One of the most common injuries of the knee is anterior cruciate ligament rupture. Knee joint consists of three bones. These are femur, tibia, and patella. These bones are attached by ligament and ligament provides stability. These is lateral collateral ligament in the medial and lateral side of the knee which prevents the knee opening outward. The cruciate ligament is intraarticular ligament in the knee, which controls back and forth movements of the knee.
Anterior cruciate ligament ruptures are generally seen in people with certain professions and doing sports actively. Injuries are generally caused by anatomic narrowness in the area where cruciate ligament adheres, poor floor on which the sports are done and unhealthy equipment.
More than half of the anterior cruciate ligament injury is accompanied by cartilage, lateral ligament and meniscus injuries.
Causes of Anterior Cruciate Ligament Injury
- Fast twist of the knee
- Falling while running
- Instant stop while running
- Incorrect position while jumping off
- Direct hitting in sports such as football, basketball.
There are possible causes, however, anterior cruciate ligament rupture generally occurs without touching. Rupture is caused by an instant twist of the knee rather than direct hitting, falling or trauma. Let’s give an example from a football match: You see a player doing free-kick lays flat with pain. Anterior cruciate ligament of the leg which does not hit the ball has rupture. Because, when the foot is stable, the knee instantly twists due to, for example, the crampon jams in the grass. There is not any hitting, falling or touching.
How to realize anterior cruciate ligament rupture?
- In the case of anterior cruciate ligament rupture, it is felt as if the knee was dislocated and swelling occurs. Besides the swelling the person walks lame and lays flat. S/he cannot stand on the foot, it feels insecure, whereas s/he should not stand.
- Swelling is seen to increase within 24 hours.
- Sensitivity occurs through the joint line.
- Edema, bruise or redness is seen in the knee.
- At the moment of rupture, a “pat” voice can be heard. (This voice is the voice of anterior cruciate ligament and it is heard clearly.)
How is anterior cruciate ligament rupture diagnosed?
For the diagnosis of anterior cruciate ligament rupture, first of all, the physician evaluates the trauma experienced by the patient. When the rupture has just occurred, swelling, pain, and tension are observed in the knee. In physical examination, the healthy knee and damaged knee are compared. The stability of the knee is examined with special tests. For pre-diagnosis, x-ray imaging may be performed however the most effective way for anterior cruciate ligament rupture is MRI. Additional injuries such as meniscus tear, cartilage lesion, and other ligament rupture are detected with MRI.
Treatment of Anterior Cruciate Ligament Injury
The only treatment method of anterior cruciate ligament rupture is surgery. Injection methods which are beneficial for meniscus tear, osteoarthritis, and other orthopedic disease are not useful for anterior cruciate ligament rupture. Treatment is possible with surgery. Non-surgical methods such as injection are beneficial for post-op recovery period. However, they cannot be used instead of surgery. Especially in some professions and people doing sports, surgery should be applied definitely and immediately. Successful surgical treatment should be supported by a good rehabilitation program. If a rupture in anterior cruciate ligament is not treated, cartilage and meniscus injuries occur in a short time. In long term, increase can be observed in cartilage damages according to the frequency of the space in the knee. Early treatment of ligament protects the meniscus and joint cartilages.
Anterior Cruciate Ligament Surgery (Knee Arthroscopy)
Anterior cruciate ligament rupture is treated with arthroscopy method. Arthroscopy is a closed surgery method. Instead of large incisions as in open surgery, the knee and through 0.5 cm incisions with cameras and instruments, and imaging and treatment are applied through 0.5 cm incisions with cameras and instruments. So, comfort is provided during the operation and recovery process. For more information about arthroscopy, you can read knee arthroscopy article.
In anterior cruciate ligament where there is a full rupture, suture procedure cannot be applied. Instead, anterior cruciate ligament is restructured with tendon transfer obtained from the patient’s own body. The tendon to be used is determined by the physician.
Rehabilitation after Anterior Cruciate Ligament Surgery
Rehabilitation has an important role for the patient to get back the daily activities. Physiotherapy is essential to increase range of motion and muscle strength. In the first phase after the surgery, the patient is made walk by standing. Physiotherapy is started as soon as possible.
It takes approximately 6 weeks for the patient to get back to daily activities and 8-12 months on average to get back to contact sports.