Where is the anterior cruciate ligament (ACL)? What it works for?
In the knee joint, between the thigh (femur) and the leg bone (tibia), behind the knee cap, the two cross ligaments are called anterior cruciate ligament and the posterior cruciate ligament. The anterior cruciate ligament connects the two bones to prevent the knee from sliding and rolling forward. Anterior cruciate ligament is a strong ligament that stabilizes the knee, with an average diameter of 11mm and a length of 38mm.
How is ACL injured?
ACL usually ruptured as a result of sporting activity. The most common form of injury in high-paced sports such as basketball, football, volleyball, handball; usually occurs on a fixed foot with sudden rotational movement of the body. Rarely, rupture may also occur with high-energy injuries such as direct impact, traffic accidents and falling from a height. These injuries may also be accompanied by other ligament injuries, cartilage damage and meniscus tears.
In adults, the injury occurs in the form of a partial tear or rupture in the middle of the ligament, whereas in children the injury occurs in the form of bone break off where the ligament is attached to the leg bone.
How is ACL rupture felt? What should be done in the first intervention?
During anterior cruciate ligament injury, there may be a sudden feeling of rupture in the knee and a thud sound. The athlete has to give up the sport. Most people notice this sound very easily and with this feeling the knee swells within a few hours. The cause of the swelling is bleeding from ruptured ligament into knee.
As a first intervention, he should not force the knee and should rest, apply ice and bandage and consult a physician as soon as possible.
What are the signs of anterior cruciate ligament rupture?
In a patient whose anterior cruciate ligament was injured; after the early period passed and swelling is gone, knee movements were gained; due to insecurity and loss feeling on sudden jumping, stopping and turning movements, not being able to run and cannot achieving sports complaint is seen. In daily life, patients complain that insecurity in their knees and they cannot control the knee during; getting of the bus, bouncing on one leg, especially stair descending.
One important issue that should not be forgotten is; In the case of anterior cruciate ligament injuries, the ligament may be damaged or partially ruptured. The findings may be milder in patients without complete rupture. If this condition is overlooked, rupture develops more quickly in the second trauma.
How are ACL injuries diagnosed?
Anterior cruciate ligament rupture is the first diagnosis idea of the patient who has, rupture sound and swelling with knee rotation during sports. There may also be a locking feel in the knees along with meniscus tear. In the examination, 90% diagnosis is made with the feeling of gap in the knee and the absence of ligament. X-rays are performed to exclude bone injuries. MRI may be ordered for cartilage, meniscus and ligament injuries accompanying the injury. However, in the first days of the trauma, since the knee has edema, MRI may give an incorrect result and in patients with uncertain diagnosis, MRI can be repeated after swelling.
How is anterior cruciate ligament rupture treated? Is non-surgical treatment possible?
ACL surgery is required if there is insecurity such as knee; gliding, gapping, or instability. Anterior cruciate ligament surgery is also essential, especially in young patients with this type of complaint. In scientific researches; In patients who hasn’t treated anterior cruciate ligament tear, X-ray taken at the end of the 10th year and arthritis findings are seen in 53% of the patients. If the anterior cruciate ligament injury is repaired in a timely and good way, as a result of fixing the knee instability problem, protective effect will be obtained against meniscus and cartilage injuries. Therefore, contrary to popular belief; Surgical treatment is the best choice for functional outcomes.
The anterior cruciate ligament, which connects the two bones that make up the knee joint, is overloaded during trauma and breaks by fraying. In addition, the anterior cruciate ligament, which is subjected to excessive stretching by unstable knee motion, does not heal by itself. Because of these reasons, the treatment of anterior cruciate ligament is surgical. Accompany of meniscus tear should be suspected in ACL injuries, if there is a complaint of pain and lockup. Only in children, the anterior cruciate ligament breaks from the bone attachment with the bone fragment and must be sutured in the early stage (first 3 weeks) with a special technique.
Nowadays, anterior cruciate ligament surgeries are performed by arthroscopy, so as closed method. The original ligament is replaced with ligaments (such as hamstring, patellar tendon) from different parts of the body. Ligaments from the cadaver can also be used.
Non-operative treatment may be preferred by exercising the muscles around the knee and keeping muscles strong in patients over 50 years of age, who do not engage in active sports and who doesn’t meet findings of knee gap or knee arthritis.
How is ACL surgery performed?
How long does ACL surgery take?
Depending on the ACL repair technique and variety of the repair of injured tissues, the operation takes between 40 and 120 minutes.
Is the ACL repair performed as a double bundle? or as a single bundle?
Although the anterior cruciate ligament appears to be a single bundle, in recent years, two bundles have been discovered, anterior and posterior. Considering this situation, although double bundle repair method was developed, many surgeons today use single bundle repair technique since there is no significant difference in patient applications.
When do I get up after ACL surgery?
Postoperative hospital stay is 2 days. The knee movements start on the same day. Postoperatively, bearing has to be started with crutches as much as the pain can be tolerated. You need to protect the knee from overloads using crutches 3 weeks and a long knee brace with hinged crutches for 6 weeks postoperatively, on average. There is a great benefit in the rehabilitation of the patient under the guidance of a physiotherapist. With the postoperative exercise program, knee movements are gained almost in three weeks.
When can I drive after ACL surgery?
Patients can use the automatic cars after the left knee surgery when they feel comfortable, but they can drive 6 weeks after the right knee surgery.
When can I return to work after ACL surgery?
Desk employees can return to work in 3-4 weeks. Those who work with their body can return to their jobs between 6 and 9 weeks.
When can I start sports after ACL surgery?
The improvement in ACL surgery varies depending on person. The reasons of this are; patient’s adequacy of muscle strength, age, type and location of used ligament, strength of ligament fixation, technique of surgical procedure and other causes accompanying injury. Generally, patients perform closed kinetic chain movements during the first 6 weeks, while open kinetic chain movements such as cycling and swimming are started after 6 weeks. After 3 months, patients can run straight. However, it is usually possible to start sports training after 6 months due to the ligament has reached its sufficient strength. It takes a year for the tissue to fully mature and firm. Therefore, it is recommended to start sports with contact after 9-12 months.
What is the success rate of ACL surgery?
The success rate in the world and in our country is around 80-90%.
What are the causes of ACL surgery failure?
Failure rate is between 10-20% and the reasons are as follows:
1. Failure of the patient to participate in rehabilitation by acting incompatible with treatment
2. Not enough thickness of placed ligament
3. Improper opening of the tunnels during surgery
4. Incomplete fixation
5. Elongation or re-rupture of the inserted ligament
6. Development of infection
What are the complications of ACL surgery?