Surgical Treatment of Anterior Cruciate Ligament

If there is a trauma of the cruciate ligaments, the operation is not always required. In case the stability of the joint is still not satisfactory after the conservative treatment, then the doctor considers the option of the surgical intervention. It is worth noting that the surgery gives the best results with strong muscles and knee joints, meaning that the conservative treatment beforehand is essential. On average, such surgeries are performed 6 months after the rupture, however this does not mean that it may not be required later.  Sometimes the operation is done even 5-7 years after the injury. In fact, it can be done at any time after the trauma, with the exception of those cases when severe arthrosis has developed. This condition is normally caused by a rupture of the anterior cruciate ligament (ACL) and subsequent instability of the knee joint.

Before the operation, the doctor conducts a comprehensive clinical examination. First, all the circumstances of the injury and the degree of knee instability are clarified. Thus, the specialist receives information about the degree of rupture. Unfortunately, the diagnosis is often made several years after the injury, since majority of patients consider this injury to be a simple sprain. If the thigh muscles are strong and healthy, then the diagnosis is usually not made as part of a clinical examination. And at the same time the option of a surgical operation is not considered as well. However, over time, the patient starts feeling discomfort in the knee joint. The cause of arthrosis can be trauma, as a result of which, the cartilage is damaged. It happens rather frequently that problems of the knee joint appear only after a few years. And only then does the patient notice some instability while climbing stairs or during rotational movements, after which he feels severe pain in the knee.

In addition to diagnosing the degree of knee instability, cruciate ligament is examined using special techniques such as the anterior drawer test (PVN), the Lachman test, or the lateral slip test (Mackintosh test).  MRI is also an important tool in the correct diagnostics. X-rays are required to exclude associated bone injuries of the knee joint. Also, joint puncture (aspiration of synovial fluid from the joint capsule) helps to diagnose in this case. The cruciate ligaments have a good blood supply. Therefore, their rupture becomes the cause of joint hemorrhage. The presence of blood in the joint fluid indicates a cruciate ligament rupture.

The most common surgical technique is a cruciate ligament replacement surgery. During this procedure, the surgeon first completely removes the damaged ligament in order to prepare the patient for transplantation. To get a transplant, the doctor takes parts of the autogenous tendons from other parts of the knee joint. As a rule, the operating physician uses the patellar ligament located between the patella and the tibia for this purpose.

The advantage of autologous tendon transplantation is undoubtedly the absence of a body rejection reaction. It is due to the fact that the graft is obtained from the patient’s body, namely from the patellar tendon and the Achilles tendon. After the completion of the transplantation process in the femur and lower leg bones with the help of special bone screws, the tendon graft is well absorbed by the body and begins to be supplied with blood vessels.

Cruciate ligament surgery is very successful and in 90% of all cases results in complete restoration of the knee joint function. Almost all patients return to their usual activities, and professional athletes can resume training. The only slight disadvantage of this surgery is that the patient may feel slight pain and discomfort for several months. Removing the tendon also slows down the development of physical strength. After the operation, the patient will have long physical therapy sessions and specialized training.

Rehabilitation after the surgical treatment takes about 6 months. Its main part is aimed at performing special physical exercises, therefore, for athletes who initially had a high level of physical fitness, recovery can be faster. Meanwhile, patients who are not physically strong will have a longer restoration process. The standard rehabilitation course is divided into 5 stages, the purpose of which is to completely eliminate edema; return a full range of motion; improve the strength of the thigh muscles; improve proprioception and joint balance; elimination of pain and swelling during physical activities; return of maximum strength and endurance, neuromuscular coordination. Rehabilitation of the patient after also includes such procedures as electromyostimulation, foot massage and active mechanotherapy.