The knee is an
important joint complex. The articulation between the tibia and the femur, in
particular, is subjected to considerable forces even when we perform routine
activities, such as standing and walking.
For this reason, its
stability (or the ability of the joint surfaces to remain perfectly aligned) is
essential.
What
is the anterior cruciate ligament?
The cruciate ligaments
are four in number (two anterior cruciate ligaments, and two posterior) and to
keep the tibia and fibula permanently connected to each other.
The anterior cruciate
ligament prevents the tibia from sliding forward with respect to the femur,
while the posterior tibia prevents the tibia from moving posteriorly.
The cruciate ligaments
are very robust and hardly damaged without reason; for some reason, the two
posterior cruciate ligaments are usually thicker and therefore much less prone
to injury, while the anterior ones are damaged and break more easily.
Among the most frequent
causes of this type of injury are traumas caused by falls and sprains or by
rapid changes of direction, typical for example of sports such as football and
volleyball.
Road accidents can also
obviously cause this type of accident.
Symptoms
of rupture
The most common
symptoms are:
• knee pain
• swelling
• feeling of
instability
• difficulty performing
certain movements
Sometimes the patient
hears a typical noise, a kind of crack that may be indicative of the rupture.
Apart from the feeling
of instability, which is permanent, the other symptoms can, however, also be
mild and disappear in a relatively short time.
If the trauma is not
particularly severe and does not damage the surrounding anatomical structures,
it is possible that, by applying ice and taking anti-inflammatory medications,
the patient can walk quite normally within a dozen days and not notices the
damage.
Diagnosis
The advice of a
qualified specialist in these cases is very important because he will be able
to make an accurate diagnosis through some physical tests that take place
during the visit, such as the Lachman test.
The diagnosis will then
be confirmed through magnetic resonance imaging, which allows the surgeon to
assess the damage also suffered by tendons and cartilage, and x-ray, to be
carried out if a bone lesion is suspected. The best orthopedic
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Conservative
treatment
When the specialist
believes that the damage is partial and can be resolved without the aid of
reconstructive surgery, or when he thinks that the patient's needs are limited
and his chances of recovery are not sufficient to take advantage of the use of
surgery, he will propose a conservative treatment.
Surgical
treatment
In most cases where an
anterior cruciate ligament is diagnosed, the most efficient solution is to have
reconstructive surgery.
The techniques
currently used have a very high success rate.
The most common is to
use autograft, a part of a tendon taken from elsewhere, through a small
incision: usually, it is the patellar tendon or the gracilis tendon, but
different solutions can also be adopted.
Alternatively, it is
possible to use a cadaver tendon transplant; however, this solution has the
disadvantage of a higher possibility of post-surgery complications.
If possible, the
minimally invasive arthroscopic mode is usually preferred, which accelerates
recovery time and leaves less noticeable scars on the knee.
Whatever the option is
chosen, the surgical procedure involves five phases:
· removal of
debris from the damaged ligament
· the preparation
of the housing of the new ligament
· the construction
of bone tunnels in the femur and tibia for the insertion of the ligament
· insertion into
the joint
· fixation of the
transplanted ligament
Post-operative
recovery
In this phase, it is
essential that the patient follows the medical team's indications regarding
rehabilitation with commitment and diligence, to maximize the result and avoid,
as far as possible, relapses and other complications.
It is possible to
resume a light physical training regimen after about 60 days from the
operation.
