In the knee there are two cruciate ligaments, the anterior and the posterior, and it is what makes stabilize the tibia with respect to the femur, that there is not a sliding in excess of the femur on the tibia, or the tibia on the femur. They are called crossed because one affects the forward movement of the tibia and the other affects the backward movement of the tibia. It influences, therefore, the anteroposterior stability.
What sports can cause a cruciate ligament injury of the knee?
Above all the sports where there is contact and where there can be alterations of the mobility of the knee, as it can be the soccer, the ski or the basketball. They are sports where, either by fall or by bad position of the knee by a collision with an opponent, the gesture of the rupture of the cruciate ligament occurs, which is the valgus-semiflexion mechanism or external rotation of the knee. This means that the knee goes forward, inwards, with the knee half-bent and with the foot facing outwards, thus injuring the anterior cruciate ligament.
What symptoms will the patient notice when the injury occurs?
This type of injury is characterized by a sharp pain. It is like a kind of rope that breaks, that does not stretch but breaks. It is a sharp and intense pain that may disappear after 4-5 minutes to go to notice that the knee fails, that it lacks stability. In addition, anterior cruciate ligament injuries may be accompanied by injury to other ligaments and even meniscus. There is what is called a pure cruciate injury, but later there may also be complications, such as meniscal or lateral ligament ruptures, which aggravate the initial injury. It is not the same to break only one cruciate ligament as to have it accompanied by other injuries.
Approach to the injury: what does the cruciate ligament operation consist of?
What the specialist in Sports Medicine mainly looks at is the sport that the person plays and the age of the patient. Also if the sport is amateur or professional, since it will not be the same an amateur futsal player with his friends than a professional player who makes a living with this sport.
In addition, it is assumed that every young and active person, sportingly speaking, has to undergo surgery. Normally, cruciate ligament surgery consists of a reconstruction of the cruciate ligament using a tendon. This tendon can be either the patellar tendon or the hamstring tendon, which is the internal tendon with the semitendinosus. They can be taken from the patient himself or from a bone bank. The difference, apart from what the patient wants, is that if a bone bank is used, we conserve our tendons and do not have to use them for the surgery, so that the recovery is always a little faster, leaving the tendons as our original ones.
On the other hand, there are no reported cases of rejection of these donor tendons. In fact, there are more reported cases of rejection of the material used to fix the plasty than for the plasty itself.
Recovery and return to sport
The classic protocol says that the patient can begin to relatively support the foot, and with two crutches, for four weeks, always carrying more weight on the healthy leg than on the operated one. Subsequently, he will spend two weeks with only one crutch and, again, after six weeks or a month and a half, he will abandon the crutches.
Up to the first three months what is worked on is the mobility of the knee, to recover it completely. And, from three to six months, which is when the patient is discharged, the muscles will be worked on and strengthened in order for this knee to recover strength, just like the uninjured knee.
This is the original protocol, always bearing in mind that, depending on the sport, and if it is a contact sport, reintegration will be later than if it is an individual sport. As a general rule, the patient is never discharged before 6 months. From then on it will depend on the sport practiced by the patient. In cases of patients who play soccer at 6 months it may be risky because the player still has the memory of the injury and may play with fear, the knee may not have enough strength and it may be counterproductive to play earlier. It is defined as the “mental stage”. When players ask, “When will I be able to play?”, the answer will be, “When you are not afraid and when you use your knee as you did before”. At that point the patient forgets about the knee and is 100% dedicated to soccer, tennis, basketball or whatever sport he/she usually plays.