[Management of the anterior cruciate ligament rupture: indications, choice of procedure, timing, concomitant and after-care].

The indication for operative or conservative treatment of the anterior cruciate ligament remains still difficult. Many years of intensive basic and clinical research and a better knowledge of biology, biomechanics and pathology have not been achieved standards of therapy. Therefore varying treatment options exist. In this paper we give an overview on the main indications and common treatments. Untreated ruptures of the ACL result in severe functional impairment. Therefore we find a wide indication for an operative reconstruction. Patient orientated factors (age, activity level, morphotype) and the range of instability are important for the decision-making between operative and conservative treatment. The time of intervention is determined by the chosen treatment. Multidirectional instabilities, ruptures of meniscus or damage of cartilage need an early, isolated injuries of the ACL an early or later (until 4 weeks) surgical therapy. An anatomical ligament reconstruction (so called "suture") is possible only for selected ruptures near the femoral insertion. Operative treatment needs a special suture technic and autologous or allogenous augmentation. In 15 until 25% of all ACL ruptures good results can be obtained in this way. In all other types of ruptures only a reconstruction using autologous material (lig. patellae, semitendinosous tendon) is recommended. Rehabilitation after ACL ruptures depends on the method of treatment (conservative procedure, reconstruction material, fixation technique, associated lesions) and has to be adapted to the biological healing process. Normally an immobilisation (cast, orthesis) has no benefit for ligament healing.