Anterior cruciate ligament tears are relatively common injuries to the knee of athletes. They occur most often in those who participate in sports that involve twisting and turning. They are usually caused by intact knee injuries, mainly due to sudden decelerations or after landing after a jump. It appears that women tend to have a higher incidence of anterior cruciate ligament tears than men.
The anterior cruciate ligament is a ligament located inside the knee that connects the femur to the tibia. It is considered one of the most important structures in the knee joint, as it resists anterior displacement of the tibia and rotational forces.
Rupture of the anterior cruciate ligament causes severe pain and immediate swelling in the knee. The patient feels unstable when loading the affected knee. Anterior cruciate ligament tears are usually accompanied by other injuries within the knee, such as meniscal tears, medial collateral ligament tears, bone swelling, cartilage lesions or posterior-external corner injuries.
The diagnosis is made by MRI of the knee. MRI has the advantage of providing a well-defined picture of all the anatomical structures of the knee. MRI can diagnose ruptures of the anterior cruciate ligament with an accuracy of more than 95%, as well as reveal coexisting injuries.
The anterior cruciate ligament is important for maintaining stability of the knee joint. The knee becomes unstable after an anterior cruciate ligament tear and the joint can become more damaged over time.
Anterior cruciate ligament reconstruction is the surgical treatment of choice to restore stability to the knee joint. Conservative treatment (mainly physiotherapy and muscle strengthening) is preferred when the patient is over 35 years of age, has no other intra-articular injury and is not active. However, there is a higher risk of damage to the menisci and articular cartilage due to instability. Surgical treatment is preferred when the patient is under 25 years of age, has severe anterior tibial displacement, additional intradiscal damage and is very active. The majority of patients fall into these two sets of criteria, so treatment should always be evaluated on an individual basis.
Reconstruction techniques vary as do the grafts that can be used. The choice of surgical treatment can vary depending on the patient’s symptoms and their level and type of activity, i.e. whether the sport involves rotational movements. Anterior cruciate ligament reconstruction is done arthroscopically, with 2-3 small incisions around the knee. The graft to be used is chosen first, which is usually an autograft from the patient’s posterior femoral or patellar tendon. Through appropriate instruments and bone tunnels, the graft is placed into the knee and secured with sutures or absorbable pins.
Postoperatively, an appropriate physiotherapy programme is required. Return to sport should take place at 6-9 months after surgery to allow the necessary time for the graft to integrate into the bone. Complications of surgery include graft loosening, infection, arthrosis, algodystrophy and problems from the area where the graft was taken.