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[Anterior cruciate ligament injuries--still an enormous challenge. Life style-related surgery likely to be used more widely].

Anterior cruciate ligament (ACL) injuries still constitute the greatest single problem in orthopaedic sports medicine. The natural history is not well known. Conservative treatment is appropriate in cases where there are no instability problems, and where activity modifications are acceptable to the patient. However, there is an increased risk of meniscus and cartilage injuries, and thus of arthrosis. The indication for surgery depends on the level of activity, and on whether instability symptoms are present. Arthroscopic surgery of the ACL seems to yield good short-term results in 80-90 per cent of cases. Out-patient ACL surgery is becoming increasingly common. Rehabilitation is often vigorous, with early mobilisation and weight-bearing. Functional range-of-motion and closed kinetic chain exercises predominate. Successful surgical outcome often allows former levels of activity to be resumed. There is still uncertainty as to whether surgery reduces the risk of arthrosis. The nature of the original trauma, and continued top level sports activity may be factors of importance. Further research is needed to elucidate the natural history, and determine the long-term effects of modern ACL surgery.