针对经选择患者组全部患者的治疗推荐
第一选择
或
腘绳肌肌腱移植（各种捆绑/强化和经隧道方案 - 关节内技术）
或
尸体异体移植（关节内技术）
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尸体异体移植（关节内技术）
从植入物导致获得感染的风险（病毒、朊蛋白、细菌）。关于长期力量的问题；与自体移植相比，破裂的风险可高达 3 倍。[92] Barbour SA, King W. The safe and effective use of allograft tissue: an update. Am J Sports Med. 2003;31:791-797.| Abstract [93] Bottoni CR, Smith EL, Shaha J, et al. Autograft versus allograft anterior cruciate ligament reconstruction: a prospective, randomized clinical study with a minimum 10-year follow-up. Am J Sports Med. 2015;43:2501-2509.| Abstract 手术创伤越少，恢复越快。 对双侧损伤，移植物翻修手术有效。[94] Kuhn MA, Ross G. Allografts in the treatment of anterior cruciate ligament injuries. Sports Med Arthrosc. 2007;15:133-138.| Abstract
计划进行手术重建的所有患者，术后必须进行高强度和较长期的物理治疗。 如果不这样做，由于肌肉萎缩、组织力量和本体感觉尚未恢复以及移植韧带的拉伸，将导致膝关节持续不稳定和移植失败。[91]Pap G, Machner A, Nebelung W, et al. Detailed analysis of proprioception in normal and ACL-deficient knees. J Bone Joint Surg. 1999;8:764-768.http://www.bjj.boneandjoint.org.uk/content/jbjsbr/81-B/5/764.full.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/10530833?tool=bestpractice.com 对于希望重返竞技体育的患者可能需要进行术后心理监测，因为心理因素可能影响运动员重返运动的效果。[89]Ardern CL, Webster KE, Taylor NF, et al. Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med. 2011;45:596-606.http://www.ncbi.nlm.nih.gov/pubmed/21398310?tool=bestpractice.com
总体来说，现有证据不充分，无法建议实施某一特定手术技术。[78]Linko E. Operative treatment of anterior cruciate ligament ruptures: a Cochrane review. Annual Meeting of the International Society for Technology Assessment in Health Care. Int Soc Technol Assess Health Care Meet. 2000;16:274.[79]Andersson D, Samuelsson K, Karlsson J. Treatment of anterior cruciate ligament injuries with special reference to surgical technique and rehabilitation: an assessment of randomized controlled trials. Arthroscopy. 2009;25:653-685.http://www.ncbi.nlm.nih.gov/pubmed/19501297?tool=bestpractice.com[81]Webster KE, Feller JA, Hartnett N, et al. Comparison of patellar tendon and hamstring tendon anterior cruciate ligament reconstruction: a 15-year follow-up of a randomized controlled trial. Am J Sports Med. 2016;44:83-90.http://www.ncbi.nlm.nih.gov/pubmed/26578718?tool=bestpractice.com[82]Mohtadi N, Chan D, Barber R, et al. A randomized clinical trial comparing patellar tendon, hamstring tendon, and double-bundle ACL reconstructions: patient-reported and clinical outcomes at a minimal 2-year follow-up. Clin J Sports Med. 2015;25:321-331.http://journals.lww.com/cjsportsmed/Fulltext/2015/07000/A_Randomized_Clinical_Trial_Comparing_Patellar.3.aspxhttp://www.ncbi.nlm.nih.gov/pubmed/25514139?tool=bestpractice.com膝关节损伤评分、关节松弛程度测量和临床失败率：有中等质量证据显示，前交叉韧带异体移植后的短期临床效果（膝关节损伤评分、关节松弛程度测量和临床失败率）与自体移植物相比没有明显区别。 [83]Carey JL, Dunn WR, Dahm DL, et al. A systematic review of anterior cruciate ligament reconstruction with autograft compared with allograft. J Bone Joint Surg Am. 2009;91:2242-2250.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2730860/http://www.ncbi.nlm.nih.gov/pubmed/19724004?tool=bestpractice.com受试者＜200名的随机对照临床试验（RCT）、受试者＞200名且方法学存在缺陷的随机对照临床试验（RCT）、方法学存在缺陷的系统评价或者高质量的观察性（队列）研究。 正如选择重建或非手术治疗一样，植入物类型的选择应个体化。此外，接受早期前交叉韧带修复重建与接受择期前交叉韧带修复重建患者的结局似乎没有差异。[69]Frobell RB, Roos EM, Roos HP, et al. A randomized trial of treatment for acute anterior cruciate ligament tears. N Engl J Med. 2010;363:331-342. [Erratum in: N Engl J Med. 2010;363:893.]http://www.nejm.org/doi/full/10.1056/NEJMoa0907797#t=articlehttp://www.ncbi.nlm.nih.gov/pubmed/20660401?tool=bestpractice.com[70]Frobell RB, Roos HP, Roos EM, et al. Treatment for acute anterior cruciate ligament tear: five year outcome of randomised trial. BMJ. 2013;346:f232.http://www.bmj.com/content/346/bmj.f232http://www.ncbi.nlm.nih.gov/pubmed/23349407?tool=bestpractice.com 通常在全身或脊髓麻醉下进行门诊手术（使用或不使用关节内麻醉）。手术时间为 1-3 小时。
最初的术后过程取决于手术类型、患者特征以及医生偏好。患者当天可借助拐杖和戴支具站立。一般采用冷敷、抬高患肢和其他治疗方法。物理治疗在术后最初几天即可开始。固定器的使用、支具和特定物理治疗方案存在差异。[71]Hiemstra LA, Veale K, Sasyniuk T. Knee immobilization in the immediate post-operative period following ACL reconstruction. Clin J Sport Med. 2006;16:199-202.http://www.ncbi.nlm.nih.gov/pubmed/16778538?tool=bestpractice.com[72]Harilainen A, Sandelin J. Post-operative use of knee brace in bone-tendon-bone patellar tendon anterior cruciate ligament reconstruction: 5-year follow-up results of a randomized prospective study. Scand J Med Sci Sports. 2006;16:14-18.http://www.ncbi.nlm.nih.gov/pubmed/16430676?tool=bestpractice.com[73]Shelbourne KD, Klotz C. What I have learned about the ACL: utilizing a progressive rehabilitation scheme to achieve total knee symmetry after anterior cruciate ligament reconstruction. J Orthop Sci. 2006;11:318-325.http://www.ncbi.nlm.nih.gov/pubmed/16721538?tool=bestpractice.com
外科干预后可考虑使用支具、休息、非负重训练和非甾体抗炎药等持续治疗。
