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Anterior cruciate ligament |
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In the center of the knee are the two cruciate ligaments whose function is to prevent the anterior and posterior translation (movement) of the tibia relative to the femur. They are called "cruciates", because they cross each other in the center of the articulation. (more details ...) |
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| What you have to know ... |
Knee anterior cruciate ligament injury (ACL) occurs to athletes during sports activity in 85% of cases (football, skiing, rugby, handball, soccer etc.) : it is a frequent, invalidating and evolutionary lesion. Surgical treatment (reliable for more than 15 years) and anterior cruciate ligament rehabilitation have an essential place. An anterior cruciate ligament tear or total lesion in the younger sportsman requires, generally, a surgical treatment. On the other hand, it is not necessary to undergo immediate surgical procedure. Continued practice of the sport with an unstable knee (in the presence of an anterior cruciate ligament tear) is discouraged. The treatment can be preserving (non surgical) among patients without sporting ambitions or who are older. A rupture of the ligament may be associated with meniscal lesions. As far as possible it is necessary to try to reconstruct the anterior cruciate ligament before the occurence of these meniscal lesions. However, in the presence of meniscal lesion, if possible, surgical treatment should be considered to preserve the meniscus (meniscal repair or meniscal allograft) and to reconstruct the ligament. The evolution of an untreated lesion in the young sportsman can result in osteoarthritis (cartilage wear) 20-30 years after the initial rupture. |
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Signs and sympto
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Rupture of the anterior cruciate ligament is very often observed in a sporting context where the quadriceps is strongly contracted (landing after a jump, putting the shot, etc. ...). ACL injuries are commonly the result of non-contact mechanisms, with a valgus force applied to a flexed knee and in external rotation or in varus and internal rotation. A cracking (pop) is sometimes heard by the patient associated with a "giving way" feeling. The pain is of variable intensity, sometimes explained by the presence of haemarthrosis (blood in the joint) which puts the articular capsule in tension. |
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| Diagnosis |
Diagnosis can be formulated on the history and a clinical examination of the knee: in the case of recent lesion, this examination is carried out so as not to aggravate the pain. The puncture of an effusion can show the presence of blood (haemarthrosis): it is evocative of a ligamentous rupture. A fixed flexion deformity is always researched and the lachman-Trillat test can confirm an anterior cruciate ligament tear. The Jerk test or pivot shift test is more difficult to find in the acute phase because of the pain. |
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Radiographs
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Simple x-rays are necessary because they can show the presence of osseous lesions (tibiale eminence fractures, notch of the external condyle). The radio of the knee can show a "Segond fracture" (lateral capsular avulsion), evocative of an ACL injury. Dynamic radiographs (radiological Lachman, Telos) can be very useful in the search for an important laxity. MRI(magnetic Resonance) is the more reliable examination for diagnosis of rupture of the ligaments and the menisci, but its realization and its interpretation require considerable experience |
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Surgery
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Surgical techniques used to reconstruct the anterior cruciate ligament of the knee are performed in arthroscopy. Most of the time it is possible to use an autograft (a tendon from the same patient): the most frequently used grafts are the central third of the patellar tendon, the tendons of pes anserinum (hamstring tendons) or semitendinosis tendons. This tendon replaces the broken anterior cruciate ligament in his anatomical position. The graft is fixed on the femur and on the tibia using "interference screws" or other fixings. Sometimes, in severe laxities or in "sportsmen at risk", an additional extra articular graft seems to be necessary to protect the intra articular graft. Experience has shown us that a direct suture of the stub of the broken anterior cruciate ligament (bibliography*) or the use of artificial ligaments does not give good results in surgery of the anterior cruciate ligament. |
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Anterior
cruciate ligament Rehabilitation
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Anterior cruciate ligament rehabilitation is essential in obtaining a good result. The objectives of rehabilitation of the knee after graft of the anterior cruciate ligament are currently well established. Rehabilitation is however different according to the surgical technique and, in particular, according to the graft utilised and its fixation. The goal is, in any case, to begin the mobilization immediately after the intervention. (On the website you can find indications of a general nature: it is in any case necessary to follow " to the letter" the indications of your treating surgeon and your physiotherapist.) |
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| Frequent questions |
How long is it necessary to wait before continuing sport after ACL graft reconstruction? Will there be a scar ? How big ? (photo) (answer) How long is it necessary to stop work after ACL reconstruction? How many days of hospitalization are likely to be necessary ? And if I don't want to undergo surgery ? After how long can I drive a car? When is it necessary to remove the suture wires?
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