Wmi Query To List Installed Programs In LinuxWmi Query To List Installed Programs UnixVB Script that connects through WMI to create a list of installed software. Comma separated value list of Caption (Software Name), InstallDate and InstallDate2 fields. I am trying to get all installed apps in the computers of my domain but. Get installed programs via cmd or powershell. Registry Query, 2) WMI query of the SCCM. But before you reinstall Windows, you should make a list of programs you currently have installed on your PC so you know what you want to reinstall on the new system. Enumerating Installed Software. The WMI Win32_Product class enables you to enumerate the. This query returns a collection consisting of all the software. The Installed applications category groups classes that represent. Represents any installed or advertised components or applications. Programs. BizSpark (for. · Wmic List all Installed. Permissions Process Pstools query session Registry Reset Session Restore. Service Windows update Wipe Disk WMI. If you need to identify machines with specific software installed on a machine but would also. WQL Query for machines with specific software installed and. SCCM 2. 01. 2 - WQL Query for machines with specific software installed and version or below. If you need to identify machines with specific software installed on a machine but would also like to know whether they have a certain version of the stated software or below, then you can use the below query. This can help with software upgrades to identify machines that have not yet been upgraded. SMS_R_System. Name. SMS_R_System. Client. Version. from SMS_R_System. SMS_G_System_ADD_REMOVE_PROGRAMS. SMS_G_System_ADD_REMOVE_PROGRAMS. Resource. ID = SMS_R_System. Resource. Id. where SMS_G_System_ADD_REMOVE_PROGRAMS. ![]() Display. Name = "Shoretel Communicator". SMS_G_System_ADD_REMOVE_PROGRAMS. Version < = "1. SMS_R_System. Name, SMS_R_System. Client. Versionselectdistinct SMS_R_System. Name, SMS_R_System. Client. Version from. SMS_R_System innerjoin. SMS_G_System_ADD_REMOVE_PROGRAMS on. SMS_G_System_ADD_REMOVE_PROGRAMS. Resource. ID=SMS_R_System. Resource. Id where. SMS_G_System_ADD_REMOVE_PROGRAMS. Display. Name="Shoretel. Communicator" and. SMS_G_System_ADD_REMOVE_PROGRAMS. Version< ="1. 7. SMS_R_System. Name,SMS_R_System. Client. Version. You can change the where statements for the software you want to query and also the version number. In the example above, we are using Shoretel Communicator and version 1. Shoretel Communicator v. HOW DO I CREATE THE SSRS REPORT? We have now created a guide that will help you to create your SSRS reports based on the data that this guide will pull into the Configuration Manager database. You can access this guide by clicking the link below: Create a SSRS Report using Configuration Manager Database Data. COMMENTSIf you have any problems with any of the above, then please leave your comments and questions below using our Disqus system and we will try to get back to you as soon as we can. We also like to hear back any success stories too, so if you have used our guide and found it helpful, we would love to hear from you.
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Play over 1,800 free online games. Shockwave.com offers the best puzzle games, cooking games, dress up games, car racing games, and more. New games every day!![]() Pac- Man - Wikipedia. Pac- Man(Japanese: パックマン,Hepburn: Pakkuman), stylized as PAC- MAN, is an arcade game developed by Namco and first released in Japan in May 1. It was created by Japanese video game designer Toru Iwatani. It was licensed for distribution in the United States by Midway Games and released in October 1. Immensely popular from its original release to the present day, Pac- Man is considered one of the classics of the medium, and an icon of 1. Upon its release, the game—and, subsequently, Pac- Man derivatives—became a social phenomenon[1. Pac- Man animated television series and the top- ten Buckner and Garcia hit single "Pac- Man Fever".[1. Pac- Man was popular in the 1. When Pac- Man was released, the most popular arcade video games were space shooters—in particular, Space Invaders and Asteroids. The most visible minority were sports games that were mostly derivatives of Pong. Pac- Man succeeded by creating a new genre.[1. Pac- Man is often credited with being a landmark in video game history and is among the most famous arcade games of all time.[1. ![]() Daily Best Games - Free Download Games. Addicting games only - Mahjong, dress up games, racing games, puzzle games, hidden object games. Download files in the Games Demo category. Create anything from small school projects to triple-A video games with the help of this powerful 3D engine and editor. We offer video and PC game soundtracks for download in a very otherwise difficult to get MP3 form. Want to get your favourite game's OST? You have found the right place. It is also one of the highest- grossing video games of all time,[1. The character has appeared in more than 3. According to the Davie- Brown Index, Pac- Man has the highest brand awareness of any video game character among American consumers, recognized by 9. Pac- Man is one of the longest running video game franchises from the golden age of video arcade games. It is part of the collection of the Smithsonian Institution in Washington, D. C.[2. 1] and New York's Museum of Modern Art.[2. Gameplay[edit]. Screenshot of the play area. The player controls Pac- Man through a maze of various dots, known as Pac- Dots, as well as four multi- colored ghosts: Blinky, Pinky, Inky, and Clyde. The goal of the game is to consume all the Pac- Dots in a stage in order to proceed to the next one. Between some stages, one of three intermission animations plays.[2. The four ghosts roam the maze, trying to kill Pac- Man. If any of the ghosts touch Pac- Man, he loses a life; when all lives have been lost, the game ends. Pac- Man is awarded a single bonus life at 1. DIP switches inside the machine can change the required points to 1. The number of lives can be set to 1 life only or up to five lives maximum. High score cannot exceed 9. Near the corners of the maze are four larger, flashing dots known as Power Pellets that provide Pac- Man with the temporary ability to eat the ghosts and earn bonus points. The enemies turn deep blue, reverse direction and usually move more slowly. When an enemy is eaten, its eyes remain and return to the center box where it is regenerated in its normal color. Blue enemies flash white to signal that they are about to become dangerous again and the length of time for which the enemies remain vulnerable varies from one stage to the next, generally becoming shorter as the game progresses. In later stages, the enemies go straight to flashing, bypassing blue, which means that they can only be eaten for a short amount of time, although they still reverse direction when a Power Pellet is eaten; starting at stage 1. Pac- Man lose a life on contact), but they still reverse direction. There are also fruits, located directly below the centre box, that appear twice per level; eating it will result in bonus points (1. North American Pac- Man title screen, showing the official enemy names. Enemies[edit]The enemies in Pac- Man are known variously as "monsters" and "ghosts".[2. Despite the seemingly random nature of the enemies, their movements are strictly deterministic, which players have used to their advantage. In an interview, creator Toru Iwatani stated that he had designed each enemy with its own distinct personality in order to keep the game from becoming impossibly difficult or boring to play.[2. More recently, Iwatani described the enemy behaviors in more detail at the 2. Game Developers Conference. He stated that the red enemy chases Pac- Man, and the pink enemy aims for a position in front of Pac- Man's mouth.[2. The blue enemy is "fickle" and sometimes heads towards Pac- Man, and other times away. Although he claimed that the orange enemy's behavior is random, in actuality it alternates from behaving like the red enemy when at some distance from Pac- Man and aiming towards the lower- left corner of the maze whenever it gets too close to him. Although Midway's 1. Pac- Man used both the terms "monsters" and "ghost monsters",[2. Atari 2. 60. 0 version caused the antagonists to flicker and seem ghostlike, leading them to be referred to in the manual as "ghosts", and they have most frequently been referred to as ghosts in English ever since.[2. Kill screen[edit]Level 2. Since this is an 8- bit game, the maximum integer value is 2. Pac- Man was designed to have no ending – as long as at least one life was left, the game should be able to go on indefinitely. However, a bug keeps this from happening: Normally, no more than seven fruit are displayed on the HUD at the bottom of the screen at any given time. But when the internal level counter, which is stored in a single byte or eight bits, reaches 2. Normally, when the fruit counter is below eight, the drawing subroutine draws one fruit for each level, decrementing the fruit counter until it reaches zero. When the fruit counter has overflowed to zero, the first decrement sets the fruit counter back to 2. This corrupts the bottom of the screen and the entire right half of the maze with seemingly random symbols and tiles, overwriting the values of edible dots which makes it impossible to eat enough dots to beat the level. Because this effectively ends the game, this "split- screen" level is often referred to as the "kill screen". There are 1. 14 dots on the left half of the screen, nine dots on the right, and one bonus key, totaling 6,3. When all of the dots have been cleared, nothing happens. The game does not consider a level to be completed until 2. Each time a life is lost, the nine dots on the right half of the screen get reset and can be eaten again, resulting in an additional 9. In the best- case scenario (five extra men), 6,7. Four of the nine dots on the right half of the screen are invisible, but can be heard when eaten. Some dots are invisible but the rest can be seen, although some are a different color from normal. One method for safely clearing this round is to trap the ghosts. To trap the three important ghosts, the player must begin by going right until Pac- man reaches a blue letter 'N', and then he goes down. He keeps going down until he reaches a blue letter 'F' and then he goes right. He keeps going right until he reaches a yellow 'B', and then he goes down again. When executed properly, Pac- Man will hit an invisible wall almost immediately after the last turn is made. Eventually, the red ghost will get stuck. The pink ghost follows a few seconds later. The blue ghost will continue to move freely for several moments until the next scatter mode occurs. At that point, it will try to reach some location near the right edge of the screen and get stuck with the pink and red ghost instead. The orange ghost is the only one still on the loose, but he is no real threat since he runs to his corner whenever Pac- Man gets close so that it is easy to eat all the dots.[3. Emulators and code analysis have revealed what would happen if this 2. Billy Mitchell and Pac- Man, Fairfield Iowa 2. Perfect play[edit]A perfect Pac- Man game occurs when the player achieves the maximum possible score on the first 2. Level 2. 56.[3. 4][3. The first person to achieve this score is Billy Mitchell of Hollywood, Florida, who performed the feat in about six hours.[3. Since then, over 2. As of 2. 01. 6[update], the world record, according to Twin Galaxies, is held by David Race, who in 2. In December 1. 98. Jeffrey R. Yee, received a letter from U. S. President Ronald Reagan congratulating him on a worldwide record of 6,1. Split- Screen Level.[3. In September 1. 98. Walter Day, chief scorekeeper at Twin Galaxies, took the US National Video Game Team on a tour of the East Coast to visit video game players who claimed they could get through the Split- Screen Level. No video game player could demonstrate this ability. In 1. 99. 9, Billy Mitchell offered $1. Split- Screen Level before January 1, 2. The prize was never claimed.[3. Development[edit]. The North American Pac- Man cabinet design (left) differs significantly from the Japanese Puck Man design (right). Up into the early 1. ![]()
The Real Expense of Driving With Expired Tags in the State of Georgia. Operating a vehicle with expired Georgia registration tags can dump a heavy load of punishment down upon you. From paying fines to having your vehicle impounded, there is no up side to an expired tag conviction. If you have been arrested for this Georgia traffic law violation, you need to understand exactly what the law says and what to do if you are ticketed. If you’re caught driving with a suspended registration. you may also have points added to your license as a penalty for driving with a suspended registration.An Alpharetta traffic violation attorney answers some questions you may have. What are the Georgia requirements for vehicle registration? According to Georgia law: All owners of motor vehicles, including motorcycles, trailers and tractors, must register their vehicles and renew the registration every year. Exceptions include vehicles used only for farming, trailers with no springs used to haul farm products or fertilizers, motorized carts, and mopeds. All purchasers or transferees of used motor vehicles must obtain a registration transfer for the vehicle. New Georgia residents have 3. A valid county decal must be displayed on the license plate. Dealers of new vehicles are required to provide a valid registration for each car sold. What are the punishments for driving with expired tags or no tags? If you are convicted of driving with an expired tag, it is a misdemeanor on your permanent record. While fines vary depending on the county, listed below is a sample of the fines in Fulton County, which are typical statewide: Expired tag (5. Expired tag (6. 0 days or more) – $1. Improper display of tag – $1. Improper registration (failure to obtain Georgia tag) – $1. No county decal (first offense) – $3. No county decal (second offense) – $1. No tag – $1. 35. Statewide, if you drive a motor vehicle with a registration that is suspended, canceled or revoked, the penalties are much stiffer for a conviction. They include: A permanent misdemeanor on your record. Jail time up to 1. A fine of $5. 00 - $1,0. A second or subsequent conviction within five years raises the stakes with: A “high and aggravated misdemeanor” on your permanent record. Mandatory jail time up to 1. A fine of up to $2,5. In addition, your car can be impounded and you will have to pay the impound and towing fees. What can you do about a ticket you received for an expired registration tag? As you can see, driving with expired tags can become very expensive. If you need help with a ticket you have received for this Georgia traffic violation, contact an Alpharetta traffic violation lawyer at the Law Office of Scott Miller and let us answer your questions. Call today at 7. 70- 4. · Penalties by state for driving while license is revoked. Driving While Revoked, Suspended or Otherwise Unli. Georgia §40-5-121. Libro electrónico - Wikipedia, la enciclopedia libre. Lector de libros electrónicos Kindle Paperwhite de Amazon. Un Irving electrónico,[1] libro digital o ciberlibro, conocido en inglés como e- book o e. Book, es la versión o evolución electrónica o digital de un libro. Es importante diferenciar el libro electrónico o digital de uno de los dispositivos más popularizados para su lectura: el lector de libros electrónicos, o e- reader, en su versión inglesa. ![]() Manual De Microsoft Word 2007 Monografias Imagenes De Animales
Con el Mejor Fútbol y la Mejor Selección de Contenidos. Canal+ es Movistar+. Servicios: Internet y Fijo, Móvil, la mejor Televisión y Fusión. Http:// http://ja.bab.la/%E8%BE%9E%E6%9B%B8/%E8%8B%B1%E8%AA%9E-%E6%97%A5%E6%9C%AC%E8%AA%9E/coup.html. Minelli- de Oliveira, Camacho- i Martí y Gisbert- Cervera afirman que las nuevas tecnologías ofrecen diferentes posibilidades para el aprendizaje. La definición de libro electrónico de Vassiliou y Rowley (2. Vassiliou y Rowley (2. Desde esta perspectiva los libros electrónicos tienen características como la búsqueda de términos y las referencias cruzadas, enlaces a hipertextos, anotaciones, subrayado, objetos multimedia y herramientas interactivas.[2]Generalidades[editar]Algunos autores proponen que se debe hacer una distinción entre los libros electrónicos y el hipertexto. El hipertexto está destinado a la estructuración de la información a través de enlaces, mientras que un libro electrónico se ha definido como la versión digital de un libro. Aunque esta definición solía referirse a libros editados inicialmente en papel, cada vez es mayor el número de libros electrónicos que no tienen una edición impresa en origen. Un ejemplo de hipertexto sería Wikisource y uno de libro electrónico, cualquier libro en formato digital que pueda encontrarse en Internet o en cualquier dispositivo de almacenamiento de datos. Podemos encontrar los libros de texto fluido y de maquetación fija. Los libros de texto fluido son aquellos que nos permiten modificar la apariencia del texto por medio del lector que usemos, podemos cambiar su tamaño, color, interlineado y márgenes. En cambio en los de maquetación fija, vemos los contenidos fijos de alguna manera, sin hablar de las características interactivas que éste pudiera contener, vemos un diseño que no podemos alterar. El libro electrónico es un recurso informativo de reciente inserción en el universo de la ciencia, la tecnología, la educación y la cultura. Hasta el momento los e- Books representan el último paso cumplido por las editoriales en tema de edición digital: un tipo de ordenador personal con una pantalla táctil de alta definición y un sistema de menús con uso de comandos básicos.[1. Existen muchos dispositivos que pueden ser utilizados como lector de libros electrónicos: PC, PDA, portátil, y en general cualquier dispositivo que posea pantalla y memoria. Sin embargo, a finales de la primera década del siglo XXI comenzaron a aparecer dispositivos cuya función era servir exclusivamente para la lectura de libros electrónicos. Estos dispositivos se caracterizan por un diseño que permite emular la versatilidad del libro de papel tradicional. Así, se buscó movilidad y autonomía (dispositivos móviles con bajo consumo de energía para permitir lecturas prolongadas sin necesidad de recargas), pantallas con dimensiones suficientes para mostrar documentos tradicionales (un A4 o un A5) y alto nivel de contraste incluso a plena luz del día. En este contexto aparece la tinta electrónica, que tiene un "efecto papel" (debido a la ausencia de iluminación propia y alto contraste obtenido) y su bajo consumo (pues esta tecnología no necesita alimentación más que en los cambios de pantalla). Ejemplos de estos dispositivos son el i. Liad (fabricado por i. Rex y primer dispositivo comercializado en España desde 2. Reader (PRS- 5. 00 y PRS- 5. Sony, el Han. Lin V3 (comercializado en España por Grammata bajo el nombre de Papyre), el STARe. BOOK STK- 1. 01, el Bookeen. Cybook, el Amazon Kindle que es un producto de Amazon. Pad, un producto de Apple que además de ofrecer una librería en línea como Amazon, también permite diversificar la presentación de libros electrónicos con capacidades multimedia. En los últimos años se ha empezado a incorporar a los acervos de las bibliotecas, en particular en aquellas que se encuentran insertas en instituciones académicas. Entre las potencialidades que ofrece el libro electrónico, se pueden mencionar las siguientes: enorme capacidad de almacenamiento de información como la posibilidad de transportarla en grandes volúmenes.[1. Acontecimientos de importancia[editar]. Michael Hart (izquierda) y Gregory Newby (derecha) responsables del Project Gutenberg, 2. Michael Hart lidera el proyecto Gutenberg que busca digitalizar libros y ofrecerlos gratis.[3]1. Francos Crugnola e Isabella Rigamonti planean y realizan, por su tesina de licenciatura a la Politécnica de Milán, el primer libro electrónico (soporte electrónico por la sola lectura de textos) y lo llaman INCIPIT. Zahur Klemath Zapata registra el primer programa de libros digitales, Digital Book, y se publica el primer libro digital: Del asesinato, considerado como una de las bellas artes, de Thomas de Quincey. Digital Book lanza a la venta los primeros 5. Colombia en Formato Digital Book (DBF). Bibliobytes, un proyecto de libros digitales gratuitos en Internet. Amazon comienza a vender libros a través de Internet. Gutenberg alcanza los 1. La meta es un millón. Rocket ebook y Softbook. Stephen King lanza su novela Riding Bullet en formato digital. Sólo puede ser leída en ordenadores. Random House y Harper. Collins comienzan a vender versiones electrónicas de sus títulos en Internet. Amazon compra Mobipocket en su estrategia sobre el libro electrónico. Sony lanza su lector Sony Reader que cuenta con la tecnología de la tinta electrónica. Zahurk Technologies, Corp. Book lanza la primera biblioteca de libros digitales para su lectura en Internet, ‘Biblioteca. Klemath. com’, al igual que loslibrosditales. Amazon lanza Amazon Kindle. Grammata lanza al mercado español el Papyre. Adobe y Sony hacen compatibles sus tecnologías de libros electrónicos (lector y DRM). Sony lanza su PRS- 5. Reino Unido y Francia. Neotake lanza su buscador de libros electrónicos. Se lanza booq, el primer libro electrónico español. Wolder lanza el Boox, el primer lector de libros electrónicos con Wi- Fi y pantalla táctil. Wi- Fi. Enero de 2. Apple lanza el i. Pad y comienza a vender libros electrónicos para su producto.[4]1. Velocity Micro anuncia una familia de libros electrónicos basadas en Android. Amazon. com desata la guerra de precios al lanzar su Kindle 3 por 1. USA. Octubre de 2. Barnes & Noble lanza el Nook. Color, el primer lector de libros electrónicos en color con sistema operativo Android. Telefónica (Movistar ebook bq), Fnac (Fnacbook) y Casa del Libro (Tagus). Septiembre de 2. 01. Amazon. com lanza el lector Amazon Kindle de 5ª generación y el lector Amazon Kindle Paperwhite. Google comienza a distribuir libros a través de su tienda de aplicaciones para posteriormente lanzar la tienda Google Play Books. Septiembre de 2. 01. Nubico desarrolla el modelo de suscripción de libros electrónicos en España. Kobo llega a España en las Librerías La Central. Kobo empieza a vender e. Readers en Media. Markt. Ventajas y desventajas de los lectores electrónicos[editar]El libro electrónico posee tanto ventajas como desventajas. No obstante, es necesario distinguir entre el lector (un aparato electrónico con una memoria capaz de almacenar cientos de libros electrónicos) y el libro electrónico en sí, que no es más que un archivo de computadora en un formato específico PDF, MOBI, EPUB, etc. Entre las ventajas derivadas del uso de los lectores electrónicos se pueden citar varias: [5][6]Con ellos se puede leer casi cualquier documento en cualquier lugar. Al utilizar la tecnología de tinta electrónica no tiene retroiluminación, como es el caso de otros dispositivos de mano (tabletas, computadoras o teléfonos móviles). La experiencia es pues similar a leer un libro en papel: sin cansancio alguno para la vista, lo que permite por tanto prolongar la lectura durante horas. La accesibilidad es otro de los puntos fuertes del libro electrónico. Los lectores más avanzados del mercado ofrecen conexión a Internet, con lo que pueden conectarse con los principales portales de venta de libros electrónicos, así como descargarse las ediciones electrónicas de diarios o revistas convencionales. Los lectores que emplean la tecnología de tinta electrónica consumen muy poca batería debido a carecer de retroiluminación: el mayor consumo se produce con el paso de las páginas, por lo que la duración de la misma es muy alta. ![]() Archives - Philly. Illinois Wants To Ban Location Tracking Without Consent. It’s increasingly difficult to do anything on your phone nowadays without sharing your geolocation information. Certain Snapchat filters, Facebook status updates, Instagrams, and even text messages are all potentially tied to geolocation data. It’s relatively simple for app developers to build in geolocation functionality—and many services require users to opt- in to sharing location data. But now the state of Illinois wants ensure that all companies extracting geolocation data from individuals must provide an opt- in, or else they’ll have to pay up. Last week, both houses of the Illinois state legislature passed the Geolocation Privacy Protection Act (HB3. Now, it’s on the desk of Governor Bruce Rauner, waiting to be signed into law. If signed, companies would be required to inform users of how they’re using the location data they collect, if the users decides to share it. Companies who don’t adhere would be in violation of the Consumer Fraud and Deceptive Business Practices Act and would face criminal penalties and damages of at least $1,0. There are a few exceptions to the law. 2017: Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2016: Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2015: Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2014. ![]() Crack upute Mp3 DOMAĆI Mp3 STRANI Mp3 DJ's PS2 igre DivX FILMOVI DivX XXX DVD FILMOVI PC IGRE PROGRAMI Info Jihad Muhammad - Spiritual Dance Ep - (Msr009). Archives and past articles from the Philadelphia Inquirer, Philadelphia Daily News, and Philly.com. President Trump loves Twitter. It’s a direct stream-of-consciousness rant about whatever pops into his mind (or onto cable TV) at any given second. But here at. For instance, private entities can collect geolocation data without consent if the information will help parents find missing children or aid firefighters, police, or medical professionals. The new law might not have a huge real- world impact, given that most devices and apps already ask people for permission before they start using location data. But this might encourage more tech companies and app developers to give users the option to opt out of being tracked. There have been plenty of times in the past when companies have faced repercussions for tracking users without their consent. For instance, Apple and Uber have been sued for allegedly tracking un- notified users. Ari Scharg, director of the Digital Privacy Alliance (DPA), told Gizmodo that the organization has done reports on the apps Selfie. Rate Selfie Pic Hot Or Not, which give developers precise GPS coordinates whenever a person uploads a photo.“When a person is just browsing through the photos to rate them, if they were intercepting the backend traffic, they would be able to get the GPS coordinates of each person they viewed,” Scharg said. Overall, a person could use this information to stalk someone or the owner of the picture could retaliate against a person that left a bad comment if they were capturing the traffic.”The DPA urges app developers to be transparent with users by clarifying how location data is being used. The organization has been advocating for the bill, and even wrote an open letter to Governor Rauner, which was signed by more than 2. Chicago- area tech companies. Illinois has a reputation of passing strict data privacy legislation. The state’s Biometric Information Privacy Act prohibits tech companies from using biometric identifiers—like face scans and fingerprints—without consent. Their Right To Know Act—which passed in May, but was put on hold—requires companies such as Facebook, Amazon, and Google to disclose what data has been collected from consumers and shared with third parties.[Naked Security]. Torrentz Search Engine. Torrentz will always love you. Essay Writing Service - Essay. 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This guide shows how to navigate Activity on Arrow diagrams. This will help students deal with such questions in the PMP exam. Gee, M. D., Assistant Professor, UW Orthopaedics & Sports Medicine. Last updated: January 2. Overview. Tears or 'ruptures' of the anterior cruciate ligament (ACL) are common injuries in athletes of different ages and activty levels. ACL tears are treatable using arthroscopy and minimally- invasive surgical techniques. The surgical success rates for ACL reconstruction exceed 9. The anterior cruciate ligament is one of the major supportive ligaments in the knee. It extends from the lower leg bone (tibia) to the thigh bone (femur) at the knee. This ligament provides knee stability by preventing excessive forward movement of the tibia in relation to the femur and is also important in controlling rotation of the two bones. While the ACL is not the most commonly injured knee ligament, tears of this ligament frequently lead to chronic knee instability or “giving way”. ACL tears most commonly result during athletics from vigorous cutting, landing, deceleration or twisting injuries. It is less common for ACL tears to occur as a result of physical contact or collisions during athletics. Many patients who suffer an ACL tear will know immediately that something “feels wrong” with the knee. Many patients report feeling or hearing a “pop” associated with pain and a sense of the knee “giving out”. The joint will typically swell within several hours which results in restricted motion of the knee. It will become uncomfortable to bear weight on the injured leg, and the patient will prefer to walk with assistive devices for added support, such as crutches or a cane. Sometimes, the patient may experience the knee “giving way” when stressed with simple activities such as walking or changing directions. In the past, injuries to the ACL prohibited athletes from returning to “cutting” or “pivoting” high- demand sports. Currently, advanced surgical techniques reliably allow the return to athletic activities and physically demanding labor within 6 to 9 months. The goals of surgically reconstructing the ACL are to decrease the time lost to the injury, avoid additional injury to the knee, and to return to unlimited participation in functional and athletic activities. There are many different ways that the ACL can be reconstructed, and depending on the age, activity level, gender, and expectations of the patient. Symptoms & Diagnosis. Characteristics of anterior cruciate ligament tears. There are several mechanisms that can cause injury to the ACL. Direct contact forces, such as those experienced in a motor vehicle accident, can cause ACL disruption. However, the ACL is most commonly injured by indirect, noncontact mechanisms such as vigorous cutting, landing, or twisting motions. An example of this would be an athlete who suddenly decelerates from running and makes a sharp cutting motion or when a skier catches their ski edge in the snow causing a rotational force at the knee. At the time of ACL injury, individuals will experience a sudden severe knee pain and possibly hear or feel a “popping” sensation in their knee. Patients will have a difficult time bearing weight on the injured leg because of an unstable “giving out” sensation in the knee. Usually within the first few hours after the injury, the knee will become significantly swollen and the range of motion will typically decrease due to the limiting effects of pain and swelling. A completely torn ACL will never heal back to it pre- injury “normal” state even after nonsurgical treatment such as rehabilitation and physical therapy. The ACL is contained within the joint and covered with a thin layer of tissue (synovium). This synovial tissue is in contact with synovial joint fluid in the knee. In order for healing to occur, a collection of blood must form and clot around the ligament, but once the ligament and synovial tissue are torn, the ligament will be bathed in synvoial joint fluid. The blood is not able to collect, as it is diluted and “washed” away by the joint fluid; therefore healing is unable to occur. In addition, even with a partially torn ligament, the mechanical function of the knee may be altered after an ACL tear such that the normal path of motion of the knee is altered (like a swing with one of the chains broken). It is very difficult for the ligament to resume a normal length and function in this setting. Types. ACL injuries can be classified by the amount of damage to the ligament (partial or complete disruption). Injury to the ACL is usually a complete disruption, classifying it as a Grade III complete tear. Grade I Sprain - There is some stretching and micro- tearing of the ligament. The ligament is intact. The joint remains stable. These injuries rarely require surgery. Grade II Sprain (Partial Disruption) - There is some tearing and separation of the ligament fibers. The ligament is partially disrupted. The joint is moderately unstable. Depending on the activity level of the patient and the degree of instability, these tears may or may not require surgery. Grade III Sprain (Complete Disruption) - There is total rupture of the ligament fibers. The ligament is completely disrupted. The joint is unstable. Surgery is usually recommended in young or athletic persons who engage in cutting or pivoting sports. Additionally, injury can be classified by the presence or absence of associated damage to other structures in the knee (isolated or combined). Combined injuries may involve damage to the menisci, stabilizing collateral ligaments, or other knee structures. Figure 1. Meniscus - The medial and lateral menisi are “cushions” between the tibia and femur that act as a shock absorber and distribute stresses placed on the knee joint. Additionally, this structure helps stabilize the knee. A meniscus tear typically occurs with twisting motions such as pivoting. PCL - The posterior cruciate ligament “crosses” behind the ACL and restrains the tibia from moving backwards (posterior) on the femur. Traumatically, this ligament is commonly injured by striking the upper tibia, causing the tibia to move backwards, thereby stretching or tearing the PCL. An example of this would be striking the upper tibia on the dashboard during an automobile accident. In athletics, a PCL will tear during a hyperextension or extreme hyperflexion injury (like falling onto the shin with the knee bent and foot pointed). MCL - The medial collateral ligament provides stability to the inside aspect of the knee. This ligament is commonly injured when a medially (inward) directed force is applied to the outside of the knee, forcing the knee to twist in and the foot to twist out. Injury to this structure is common, but if it is an isolated partial disruption injury then it can typically be treated with physical therapy and bracing. LCL - The lateral collateral ligament imparts stability to the outside aspect of the knee. Isolated LCL injuries are infrequent, but when injured it is commonly due a lateral (outside) force applied to the inside of the knee. It is not uncommon to hear the term “unhappy triad” associated with an ACL injury. This describes an ACL injury associated with a concomitant MCL injury and medial meniscus tear. This triad usually occurs when the ACL has been torn for a long time (‘chronic tear’). It is more common to tear the lateral (outside) meniscus after an ‘acute’ ACL tear. Similar conditions. ACL injuries are usually not subtle and most individuals will know exactly when the injury occurred. There are conditions in the knee that can mimic a sense of instability, some operative and others non- operative: Isolated collateral ligament injury - Severe injury to any of the knee ligaments (ACL, PCL, MCL, LCL) can result in a sense that the knee does not behave normally. Meniscal tear - A torn fragment of the meniscal cartilage can become temporarily “trapped” in the joint, and produce a sense of “giving way” or “instability”. Arthritis/articular cartilage injury - A flap of cartilage, or a loose fragment of cartilage or bone in the knee will produce “locking” or “giving way” that may be likened to “instability”. Patellofemoral joint instability/dislocation - Dislocation of the kneecap off the front of the femur can often mimic the “pop” that is heard when an ACL injury occurs, and can result in pain, inflammation, and a sense of instability. 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