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Knee ligament injury

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Written by Garotta Lorenzo   

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Knee ligament injury
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.

Knee ligament injury: what you have to know about knee ligament injuries ...
Knee anterior cruciate ligament injury (ACL)  occurs to athletes during sports activity in 85% of cases (football -look at the video-, 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 ACL lesion in the young sportsman can result in osteoarthritis (cartilage wear) 20-30 years after the initial rupture.

Knee ligament injury: signs and symptoms
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.

Knee ligament injury: 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.

Knee ligament injury: radiographs
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.

Knee ligament injury: surgery

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 or the use of artificial ligaments does not give good results in surgery of the anterior cruciate ligament.

 

Knee ligament injury: anterior cruciate ligament rehabilitation

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.)

 

 

Knee ligament injury: frequent questions

  • How long is it considered necessary to wait before returning to sports after ACL reconstruction?

You can practice contact sports (football, rugby, handball, etc.) from 6 to 9 months after intervention. 

 

  • Will there be a scar ? How big ?

Yes: the intervention is performed in arthroscopy, but an incision is necessary to take the graft. The scar from a hamstring graft is shorter and more "aesthetic". A patellar tendon graft scar is approximately 6 to 8 cm. In the case of a double incision technique a small external scar, less than 2 cm, is necessary. 

 

  • How many days of hospitalization are likely?

Hospitalization is short: in general from 3 to 5 days, but the operation can alternatively be performed during day-surgery.

 

  • And if I do want  an operation on the knee?

We advise surgical procedure for sportsmen with an anterior cruciate ligament injury if they wish to continue sports activities: performing sports activities without ACL can cause meniscal injuries and later lead to cartilage damage (sometimes even to a disabling knee osteoarthritis condition).

 

  • How long do I have to stop to work for (or school) after an anterior cruciate ligament reconstruction in arthroscopy ?

For schoolpupils it is necessary to take a break of about fifteen days: for a "manual" worker (mechanic, electrician etc.) it is necessary to stop working for 6 to 9 weeks. For hard physical work (builder, gardener, etc.) 3 months are necessary.

 

  • How soon after surgical procedure can I drive a car?

Once the graft has taken well (the osseous blocks consolidate normally 45 days after surgery) you can lead a normal everyday life (climbing stairs,  driving a car etc....)

 

  • Can I take a shower?

Personal hygiene before and after any intervention in orthopedic surgery is very important: nevertheless, the wound should not be allowed to become wet - by taking a bath for example , because the risk of infection is high if cicatrization is not obtained. Currently there is the possibility of applying tight bandages, which allow one to take a shower without any problem.

 

  • When is it necessary to remove the wires?

Wires fall away within 10-15 days, if they are the resorbable type. If not, they should be removed approximately 14 days after intervention (and you will not have any pain....).


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Last Updated on Tuesday, 20 September 2011 09:16