A rupture of the cruciate ligaments of the knee joint - anterior and / or posterior - is an injury to the largest and most important ligaments in the knee. It is mainly thanks to them that the knee can withstand enormous loads, which is why their damage leads to serious knee dysfunction. What are the causes and symptoms of cruciate ligament rupture? What is the treatment?

A rupture of the cruciate ligamentsof the knee joint - anterior and / or posterior - is an injury to the two largest and most important ligaments in the knee. There are eleven ligaments in the knee that stabilize the knee joint and allow it to function properly, but these two play a key role in this process.

The most common is the rupture of the anterior cruciate ligament. This ligament consists of two bundles of fibers. When the leg is straight, they are placed parallel to each other. When we bend it - the bunches cross to form a kind of bolt that prevents the thigh bone from moving relative to the tibia. This keeps the leg stable. The anterior cruciate ligament is not only a great stabilizer. It is also an organ of the so-called deep feeling. Thanks to it, we know the position of the leg and we control it.

Rupture of cruciate ligaments - causes

The knee stabilization system is sometimes damaged, especially when the muscles are weakened, especially the thighs, which also work to stabilize the knee joint. However, most of the small ligaments, even if we tear them, regenerate on their own after immobilizing the knee. The situation is different in the case of rupture of the cruciate ligaments. The greatest damage occurs when the anterior cruciate ligament ruptures. This happens most often when practicing downhill and water skiing during team games - especially football.

Rupture of cruciate ligaments - symptoms

  • "knee escape" combined with a sharp pain and a characteristic sound (crack or crunch)
  • knee pain that makes you unable to walk
  • swelling, which later gradually subsides, but the knee instability, running away and pain remain.

If this injury is left untreated, instability causes further injuries inpond.

Rupture of cruciate ligaments - diagnosis

In the diagnosis of cruciate ligament rupture, the "anterior drawer" test and the "Pivot Shift" test can be used, but the "Lachman" test is considered more reliable. During the examination, the patient is lying on his back and the knee is bent at an angle of 20-30 degrees. One hand of the examiner stabilizes the thigh, the other hand behind the lower leg, and then moves the knee back and forth. An intact anterior cruciate ligament should prevent excessive protrusion of the lower leg relative to the thigh, which can be observed in the case of an anterior cruciate ligament injury.

In addition, the doctor should squeeze out the fluid from the upper and lateral recesses of the knee joint (the so-called kneecap baling).

If in doubt, a knee imaging (usually an MRI) may be ordered.

Rupture of cruciate ligaments - treatment

Anterior cruciate ligament injury is a serious injury and treatment usually involves reconstruction. Today, orthopedists have developed a very good technique of restoring the ligament, which gives a physiological effect. This is calledtwo-bundle reconstruction .

Injured anterior cruciate ligament requires surgical treatment

The treatment is preceded by a thorough diagnosis using magnetic resonance imaging and ultrasound. The traumatologist must determine the site and degree of damage, and the presence or absence of additional injuries. Sometimes it is necessary to perform diagnostic arthroscopy, i.e. inserting a device with an optical system into the knee joint, thanks to which the doctor can see the inside of the joint. During such arthroscopy, elements of the broken ligament are removed. Most often, however, it is performed during one arthroscopic ligament reconstruction surgery.

Anterior cruciate ligament reconstruction surgery - the course of the operation

The reconstruction of the anterior cruciate ligament is performed under epidural anesthesia (a catheter is inserted into the spine through which drugs are administered to anesthetize the lower half of the body), spinal (a special needle is used to introduce an anesthetic drug deeper than under epidural anesthesia, it removes he feeling in the lower half of the body) or general. The type of anesthesia used is decided by the operator together with the anaesthesiologist and the patient in each case individually. The procedure takes about 90 minutes, and the stay in the clinic is 2-4 days. Reconstruction is performed using the patient's tissue autograft or material obtained from a tissue bank or donors.

The anterior cruciate ligament reconstruction procedure involves collecting the tendon from another place of the leg, andthen, after appropriate preparation, implanting it in the knee joint, so that it replaces the damaged anterior cruciate ligament (biological, allogeneic transplant). Less often, biological materials collected from the corpse of a tissue donor. Usually, the tendons of the sciatic shin muscles, located on the inside of the thigh, or the patella ligament at the front of the knee, are collected. - Each such procedure is associated with the risk of the transplant failing to heal, lengthening it or breaking it again - says Dr. Rafał Mikusek from the Enel-Med hospital. - This means that in some patients who have undergone surgery, symptoms may recur, requiring re-intervention. In addition, some patients experience pain at the site of the collection of the tendon used for the transplant - indicates Dr. Rafał Mikusek.

Ligament lining - Internal Bracing method as an alternative to traditional surgery

Recently, the first treatments of the innovative ACL repair have been carried out in Poland, using the innovative Internal Bracing method, which allows partial or complete preservation of the patient's ligament. The Internal Bracing procedure can be compared to ordinary arthroscopy, and its benefits include: no discomfort related to the transplant, less interference in the knee joint, as well as the preservation of the own ligament and the receptors of deep sensation present in it, and the preservation of the natural stabilization of the knee joint.

According to an expertDr. Mikusek from the Enel-Med hospital

By using the Internal Bracing method in ACL reconstruction, the patient retains his or her own ligament in whole or in part. The surgical procedure consists in lining the damaged ligament to the place of its attachment on the femur and reinforcing it with a synthetic tape that replaces the ligament until it heals - This can be compared to the internal "plaster" supporting the ligament. In some cases, one of the two bundles forming the anterior cruciate ligament is broken. In these cases, the damaged fragment of the ligament is reconstructed. In some knees, it is necessary to underline one of the bunches and reconstruct the other. This creates a natural exoskeleton, leaving as much of the natural ligament as possible. It should be emphasized that, unfortunately, not every patient will be able to undergo this procedure. It is imperative that the procedure be performed no later than 4 to 6 weeks after the injury. Sometimes, when the ligament fragment is well preserved, this period may be longer. Additionally, the lesion should be located where the anterior cruciate ligament attaches to the femur. However, I do notdoubt that the Internal Bracing method can be safely called a "tailor-made reconstruction", the effects of which are more than satisfactory.

Source: youtube.com/Enel-Sport

Ligament reconstruction - getting back into shape

After the procedure, the knee is immobilized in the postoperative shell. During the first 24 hours after the procedure, you can move around on crutches without putting any strain on the operated leg. After removing the drains, usually on the second day after the surgery, you can start to put some weight on her. After three or four days, you can leave the clinic. After a week, you have to come to the removal of stitches and a checkup. The full acceptance of the transplant and proper strengthening of the ligament takes place after 8-10 months, but you can walk much earlier, although, of course, rehabilitation is needed from the very beginning after the operation. You must wear a brace for the first three months. Later, it should be put on when we have more effort or we are walking in difficult terrain.

Internal Bracing reconstruction is associated with a lower risk of complications and a much faster return to normal activity compared to traditional anterior cruciate ligament reconstruction. Importantly, rehabilitation can be started very quickly after the procedure and is much more efficient compared to other treatment methods. The method of carrying out the procedure means that patients who undergo rehabilitation do not have problems with excessive swelling or with the amount of fluid in the joint. Usually there are also no major movement restrictions. Thanks to this, we can start strength, coordination and stabilization therapy much faster, and as a result, patients return to full fitness much faster - says Adam Bronikowski, a physiotherapist at the Enel-Sport Orthopedics and Rehabilitation Clinic.

Ligament reconstruction - complications

As with any procedure, anterior cruciate ligament reconstruction surgery may have complications. The most difficult thing is transplant rejection, but this is rare. Sometimes there is an exudate in the joint and you have to pull off the fluid that has accumulated there. As mentioned, Internal Bracing reconstruction is associated with a lower risk of complications

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Spine, bones, joints