Johnson R J
Int J Sports Med. 1982 May;3(2):71-9. doi: 10.1055/s-2008-1026066.
This study presents an extensive review of the literature concerning the natural history, diagnosis and treatment of anterior cruciate (AC) injury. This ligament is the most frequently disrupted ligament in the human knee, yet wide disagreement exists concerning the effects of its rupture and the appropriate means of treatment. Diagnosis of AC sprain is difficult, however the appropriate use of the Lachman and pivot shift tests can improve accuracy markedly. The Lachman test has several advantages over the standard drawer test: 1) the knee is examined in 10--20 degrees of flexion (a comfortable position for the injured knee); 2) it minimizes the blocking effect of the hamstring muscles on the anterior drawer motion; 3) minimized the blocking effect of the posterior horns of the menisci; 4) eliminates confusion with rotary instability. The pivot shift test demonstrates the clinical effects of loss of anterior cruciate function, but does not correspond to anterolateral rotary instability which, unfortunately, it has been named. The wide variety of treatment of acute total disruption suggested numerous authors reveals the lack of a single satisfactory way to successfully obtain excellent results. A survey of 56 North American knee surgeons concerning their treatment of "isolated" tears of the AC ligament in young vigorous athletes revealed that 30.3% would treat nonoperatively, 62.5% would repair the ligament with or without a graft and 7.2% would ignore the ligament but replace it with a graft or do a capsular reconstruction.
本研究对有关前交叉韧带（AC）损伤的自然史、诊断和治疗的文献进行了广泛综述。该韧带是人体膝关节中最常断裂的韧带，但对于其断裂的影响及合适的治疗方法仍存在广泛分歧。AC扭伤的诊断较为困难，然而正确使用拉赫曼试验和轴移试验可显著提高准确性。与标准抽屉试验相比，拉赫曼试验有几个优点：1）在膝关节屈曲10至20度时进行检查（这是受伤膝关节的舒适位置）；2）它将腘绳肌对前抽屉运动的阻挡作用降至最低；3）将半月板后角的阻挡作用降至最低；4）消除了与旋转不稳定的混淆。轴移试验显示了前交叉韧带功能丧失的临床影响，但与不幸被命名为前外侧旋转不稳定并不对应。众多作者提出的针对急性完全断裂的各种治疗方法表明，缺乏一种能成功获得优异效果的单一令人满意的方法。一项对56位北美膝关节外科医生关于他们对年轻活跃运动员“孤立性”AC韧带撕裂治疗方法的调查显示，30.3%的医生会选择非手术治疗，62.5%的医生会修复韧带，无论是否使用移植物，7.2%的医生会忽略该韧带，但用移植物替代或进行关节囊重建。
