What are Anterior Cruciate Ligament Injuries?
The anterior cruciate ligament is one of the important structures that connect the bones in the knee joint.
This ligament, which is very important for the normal functioning of the knee, prevents the tibia from abnormally moving forward. The injury usually occurs during a sudden turning movement on a fixed foot. More rarely, ACL injuries can occur after direct blows to the knee, traffic accidents, falls from heights, and industrial accidents. In this case, injuries to the posterior cruciate ligament, lateral ligaments, and menisci can also be added to ACL injuries. During ACL injuries, a sudden rupture in the knee and severe pain occur. Some individuals can hear the sound of the ligament rupture and often fall to the ground. Swelling occurs due to rapidly developing bleeding inside the knee joint.
Ön çapraz bağ yırtığının tanısı, yaralanma oluş şeklinin ayrıntılı olarak anlatılması ile başlar. Bunu dikkatli bir muayene izler. Sadece bu hikaye ve muayene ile ön çapraz bağ yırtığının tanısı %90’ın üzerinde bir oranda konabilir.
Sometimes, an adequate examination may not be performed at first because the knee is very painful. In this case, a second examination within 10 days is diagnostic. If an early diagnosis is needed, MRI is helpful in the diagnosis.
Ciddi diz yaralanması geçiren bütün hastalarda röntgen grafileri elde olunmalı ve kemiklerde kırık olup olmadığı araştırılmalıdır. Ön çapraz bağ yaralanmalarında grafiler genellikle normaldir. Manyetik rezonans görüntüleme ön çapraz bağ yırtıklarının tanısında %90’ın üzerinde doğruluk oranına sahiptir. Ayrıca eşlik eden menisküs, yan bağ ve kıkırdak yaralanmaları ve kemik ödemlerine tanı konabilir. Ancak nadir de olsa MRG yanıltıcı olabilir, bağ işlev görmeyecek derecede yaralanmış olduğu halde MRG’de bağın devamlılığı korunmuş gibi görülebilir. Bu nedenle tedaviye karar verirken MRG tek belirleyici değildir, muayene ve hikaye bulguları da göz önüne alınmalıdır.
Treatment of Anterior Cruciate Ligament Injuries
The treatment for anterior cruciate ligament injuries in young individuals who do sports or have an active lifestyle is surgery. Surgical treatment may not be performed in individuals who are older, do not have a high activity level, do not do sports, and do not have complaints such as space or insecurity in their knees in daily life.
In children who have not yet completed their growth, it was previously recommended to wait until growth was complete and then perform surgical treatment. However, today, since it has been observed that children who have not undergone surgical treatment develop irreversible meniscus and cartilage injuries in the knee, the needle has shifted to performing surgery at an earlier age.
If nonsurgical treatment is chosen, muscle strengthening programs are recommended to reduce the feeling of insecurity and emptiness in the knee, and protective knee pads can be used in sports that strain the knee. However, if there is severe strain, neither can prevent the knee from dislocating and additional injuries to the knee may occur.
The goal for individuals with ACL injuries is to eliminate the feeling of emptiness and insecurity in the knee and to obtain a knee that the person can safely step on during sports or strenuous activities. Another goal is to protect the menisci if they were not damaged during the initial injury and to prevent wear and tear that may occur in the knee in the future by repairing meniscus tears that can be repaired. Another goal of surgery is to return athletes to the level of sports they were at before the injury and to prevent new injuries to the knee.
How is anterior cruciate ligament repair performed?
If the anterior cruciate ligament has separated by tearing off a piece of bone from where it is attached, the broken piece of bone is reattached. In this case, which is more common in children, the fixation can be done with screws or stitches. This procedure is usually done arthroscopically, in rare cases open surgery may be necessary. In adults, the anterior cruciate ligament is usually torn by separating and fragmenting the fibers in its body. It is not possible to repair a ligament in the form of a frayed tissue, and the ligament must be repaired with new tissue during surgery. The tendons of the muscles around the knee are often used for ligament repair. The most commonly used tissue for this is the patellar tendon, which is located in the front of the knee and is taken with a bone block at both ends. The second most commonly used tissue is the tissue located in the back of the knee, known as the hamstring tendons. There is no bone block at the ends of the hamstring tendons. In some cases, tissues taken from cadavers, sterilized and made ready for use can be used. These tissues, called allografts, are usually preferred in cases where more than one ligament is injured and the person's own tissues are not sufficient; in cases where surgery has been performed before and their own tissues have been used, and in very young children. Synthetic ligaments, popular in the eighties, were abandoned due to their poor results.
Anterior Cruciate Ligament Injury Surgery
First, the tissue to be used in ligament repair is taken, this tissue is called a graft. Then, knee arthroscopy is performed to evaluate other structures within the joint. If there is an injury to the meniscus and joint cartilage, the necessary intervention is performed. Then, tunnels are opened in the bones in the knee joint, and the path for the new ligament is prepared. The graft is passed through these tunnels and the bone is fixed in the tunnels with appropriate tension. Metal or dissolvable screws, cross nails and U-shaped nails are used for this. These screws and nails that hold the ligament in place can remain in the body for life as long as they do not cause discomfort and do not need to be removed.
The surgery may take between 40 minutes and 1 hour. A thin plastic tube called a drain is placed to drain the blood that has accumulated in the knee joint. This drain is usually removed during the dressing change 24 hours after the surgery.
What does double bundle anterior cruciate ligament repair mean?
Depending on the characteristics of the patient's knee, the surgeon's experience and preference, single or double-bundle anterior cruciate ligament repair can be performed. In large-bodied patients in particular, double-bundle ligament repair can be performed to better recreate the original fan structure of the ligament. In these patients, 4 separate tunnels are opened instead of 2 and 2 graft tissues are detected by adjusting the tension at different angles. Although it is superior to single-bundle in experimental studies, it has not been found that there is no significant difference in patient applications.
Post-Anterior Cruciate Ligament Surgery Period
The length of hospital stay after surgery can vary from 1 to 3 days. It is possible to stand up with crutches after the effect of the anesthesia has worn off. Knee movements are started the same day or the next day, and the aim is to bend your knee to 90 degrees. It may be necessary to protect the knee from overload by using crutches for a few weeks after surgery. Full knee movement should be achieved within three weeks. It takes 6 weeks for the placed graft tissue to fuse and attach to the bone tunnels. After this period, normal walking and driving are possible. It takes a year for the placed tissue to fully mature and solidify, but it is possible to start sports activities after the 5th month.
What is the Success Rate of Anterior Cruciate Ligament Surgery?
Ön çapraz bağ cerrahisi sonrası ülkemizde ve dünyada bildirilen başarılı sonuç oranları %80–90 arasındadır. Teknik sorunlar, yeni oluşan yaralanmalar ve dize yerleştirilen dokunun yeni bir bağ şeklinde olgunlaşıp sağlamlaşmaması nedeniyle hastaların % 10-20’sinde yeterli başarı elde edilmeyebilir. Bunların da bir kısmında yeniden bağ cerrahisi gerekli olabilir.
What is the anterior cruciate ligament (ACL) and what is its function?
The anterior cruciate ligament is an important ligament that connects the thigh bone (femur) and the shin bone (tibia) in the knee joint and provides stability to the knee. This ligament prevents the shin bone from sliding forward, allowing the knee to move normally and maintaining balance.
How do anterior cruciate ligament injuries occur?
Anterior cruciate ligament injuries usually occur in the following situations:
- Sudden stopping or change of direction: Especially during sudden stops or changes of direction in sports such as football and basketball.
- Jumping and landing: Excessive load on the knee after jumping from a height.
- Direct impact: Direct blows to the knee, traffic accidents or industrial accidents.
What are the symptoms of anterior cruciate ligament injury?
- Sudden detachment feeling: A snapping or popping sensation in the knee at the time of injury.
- Severe pain: Pain that begins immediately and continues.
- Swelling: Rapidly developing swelling of the knee, usually within a few hours of the injury.
- Limited movement: Limited movement in the knee and inability to bear weight on the knee.
- Feeling of emptiness in the knee: The knee feels unsafe or unstable.
How is anterior cruciate ligament injury diagnosed?
Tanı, yaralanmanın nasıl gerçekleştiği hakkında bilgi alınıp, detaylı bir fizik muayene ile başlar. Manyetik Rezonans Görüntüleme (MRG), ön çapraz bağ yırtıklarının tanısında %90'ın üzerinde doğruluk oranına sahiptir ve eşlik eden menisküs, kıkırdak veya diğer bağ yaralanmalarını da tespit edebilir.
What are the treatment options for anterior cruciate ligament injuries?
Treatment varies depending on the patient's age, activity level, and severity of injury:
- Surgical treatment: Surgical treatment is often recommended for young, active individuals and athletes. In this procedure, the torn ligament is reconstructed with grafts taken from the patient's own tissue.
- Nonsurgical treatment: For less active individuals, physical therapy and rehabilitation programs can be applied. These programs aim to increase knee stability and strengthen muscles.
What is the recovery process like after anterior cruciate ligament surgery?
Although the post-operative recovery process varies from person to person, it is generally as follows:
- The first few weeks: Use of crutches and exercises to increase knee range of motion.
- 3-6 months: Regaining muscle strength and knee functions with physical therapy.
- 6-12 months: Gradual return to sports and vigorous activity.
Can anterior cruciate ligament injuries be prevented?
Although it cannot be prevented completely, it is possible to reduce the risk factors:
- Regular exercise: Doing exercises that strengthen leg muscles and increase flexibility.
- Correct technique: Using the right techniques while doing sports and being careful during training.
- Suitable equipment: Using appropriate shoes and protective equipment when doing sports.
When can I return to sports after an anterior cruciate ligament injury?
The time it takes to return to sports depends on the treatment method and the individual's recovery rate. Generally, return to sports is possible within 6-12 months after surgical treatment. However, approval from orthopedic and physical therapy physicians is required for full recovery and stability of the knee.
What happens if an anterior cruciate ligament injury is left untreated?
Untreated anterior cruciate ligament tears can lead to chronic instability in the knee, which can lead to meniscus and cartilage damage, premature joint degeneration, and osteoarthritis.
What is the success rate of anterior cruciate ligament surgery?
Ön çapraz bağ rekonstrüksiyon ameliyatlarının başarı oranı %80-90 arasındadır. Başarı, cerrahın deneyimi, hastanın rehabilitasyon sürecine uyumu ve genel sağlık durumu gibi faktörlere bağlıdır.
