Anterior and posterior cruciate ligaments function as the most important passive knee stabilizer. They are located inside the knee joint. Anterior cruciate ligaments are torn either isolated or combined with other structures. The mechanism of an isolated anterior cruciate ligament rupture is a sudden deceleration i.e. contraction of quadriceps (landing, skiing …). A combined anterior cruciate ligament injury occurs by an abduction mechanism and external rotation of the lower leg, often associated with a rupture of the medial collateral ligament and a rupture of the medial meniscus.

The treatment can be conservative and operative. The younger the patient is, and the more they want to engage in sport activities, are more motivated, and have less arthrosis, the sooner we will opt for surgical treatment. The conservative treatment consists of muscle strengthening which contributes to an active stabilization of the knee. A surgical treatment consists of a reconstruction of the anterior cruciate ligament.

Currently, two operative methods prevail, one of which includes reconstruction of the middle third of the patellar ligament and the other includes hamstring muscle tendons (Figure 1). This is currently carried out with minimal level of invasiveness, arthroscopically. It is very important to follow the postoperative rehabilitation program, and a full knee load is expected after 6 months following the surgery.

Fig. 1 Anterior cruciate ligament rupture. After cleaning of the intercondylar notch, the quadruple tendon m. semitendinosus and gracilis reconstruction was carried out.

Since the structure of the anterior cruciate ligament is very complex, consisting of anteromedial and posterolateral bundles, each bundle is tightened to a different flexion degree. To get as close as possible to the natural function of a cruciate ligament, the reconstruction of an anterior cruciate ligament has lately been carried out with two bundles (Fig. 2)

Figure 2. Reconstruction of the anterior cruciate ligament with two bundles, by reconstruction of anteromedial and posterolateral bundles.
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