Anterior Cruciate Ligament Tear
There are four important ligaments in the knee joint (the anterior cruciate ligament, the posterior cruciate ligament, the medial collateral ligament and the lateral collateral ligament) that maintain the stability of the joint and connect the bones to each other. The most important and most susceptible to injury is the anterior cruciate ligament. Most cases of anterior cruciate ligament rupture occur in athletes who practice some sports that require great effort such as football, basketball, tennis, and others. The anterior cruciate ligament is located in the middle of the knee in an oblique manner and intersects with the posterior cruciate ligament in the shape of the letter “X”. Its main tasks include providing stability to the knee joint when rotating the joint and preventing the shinbone from sliding to the front of the thighbone.
Degrees of anterior cruciate ligament rupture
About 50% of anterior cruciate ligament injuries occur with other injuries such as a torn meniscus or injuries to the cartilaginous surface of the knee or injuries to other ligaments such as the lateral ligaments of the knee joint. It can also cause bone bruises under the cartilaginous surface that can be observed via magnetic resonance imaging. The degrees of anterior cruciate ligament tears can be classified according to their severity as follows:
First-degree tear: When the anterior cruciate ligament is slightly torn with a slight stretching of the ligament, with its ability to perform its function by stabilizing the knee joint.
Second-degree tear: When the ligament is torn and stretched to the point that the knee joint is relatively unstable, and this condition is usually called a partial cruciate ligament tear.
Third-degree tear: When the anterior cruciate ligament is completely torn and divided into two parts, causing instability of the knee joint.
Complete ruptures of the anterior cruciate ligament are more common than partial ruptures of the anterior cruciate ligament.
Grades of anterior cruciate ligament tears
Causes and symptoms
An anterior cruciate ligament tears may occur for many reasons, including:
A sudden and rapid change in direction. Sudden stopping.
Landing incorrectly when jumping.
Friction or direct collision that may occur in several types of sports such as football.
Accidents.
There are a number of scientific studies that show that female athletes are more susceptible to ACL injuries than males, which may be due to many reasons such as physical position, muscle strength, the effect of estrogen on the ligaments, and several other reasons. Common symptoms of a torn cruciate ligament include:
Pain and swelling within 24 hours of the injury. The pain and swelling may go away with rest, but return when exerting effort, and you will feel that the knee joint is unstable, which may increase the risk of injury to the meniscus of the knee.
Restriction in movement and inability to fully bend or extend the knee joint.
Local pain in the knee joint.
Feeling after rest when walking.
Diagnosis
Clinical examination: When you visit the doctor, he will perform a specific clinical examination of the knee to determine the locations of damage in the knee. Most ligament injuries to the knee joint can be diagnosed clinically through a clinical examination of the knee joint.
X-rays: X-rays do not show any aspects related to the cruciate ligament, but they show whether the injury caused some damage or fracture in the bone.
Magnetic resonance imaging (MRI): MRI clearly shows the structure of the cruciate ligament.
Diagnostic arthroscopy: This is the most accurate and most illustrative method for all damaged aspects within the knee joint. It may be used in some rare cases.
Arthroscopic cruciate ligament
Treatment
The nature of the injury, the lifestyle of the injured person, his age, his level of activity, his acceptance of changing his lifestyle after the injury, and many other aspects affect the determination of the appropriate treatment plan for a specific person. Conservative treatment methods may be preferred for some cases, and the surgical option may be preferred by implanting a cruciate ligament for other cases. Recently, regenerative treatment has been applied for some cases by local injection of the anterior cruciate ligament for cases of partial rupture of the ligament.
Conservative (non-surgical) treatment methods: Non-surgical options may be suitable for a group of elderly patients whose level of activity is low, if the level of stability of the knee joint is considered acceptable. There are recent studies showing that the anterior cruciate ligament implantation operation is an effective option even for elderly patients if the level of activity in these patients is high. Also, some young patients who have not reached the stage of maturity and puberty, the doctor may choose to wait until the patient's growth is complete in order not to injure the patient's growth centers, and there are recent studies on this where alternative methods have been developed to perform cruciate ligament transplantation and not injure the child's growth centers. Therefore, each case requires an independent study to determine whether the non-surgical option is more appropriate for a particular patient. In general, the non-surgical option may be more appropriate for cases of cruciate ligament rupture (and no other accompanying injuries) if:
There is a partial cruciate ligament tear with knee stability.
Patients who have a complete cruciate ligament tear with no symptoms of knee joint instability, and are ready to give up exercise that requires high effort.
Those who have a sedentary lifestyle or whose activities are considered light.
Those who are still in the growth stages (children).
Some non-surgical treatment options may include:
Physiotherapy.
Using a special knee brace.
Surgical treatment methods (anterior cruciate ligament transplantation): This is done by taking a part of the ligament from another location in the body and transplanting it in place of the torn anterior cruciate ligament. The ligament can be taken from several sources such as the patellar tendon (patellar tendon), the hamstring tendon, or the quadriceps tendon. The anterior cruciate ligament transplantation is performed through an endoscope. The video below shows how to transplant the anterior cruciate ligament from the patellar tendon. The patient needs to undergo intensive physical therapy before returning to work.
Frequently Asked Questions
What is the success rate of ACL reconstruction?
Studies show that the long-term success rate ranges from 82% to 95%, and failure of the implanted ligament or recurrence of symptoms of knee joint instability may occur in 8% of cases.
What is the purpose of ligament reconstruction and is it necessary?
The goal is to reduce symptoms of knee instability and restore the function of the anterior cruciate ligament in stabilizing the knee joint, as 90% of cases suffering from chronic knee instability lead to the destruction of the meniscus and cartilage surfaces of the joint and accelerate the patient's suffering from early osteoarthritis of the knee joint. Also, cruciate ligament reconstruction restores stability to the knee joint, enabling athletes to return to sports. Patients whose lifestyle depends on many activities or whose work depends on physical activity to a large extent or athletes are advised to undergo anterior cruciate ligament reconstruction.
Will the pain continue after ligament reconstruction?
You will feel pain after the operation, and this is normal and is considered part of the recovery process. Your doctor will prescribe the necessary medications for a short period to help you during the recovery process and improve the pain.
When can I return to my activities?
Post-operative physical therapy is a very important part of the success of the ACL transplant and begins immediately after the operation. Most successful ACL surgeries depend on the patient’s interest and dedication to intensive post-operative physical therapy. You will need to use crutches for the first 7 to 10 days to walk after the operation, after which you may use a brace for several weeks. As for returning to high-impact sports, the time may vary from patient to patient, and this will be when the pain and swelling have subsided and the full range of motion of the joint has been restored and balance, control and function of the joint are fully restored, and this may take 3 to 6 months.
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