Anterior cruciate ligament injuries

The anterior cruciate ligament is one of the ligaments that provides the stability of the knee joint. In addition, the posterior cruciate ligament, internal and external lateral ligaments contribute to this. The anterior cruciate ligament is the most commonly injured ligament, especially during sports activities.
What are the findings of anterior cruciate ligament tear?
When the anterior cruciate ligament is torn, blood accumulation and swelling occur in the knee joint due to bleeding. Pain is prominent and knee movements are very difficult. It is often painful to put a load on it.
After the first period of injury, pain decreases and movements are partially regained due to the reduction of swelling within a few weeks. In the advanced period, a feeling of space in the knee, spontaneous rotation of the knee during movement or walking can be seen. In the presence of accompanying meniscus tear, there may be findings such as snagging and locking.
What should be done after anterior cruciate ligament injury?
Applying ice first after injuries to the knee area reduces the amount of bleeding and therefore swelling. If the diagnosis of anterior cruciate ligament rupture is made by the patient’s history and examination as much as possible, on the day of the injury or immediately after the patient is admitted to the hospital, ice application is continued, knee movements are limited with bandages or knee braces and resting is ensured for a while.
After the first period of the injury has passed (1-3 weeks), the diagnosis is confirmed by re-examination and a decision is made for treatment.
Is the treatment necessarily surgery in anterior cruciate ligament tear?
The patient’s age, functions, complaints and expectations are important for treatment. Surgical treatment should be considered in the presence of co-occurring meniscus or cartilage injury. Young patients are more negatively affected by ligament tears as they are more active and mobile. Knee rotation and feeling of emptiness are common in daily functions. In addition, as time passes, the possibility of developing cartilage wear (calcification) increases due to the decrease in the stability of the knee due to the dysfunction of the anterior cruciate ligament. Therefore, surgical treatment should be considered primarily in young patients.
In older patients, the treatment is decided by taking into account the expectations and the patient’s activity. For example, a 50-year-old patient who walks regularly, does intermittent sports, works actively, and whose knee stability affects his daily life negatively can be treated with surgery. A patient at the same age who has a calmer life, does not exercise less, does not do sports and is not adversely affected by the absence of ligament in his daily functions can continue to live without any problems by strengthening the knee area with exercise and physical therapy.
How is the anterior cruciate ligament surgery?
A ligament tear is not a tear that can be sewn end to end. Therefore, in surgical treatment, the ligament is reconstructed and repaired. For this, ties taken from the patient’s own or cadaver tissues and sterilized under special conditions can be used. Ligaments taken from the patient are mostly used.
Today, anterior cruciate ligament repair surgery is performed by arthroscopic (closed) method. The ligament, which is taken in appropriate thickness and length, is passed through the tunnels opened in the two bones forming the knee joint and fixed to the bones with various metal and non-metal materials.
What should be done after the operation?
Depending on the method applied after ligament repair surgery, the patient can be given a knee brace. Ice is applied in the first days. Exercises aimed at gaining joint movements are started. Again, according to the applied method, walking is provided with or without weight bearing with crutches.
A special rehabilitation program (physical therapy) is applied after anterior cruciate ligament repair some time after the operation. Rehabilitation is an important step of treatment, if it is not applied, success will not be possible with only surgical treatment. The duration of rehabilitation may vary according to the method applied, the surgeon’s preference and the program of the rehabilitation center.
Generally, 4-6 weeks after the operation, it is possible for the patient to walk and go to work by leaving the crutches. However, activities such as running and doing heavy sports can only be possible after 6-9 months. Rehabilitation and return time to the field differ in professional athletes.

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