; therefore the patient does not have to rehabilitate more than just their ACL. Others prefer to use tendons directly from the patient in order to counteract the potential for an immune system rejection of the cadaver tissue. Furthermore surgeons have the choice between several surgical techniques to fixate the ACL replacement to the femoral bone: staple fixation, tying sutures over buttons, and screw fixation.[3] There are several studies currently testing all the variables involved in ACL reconstructive surgery accounting for the lifestyle, age, and future goals of the ACL reconstruction patients. There are no quantitative results as to which combination of ligament and grafts work best with the different surgical techniques for every individual. A 2010 Los Angeles Times review[4] of two seemingly conflicting medical studies discussed whether ACL reconstruction was advisable. One study found that children under 14 who had ACL reconstruction fared better after early surgery than those who underwent a delayed surgery. For adults under 35, though, patients who underwent early surgery followed by rehab fared no better than those who had rehab therapy and a later surgery. The first report focused on children and the timing of an ACL reconstruction. ACL injuries in children, according to orthopedic surgeon Howard Luks, MD,[5] are a challenge because children have open growth plates in the bottom of the femur or thigh bone and on the top of the tibia or shin. An ACL reconstruction will typically cross the growth plates, posing a theoretical risk of injury to the growth plate, stunting leg growth or causing the leg to grow at an unusual angle. The second study noted in the L.A. Times piece[4] focused on adults and questioned whether an ACL reconstruction was necessary when an MRI-is not merely an existing tear;[clarification needed] many patients without instability, buckling or giving way after a course of rehabilitation can be managed non-operatively. Patients involved in sports requiring significant cutting, pivoting, twisting, or rapid acceleration or deceleration may not be able to participate in these activities without ACL reconstruction, and may want to consider an early reconstruction to minimize the risk of developing common associated injuries. "You can change your knee to suit your lifestyle," says Dr. Howard Luks, "or change your lifestyle to suit your knee."

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