The anterior cruciate ligament (ACL) is located inside the knee and is so named because of its arrangement in space in relation to the posterior cruciate ligament and the knee axes.
ACL acts as the primary stabilizer of anterior displacement of the tibia to the femur and, secondarily, limits the internal tibial rotation, mainly in the last degrees of extension of the knee
Lesions of the anterior cruciate ligament
The main lesion of the ACL is its partial or total rupture, which may be caused by sports or recreational activities, because of:
A) Direct trauma: contact of the knee against another object, sometimes associated with major or minor injuries of other ligaments, mainly sprains of the lateral ligaments.
B) Indirect injuries: no contact on the knee. These are usually injuries caused by sudden turns with the foot fixed to the ground. Here they are frequently associated with meniscal injuries.
C) Hyperextension of knee and high energy trauma (traffic accidents). They are less frequent and sometimes involve complex ligament and joint capsule injuries when knee dislocations occur.
How to treat injuries to the anterior cruciate ligament
According to the type of injury, the type of patient and the degree of instability it provokes, it will be necessary to choose a conservative or a surgical treatment:
- Conservative treatment: In sedentary patients with moderate levels of activity, who do not want to perform sports involving sudden changes in direction and speed, intervention is not necessary (provided they do not suffer from a major instability that makes their daily activity difficult). The patient will have to perform a directed rehabilitation to gradually recover the mobility of the knee and to strengthen the musculature. If everything goes well they can then practice running, swimming or cycling without problems. The treatment will last between 10-14 weeks.
- Surgical treatment: The sutures of this ligament are not effective and it will be necessary to reconstruct the ligament, that is, to make a new ligament. Different grafts and devices can be used for this purpose. Currently this surgery is assisted by arthroscopy and only opens the knee to obtain the graft (if necessary). The grafts can be obtained from the patient (autograft) or from a donor (allografts).
When to operate an anterior cruciate ligament injury?
In young and active patients reconstruction of the ligament is the best possible treatment, since conservative treatment can lead to a high risk of failure episodes, in addition to increasing the risk of secondary (meniscal and degenerative cartilage) injuries.
Age does not in itself constitute a contraindication for this intervention, and if the patient practices high-demanding sports for his knee or presents clear episodes of instability for his daily life, reconstruction will be necessary.
Postoperative operation of the anterior cruciate ligament
Postoperative recovery is usually rapid, since it usually employs an accelerated rehabilitation system that allows the patient to quickly recover mobility and ambulation. After a regular admission of about 24 hours to maintain an initial drainage, the patient is able to perform isometric exercises and mobilization of his knee, since I do not use any type of knee.
The patient can perform immediate and progressive support with the help of crutches and lead a normal life, with no physical demand at around 6 weeks. Subsequently, a period of progressive rehabilitation for muscle strengthening will begin, allowing you to start with controlled physical activity (bicycle, swimming pool, etc.) from 6-8 weeks. The return to risk sports with significant pivots can be done from the 6th month, if mobility and strength are similar to the contralateral leg.
After the operation of the anterior cruciate ligament, does physical activity recover prior to injury?
The reconstruction surgery of the cruciate ligament achieves excellent results, reaching 90% the percentage of patients who return to practice sports. At times (20%) the previous competitive level is not recovered if it was very high.