The rupture of cruciate ligaments is one of the injuries par excellence suffered by athletes, due to the continuous overexertion and sudden changes of rhythm or direction of movement.
The cruciate ligaments are responsible for providing the anteroposterior stability of the knee, which is vital for sports practice. The most frequently injured cruciate ligament is the anterior cruciate ligament (ACL) in sports such as soccer, skiing or rugby. The injury usually occurs in a knee twisting gesture with the foot resting on the ground or a sudden hyperextension gesture. On many occasions, these tears usually produce an audible ‘crack’ and the knee swells within a few hours.
Normally, the effusion disappears after a few days with ice and anti-inflammatory drugs, but it is common for the patient’s knee to feel “loose” or unstable.
In which cases should we operate and in which should we not?
The main factor in deciding to perform the operation is the degree of instability felt by the patient. There are patients who are not able to run because of instability and, in certain gestures, such as the simple fact of pivoting while playing basketball, they can cause a failure due to the ACL injury and end up suffering a fall with a new effusion in the knee.
Other factors to take into account are age, whether it is associated with internal or external meniscus tear, the degree of sports activity performed by the patient and the type of sport, among others. In cases of sedentary people, the patient may initially be referred for rehabilitation and the knee may be re-explored after 6-8 weeks to assess the function of the damaged ligament.
What does the operation consist of?
The operation in which a torn ACL is replaced with a graft, which will heal in the same place as the original ligament, is called an ACL plasty. This graft can be of three types:
– The patient’s own hamstrings: The two tendons – the medial rectus and the semitendinosus – are removed through a small incision in the anterior aspect of the knee. Once removed, they are prepared and tightened to be tunneled to the site of the original ACL.
– Patellar tendon: It is taken in association with the bone, in what is called a bone-tendon-bone graft. Allows the bony ends of the plasty to heal within the femur and tibia, and the patellar tendon is left reproducing the anatomy and functionality of the ACL.
– Tendon allograft: Grafts from a donor tissue bank. They can be hamstring or patellar tendon. These grafts have the advantage of less surgical aggression.
Normally, rehabilitation begins the day after the operation until completing different phases of the same and return to competition at approximately 6 months. Initially they consist of a series of exercises that strengthen the quadriceps and soft flexion and extension exercises (movement of stretching and flexion of the affected leg). After 3 weeks, it is advisable to go to a specialized rehabilitation center where professional physiotherapists will help you with all the progressive work to complete the recovery, readaptation and return to sport.