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Several studies have shown that the Laehman test and the pivot shift test have a high diagnostic accuracy in the clinical evaluation of acute anterior cruciate ligament (ACL) insufficiencies. Controversy still exists however, whether an acute ACL rupture leads to an abnormal translational or rotational laxity of the knee.

“What can be expected of primary repair of acute anterior cruciate ligament tears?” This question has been the subject of a number of clinical follow-up studies. The conclusions of these reports differ and thus the efficacy of primary repair of the anterior cruciate ligament (ACL) remains controversial [9, 10, 11, 13, 17, 18, 21, 22]. On the other hand, the secondary consequences of ACL insufficiency have been clearly demonstrated in several clinical and experimental studies [2, 10, 11, 15, 18, 20]. Most authors therefore advocate early operative treatment of ACL rupture, in an attempt to avoid these sequelae.

90 consecutive patients ranging in age between 13 and 49 years (mean 24.2) with an acute ACL rupture, underwent arthroscopy and clinical examination under anaesthesia within 5 days after injury. All patients showed a total midsubstance rupture of the ACL. The patients were randomized into two groups, surgical treatment and conservative treatment of the ACL. All associated injuries were sutured when necessary in both groups. Patients in group I, surgical treatment group had their ACL repaired with sutures and augmented with a strip from the iliotibial band. This group I underwent a control arthroscopy in mean 9.1 months after operation. 67 % of the patients had an excellent result with normal ACL, 27% were classified as good and 7% as poor. All patients were reviewed at the follow-up in mean 18.2 months after operation. The patients underwent clinical examination, a functional knee test isokinetic muscle strength (Cybex II) a standardized one leg jump, a figure of eight running and a functional knee score (Lysholm & Gillquist, 1982) was obtained.

Acute anterior cruciate ligament (ACL) ruptures most often occur during vigorous internal rotation near extension, accompanied by a forced quadriceps contraction. Other mechanisms for ACL ruptures are hyperextension and hyperflexion. External rotation always results in ACL rupture after rupture of the entire medial collateral ligament (superficial plus deep layer). The main symptoms of “isolated” ACL ruptures are somewhat similar to those of an acute patellar dislocation (Table 1).

The risk of overuse and traumatic tendon and ligament injuries differ between women and men. Part of this gender difference in injury risk is probably explained by sex hormonal differences which are specifically distinct during the sexual maturation in the teenage years and during young adulthood. The effects of the separate sex hormones are not fully elucidated. However, in women, the presence of estrogen in contrast to very low estrogen levels may be beneficial during regular loading of the tissue or during recovering after an injury, as estrogen can enhance tendon collagen synthesis rate. Yet, in active young female athletes, physiological high concentration of estrogen may enhance the risk of injuries due to reduced fibrillar crosslinking and enhanced joint laxity. In men, testosterone can enhance tendon stiffness due to an enhanced tendon collagen turnover and collagen content, but testosterone has also been linked to a reduced responsiveness to relaxin. The present chapter will focus on sex difference in tendon injury risk, tendon morphology and tendon collagen turnover, but also on the specific effects of estrogen and androgens.