Features of diagnosis and treatment of ACL rupture.

At the SportClinic you can undergo accurate diagnosis and effective treatment, including arthroscopy, for damage and rupture of the anterior cruciate ligament.

Playing sports without preparation is a major risk factor for ACL rupture.

The cruciate ligaments are stabilizing elements located at the “heart” of the knee joint. They connect the femur (thigh) and tibia (shin) bones, forming a decussation between them (hence the name). The anterior cruciate ligament (ACL) connects the lateral epicondyle of the femur and the tibial plateau. Its main function is to prevent the tibia from turning inwards relative to the thigh (internal rotation) and moving it anteriorly. This is what typically happens with ACL injuries.

The cause of injury is a sharp landing on the leg with a change in direction, a fall on alpine skiing, a snowboard (where the lower leg is fixed, and the thigh continues to rotate) or a blow. The rupture most often occurs in the thinnest place, where the ligament attaches to the femur. ACL rupture is one of the most common types of traumatic injury. This is due to the fact that more and more people lead an active lifestyle, but do not always approach the load with proper preparation and correct technique, neglecting knee protection, etc. Often combined with damage to the meniscus, as well as the internal collateral ligament (“unlucky triad”).

Structure of the anterior cruciate ligament

The structure of the knee joint and the location of the ACL.

All ligaments in our body are connective tissue structures. The peculiarities of the connective tissue of the ligamentous apparatus are that it contains a large number of elastic fibers located longitudinally in the direction of the forces acting on the ligament. This provides sufficient elasticity and stretchability, but less strength compared to tendons. Age-related changes mean a decrease in their elasticity and an increase in susceptibility to rupture.

The ligament is represented by two separate bundles - anterior-external and posterior-internal. They change (stretch and contract) differently depending on the movement of the knee. There are nerves inside it that give the brain a signal about a bent or straightened position. Based on the direction of the beams - from bottom to top, from front to back and from outside to inside - it becomes clear that damage to the ACL occurs when the lower leg is displaced forward and inward.

Posterior cruciate ligament injuries and ruptures

Anatomy

The stability of the knee joint is ensured by a large number of ligaments, among which four main ones can be distinguished: the anterior and posterior cruciate ligaments, the tibial collateral ligament (internal collateral ligament) and the fibular collateral ligament (external collateral ligament).

The cruciate ligaments keep the lower leg from moving anteriorly (anterior cruciate ligament) and posteriorly (posterior cruciate ligament).
The tibial collateral ligament (internal collateral ligament) keeps the tibia from tilting outward.
The fibular collateral ligament (external collateral ligament) keeps the tibia from deviating inwards.

The posterior cruciate ligament (PCL) is located just behind the anterior cruciate ligament (ACL). The posterior cruciate ligament prevents the lower leg from moving posteriorly. Anterior cruciate ligament injuries are much more common than posterior cruciate ligament injuries, and in general, anterior cruciate ligament tears are quite common and are fairly well diagnosed and treated. At the same time, the posterior cruciate ligament is a kind of “terra incognita”. Many doctors, even traumatologists, are not familiar with the diagnosis of her injuries and the principles of their treatment.

The posterior cruciate ligament is attached from above to the internal condyle of the femur, after which it goes down and slightly inward and is attached to the depression on the tibia (posterior intercondylar field). The anterior cruciate ligament runs perpendicular to it anteriorly, and if you look at these ligaments from the front, you can see how they form a cross, which gives these ligaments their name - cruciate ligaments. The posterior cruciate ligament, like other ligaments, is primarily composed of strong collagen fibers that have virtually no stretch.

The posterior cruciate ligament consists of two bundles: anterior external and posterior internal. With the knee bent, the anterior-outer bundle is relaxed, and the posterior-inner bundle is tense; with the knee bent, both bundles are tense, but the anterior-outer bundle is more tense. The posterior cruciate ligament also contains a bundle or ligament of Humphrey, which is attached from below to the outer meniscus.

Bundle structure of the posterior cruciate ligament: AA` - postero-internal bundle, BB` - anterior-external bundle, C-C` - Humphry’s ligament. The tension of the bundles changes when bending the knee

Causes of posterior cruciate ligament rupture

It takes a lot of force to tear the posterior cruciate ligament. The most common rupture mechanism is a blow to the front of the shin, as occurs in motor vehicle accidents and sports. For example, this could be a bumper injury - when the bumper of a low car hits the top of the shin, but below the knee. Drivers may have a similar mechanism of injury - during a collision, the driver moves forward by inertia and hits his knee on the dashboard of the car. To prevent just such damage, modern cars have airbags under the steering wheel. The only way to prevent it, other than limiting activity, is to strengthen the muscles of the knee joint.

Typical mechanism of a driver's posterior cruciate ligament rupture

Airbag protecting the driver's knee joint in a Skoda Superb

On the left is a normal posterior cruciate ligament, on the right is a torn posterior cruciate ligament

Diagnosis

As a rule, a rupture is accompanied by pain, limitation of movements, and swelling of the knee due to hemarthrosis (accumulation of blood in the joint). When the posterior cruciate ligament is injured, patients sometimes hear a cracking noise or immediately feel instability in the knee joint. However, immediately after the injury, the pain is so pronounced that the person begins to instinctively spare the leg, not load it, and therefore instability is not felt.

If a posterior cruciate ligament rupture is suspected, it is important to clarify the mechanism of injury, its severity and possible concomitant injuries (ruptures of other ligaments, menisci, fractures). If the patient seeks help some time after the injury, then even then significant pain is possible, which will make it difficult for the doctor to test the joint and instability will not manifest itself.

However, instability can be evident even in the acute phase, especially if the person's legs have a pronounced O-shape or there is concomitant damage to other ligaments, such as the lateral ligament. Instability may be felt as a feeling of the lower leg sinking backwards, the knee sliding out, or becoming unruly. Often with instability you can hear the phrase “I’m not confident in my knee.”

During an initial examination by a traumatologist, damage to the posterior cruciate ligament can be suspected by abrasions or hemorrhages on the anterior surface of the leg and hemorrhages in the popliteal fossa. Tear of the menisci and other ligaments should be excluded.

Examination of the posterior cruciate ligament immediately after an injury is not easy - pain and swelling will interfere with the examination. Therefore, quite often, primary treatment begins with pain relief (application of cold, painkillers), immobilization of the joint with an orthosis. After the acute period has passed, a full examination of the joint and an accurate diagnosis will become possible.

Although the doctor may already suspect a torn posterior cruciate ligament based on the mechanism of injury, in many cases the damage is not immediately detected. The most indicative symptom is the rear drawer. With the patient lying on his back, the knee is bent at a right angle and pressure is applied to the tibia in front, assessing the posterior displacement of the tibia. This test is first performed on the healthy leg.

Posterior drawer sign of posterior cruciate ligament rupture (posterior tibia instability at the knee joint). In this case, testing is performed outside the acute period, when pain from injury and hemarthrosis have passed

Another test to evaluate the condition of the posterior cruciate ligament is the Godfrey test. Having bent the patient's knee and thigh, observe the retraction of the lower leg - a step is formed between the tibia and the patella. With active contraction of the quadriceps femoris muscle, you can notice the reduction of this subluxation.

Godfrey's test for testing posterior instability of the knee joint in cases of posterior cruciate ligament rupture

If a posterior cruciate ligament injury is suspected, it is very important to examine the ligaments of the posterolateral part of the knee joint (polsterolateral angle), since in 60% of cases they are also damaged.

You can confirm the diagnosis of a ruptured posterior cruciate ligament and find out whether there are other injuries using instrumental examination methods, the main of which are radiography and magnetic resonance imaging. Ultrasound examination (ultrasound) for cruciate ligament injuries is not informative.

Considering that the posterior cruciate ligament ruptures in very severe injuries, first of all, radiographs of the knee joint are taken, which look for fractures of the femoral condyles, tibial condyles, and patella. Damage to the posterior cruciate ligament may be indicated by a slight posterior subluxation of the tibia, visible on a lateral radiograph. You can increase the information content of radiographs in a simple way: during the image, a posterior drawer test is performed, and the image is compared with the same image of a healthy knee.

Radiographs of the healthy (left) and injured knee (right) during the posterior drawer test. Notice how the shin on the right is displaced when pressure is applied due to a torn posterior cruciate ligament

The “gold standard” for instrumental diagnosis of injuries and ruptures of the knee ligaments is magnetic resonance imaging (MRI). Its sensitivity for ruptures of the posterior cruciate ligament is 96-100%. It is especially valuable that MRI can detect concomitant injuries, in particular damage to the posterolateral ligamentous apparatus, often not detected during the initial examination, meniscus tears, cartilage damage (osteochondral fractures).

Magnetic resonance imaging of the knee joint. On the left is a normal posterior cruciate ligament. In the photo it looks like a uniform dark strand. On the right is a rupture of the posterior cruciate ligament in its upper part. The ligament in the picture is not intact and light.

There are three degrees of damage to the posterior cruciate ligament, which are determined in combination based on data from osmortem, joint testing and magnetic resonance imaging:

I degree: partial rupture of the posterior cruciate ligament (including rupture or sprain). This type of grass does not usually cause posterior knee instability.
II degree: complete isolated rupture of the posterior cruciate ligament. Those. there are no other injuries other than a torn posterior cruciate ligament. This type of injury often leads to instability.
III degree: rupture of the posterior cruciate ligament is combined with ruptures of other ligaments. The posterolateral corner is most often damaged (in approximately 60% of cases). Such an injury always leads to instability.

Treatment

Partial ruptures of the posterior cruciate ligament are successfully treated conservatively. After an acute period, during which the knee is completely immobilized, blood is removed from the joint (hemarthrosis) and pain is relieved, gradual recovery begins. Movements in the knee joint are not completely limited due to the orthosis, which allows you to flex and extend the leg at the knee and eliminates movements that lead to posterior displacement of the tibia. It makes no sense to exclude support for the injured knee in case of a partial tear. Gradually increase the range of motion and intensity of physical exercises to train the anterior and posterior thigh muscles, which also play an important role in stabilizing the knee joint. For incomplete ruptures, the prognosis is quite favorable.

Treatment of isolated posterior cruciate ligament injuries remains a matter of controversy. When choosing a treatment method, many factors must be taken into account, including age, level of physical activity, patient expectations, and associated injuries. Literature data comparing conservative (non-surgical) treatment and surgical treatment are contradictory, and there are no high-quality studies with a long follow-up period.

Conservative treatment. Conservative treatment of posterior cruciate ligament rupture largely depends on concomitant injuries, primarily injuries to the posterolateral ligamentous apparatus. An isolated rupture of the posterior cruciate ligament is often treated conservatively. To get the best results, you need to restore as much quadriceps muscle strength as possible. The initial goal of treatment is to stabilize the tibia relative to the femur and reduce tension on the injured ligament. In case of a complete rupture, the knee joint is usually fixed in a fully extended position so as not to injure the posterolateral ligamentous apparatus. In the early period, exercises are prescribed to strengthen the quadriceps muscle: static tension of the muscle, raising straight legs, partial support when walking on an extended leg.

Conservative treatment often gives good results. During examination, signs of instability are often found, but they usually do not manifest themselves in everyday life and do not impair the function of the knee joint.

On the other hand, this approach has its negative consequences: immediately after treatment, most patients have no complaints, but upon examination, instability is noted, and over time, arthrosis occurs in the joint. Observation for 15 years after the injury showed that pain persisted in 89% of patients, and effusion in the joint cavity was detected in 50%. All patients observed for 25 years showed signs of arthrosis. Therefore, in recent years, surgical reconstruction of the posterior cruciate ligament has become increasingly recognized.

Surgery. It is not the rupture that is operated on, but the instability that develops after it. It should be noted that often with chronic insufficiency of the posterior cruciate ligament, patients usually complain not of instability, but of pain. Posterior subluxation of the tibia significantly increases the load on the internal part of the knee joint and the articulation of the patella with the femur, which leads to the development of arthrosis. When assessing a series of radiographs in patients with a posterior cruciate ligament injury, arthrosis in the internal part of the knee joint is detected in 60% of cases.

Surgical treatment is indicated for the combination of a rupture of the posterior cruciate ligament with an avulsion fracture, after an acute isolated rupture of the posterior cruciate ligament with unsuccessful conservative treatment, for injuries of several ligaments and chronic insufficiency of the posterior cruciate ligament. An avulsion fracture at the posterior cruciate ligament insertion is rare. In the absence of displacement, such fractures are treated conservatively. If the fragment is significantly displaced, it is also necessary to put it in place and fix it with a screw.

Previously, with a complete central rupture, the operation consisted of suturing the ligament, but the stability of the joint after this, as a rule, left much to be desired. Modern methods involve passing a tendon autograft through bone canals, which allows for a more complete restoration of the original anatomy of the ligament.

There are several methods for reconstruction of the posterior cruciate ligament, differing in the restoration of one or two bundles. At first, during the operation, only the anterior-external bundle was duplicated with a graft, then, having discovered that after such operations weakness of the posterior part of the joint often occurred, they began to strengthen the posterior-internal bundle. The benefit of strengthening both bundles has not yet been proven, since there are no long-term comparative clinical studies.

The need for surgical intervention in cases of simultaneous injury to several ligaments of the knee joint is even more obvious.

Scheme of the posterior cruciate ligament plastic surgery with a tendon graft

Rehabilitation

You can watch videos of exercises for rehabilitation after posterior cruciate ligament surgery on our website.

Complications

The most common complication after posterior cruciate ligament reconstruction is posterior joint laxity. At the same time, patients themselves usually do not make any complaints and are satisfied with the results of treatment, despite the data of an objective examination. With a combined injury, early repair of the posterior cruciate ligament can lead to scar adhesions inside the joint.

Forecast

Even with conservative treatment of isolated posterior cruciate ligament injuries, the prognosis for function and return to sports is very good. Ligament weakness can be largely compensated for by quadriceps strength and an adaptive extension mechanism. The minimum rehabilitation period is 3 months. However, after a complete tear of the ligament, some patients have such instability in the joint that they cannot continue to play sports. In such patients, it is advisable to undergo surgery to reconstruct the ligament.

Concomitant injuries to the ligamentous apparatus of the joint worsen the prognosis. Timely diagnosis and treatment, as well as a rehabilitation program, are very important for the full restoration of function, but even if these conditions are met, a significant part of patients cannot return to their previous level of activity.

Symptoms of damage

The patient can often associate the onset of symptoms with exposure to a traumatic factor. When the ligament ruptures and the joint is dysfunctional, the vessels are damaged and hemorrhage occurs – hemarthrosis. Its increase leads to increased pain to the point that it is impossible to touch the sore spot. This can make diagnosis difficult. To avoid extensive hemarthrosis, it is necessary to apply cold and hold it until arriving at the clinic.

Symptoms appear quite acutely and increase over time. There are complaints about:

Sensation of displacement, twisting of the lower leg, instability of the knee joint.
Cracking in case of injury.
Severe acute pain not only in the area of the bruise, but also in the area of the joint cavity.
Swelling that appears on the first day.
The pain intensifies with movement.

What happens before surgery?

Before the operation, the doctor conducts a comprehensive clinical examination. First, all the circumstances of the injury and the degree of instability of the knee are clarified. Thus, the specialist receives information about the extent of the gap. Unfortunately, the diagnosis is often made several years after the injury, since patients do not attach much importance to it and consider the injury to be a simple sprain.

In the presence of strong thigh muscles, the diagnosis is usually not made as part of a clinical examination and surgery is not considered. However, over time, the patient feels discomfort in the knee joint. Arthrosis can be caused by trauma that damages the cartilage. Very often, problems of the knee joint appear only after several 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 instability of the knee joint, a cruciate ligament tear is determined using special techniques such as the anterior drawer test (ADT), the Lachman test, or the lateral slip test (McIntosh test).

The Lachman test helps determine the stability of the cruciate ligaments. The test is performed using the anterior drawer principle (ADD), but also involves bending the knee to 30°. © joint-surgeon

In addition, the condition of the cruciate ligaments is determined by MRI. X-rays are required to rule out osseous associated injuries to the knee joint. Also, joint puncture—aspiration of synovial fluid from the joint capsule—helps make the diagnosis. Cruciate ligaments have a good blood supply. Therefore, their rupture causes hemorrhage into the joint. The presence of blood in the joint fluid indicates a cruciate ligament rupture.

AAfter diagnosing and checking the patient’s health status, the attending physician conducts an explanatory conversation with the patient, during which he talks in detail about the progress of the surgical intervention, as well as possible complications. After this, you will be referred to an appointment with an anesthesiologist, who will once again check whether your health condition allows the administration of anesthetic drugs. As a rule, surgery for cruciate ligament rupture is performed the next day after a conversation with the surgeon and anesthesiologist.

Main reasons for the breakup

Sharp unnatural rotations of the knee joint relative to the ankle provoke a rupture of the anterior cruciate ligament.

There are two mechanisms for rupture of the anterior cruciate ligament:

Contact – when there is a blow to the femur or tibia with their displacement relative to each other during a fall, sports or other physical activity. A direct blow to the knee joint provokes its excessive extension, which results in a rupture. This doesn't happen often.
Non-contact – twisting of a limb during an unsuccessful landing, braking or jump. Football players and basketball players often get injured when turning sharply on one leg. Skiers and snowboarders have their feet fixed in rigid, high shoes, so when they fall or make a wrong turn, the hip often twists if the skis or snowboard rest against something.

Predisposing factors are:

large angle between the lower leg and thigh in the frontal projection;
small size of the intercondylar fossa;
hormonal imbalances;
weakness of the thigh muscles.

These factors are more common in women, which is why they are injured more often. With age, the risks increase due to a decrease in the elasticity of connective tissue.

Classification

Because the anterior cruciate ligament has two bundles, only one or both of them can be damaged. There is a possibility of complete tearing off along with a section of the bone at the place of its attachment to the lower leg (Segond fracture).

There are three degrees of ACL rupture:

The first is characterized by stretching, accompanied by moderate pain and swelling. As a rule, the ligament is restored after such cases.
Second , there are also small tears. Recovery is longer and the regimen plays a decisive role. However, relapses are likely due to a decrease in its strength.
The third degree is a complete break. The pain is sharp, intense, accompanied by limitation of movement and joint instability. Hemarthrosis (free blood due to vascular damage) is most likely. In this situation, the issue of surgical treatment is resolved.

Also, according to age, fresh ruptures are distinguished - up to 3-5 days, stale - up to 3 weeks and old - more than three weeks. The choice of treatment tactics depends on the determination of these parameters.

ligament tears

ligament tears
Most people strive to recover without surgery. After all, surgery is always associated with some discomfort. Such treatment is expensive and requires lengthy recovery. However, most clinical cases of knee ligament ruptures require surgical treatment. Whether surgery is needed depends on which ligaments are torn, whether the rupture is complete or partial, and how much joint function is preserved. If a person needs surgery but does not receive it, this is fraught with serious consequences:

development of post-traumatic gonarthrosis;
chronic pain;
instability of the joint.

There are several ligaments inside the knee. These are the anterior and posterior cruciate, lateral, and patellar ligaments. The prognosis largely depends on which ligamentous structures are damaged.

When a complete rupture occurs, joint instability always develops. Because the ligaments no longer limit his mobility. There are three forms of instability:

Compensated form. Most indicators are normal. Muscle atrophy is not detected clinically. Joint dysfunction can only be detected through instrumental studies.

Subcompensated form. There is pain, crunching in the joint, and the thigh muscles atrophy. On the affected side, the thigh circumference is 3-4 cm smaller. But clinically, instability manifests itself only under heavy load: running, squats, etc. The radiograph reveals signs of grade 1 gonarthrosis.

Decompensated form. Constant pain, unsteadiness when walking, obvious clinical signs of joint instability. Many people use a cane. The patient complains of pathological joint mobility. An x-ray can reveal grade 2-3 gonarthrosis.

Diagnostics

Visualization of the mechanism of anterior cruciate ligament rupture.

After an injury, there is no need to delay going to the clinic. When visiting a doctor, the patient talks about how this happened. Details matter a lot. Then the doctor conducts a detailed examination, performing functional tests to identify instability, the presence of abnormal fluid, and limited mobility. When diagnosing, the best visualization in great detail is provided by magnetic resonance imaging or computed tomography.

Treatment of ACL rupture.

As a rule, advantage is given to conservative treatment. Only in cases of persistent dysfunction and instability is surgical treatment indicated. It is also necessary, when transporting the patient to the clinic, to provide rest to the leg and cold to the injured area to reduce swelling and to avoid an increase in hemarthrosis. For fixation, orthoses are used as the most convenient option for limb immobilization.

Conservative technique

To relieve pain and reduce the inflammatory response, non-steroidal anti-inflammatory drugs are prescribed. If hemarthrosis is present, blood is removed from the joint using a syringe. Sometimes intra-articular glucocorticosteroids are prescribed. After reducing inflammation, a course of intra-articular injections of hyaluronic acid or platelet-rich plasma can be prescribed to speed up the regeneration of damaged structures. For a speedy recovery, exercise therapy, mechanotherapy, physiotherapy, etc. are prescribed.

Anterior cruciate ligament arthroscopy

Arthroscopy is the most modern and effective method of repair for ACL rupture.

Arthroscopy is performed in cases where there is instability of the joint or other tissues are damaged. The operation is a minimally invasive method of diagnosis and treatment, since the cavity is not opened, and surgical instruments are inserted into it through two small incisions in the skin. The arthroscope allows you to visualize all structures at multiple magnification, thanks to which the doctor can most accurately make a diagnosis and begin surgical treatment.

Treatment of ACL injuries

Treatment of anterior cruciate ligament injuries begins with the use of conservative methods, provided that there is no instability of the tibia in the knee joint and there are no other serious injuries, such as meniscal tears. Partial ruptures of the ACL, as a rule, do not cause the development of instability of the lower leg, since its fragment that has preserved its integrity is able to provide a sufficient level of stabilization of the joint.

Even complete tears do not always require surgical intervention, since the ACL can fuse with the posterior cruciate ligament over time and, in the absence of high loads, will provide a sufficient level of stability to the joint. However, with complete ruptures of the anterior cruciate ligament, especially in athletes and young patients, orthopedic surgeons cannot always rely on the high quality of fusion of the torn anterior cruciate ligament with the posterior ligament. Therefore, more often, in case of complete ruptures of the ACL, surgical intervention is still performed, except for children and adolescents with unclosed growth plates.

Also, surgery for ACL injuries is performed 5-6 weeks after the injury if there is no effect from the use of conservative methods, i.e. when:

maintaining a feeling of “failure” in the knee;
slipping or twisting of the shin;
unruliness of the knee joint.

Immediately after a knee injury, you should not try to get up and move independently, as this can lead to even greater damage to the intra-articular structures. It is important to provide complete rest to the injured leg, apply cold and even try not to lean on it.

Conservative treatment

Thus, in the acute period with fresh injuries, they always start with conservative treatment. It is aimed at eliminating soft tissue swelling and pain. For these purposes, painkillers and cold compresses are prescribed for 2-3 days, and a puncture of the knee joint may be performed to remove blood. The leg is provided with complete rest, and subsequently the load is limited, allowing partial support on it and limiting the range of movements.

Immobilization of the knee joint can be achieved by applying a plaster splint or a special orthosis. The cast completely immobilizes the leg and makes movement in the knee impossible. The orthosis can either provide complete fixation or allow movements with a given amplitude. Adjustment is carried out using special hinges, but changing their position independently is unacceptable. Only an orthopedist can accurately assess the extent of ACL damage and set a safe range of motion.

In the absence of damage to other structures, the knee joint can be completely immobilized only during the acute period. Longer immobilization can only worsen the situation and lead to contracture, i.e. persistent limitation of knee mobility as a result of the formation of adhesions.

After the acute period is over, i.e. a few days after the injury, severe pain and hemarthrosis are eliminated, patients are prescribed specially selected exercises. But wearing an orthosis is not canceled! Their regular implementation will allow you to maintain the necessary muscle strength and gradually restore the range of motion in the knee joint.

Thus, the main method of conservative treatment of ACL injuries is exercise therapy. In the absence of additional damage, i.e., while maintaining the integrity of the menisci and other ligaments of the knee joint, the exercises prescribed by the doctor are performed with increasing amplitude and gradually increasing intensity. But it is strictly forbidden to perform any movements that can provoke instability of the knee joint. Therefore, it is important to strictly follow the exercise therapy program developed by the orthopedist and not perform exercises obtained from other sources on your own, although a properly adjusted orthosis will help to avoid such mistakes.

Strong thigh muscles help stabilize the knee joint, which is critical for ACL injuries.

3-5 weeks after the injury, the patient must be re-examined by an orthopedist. This time, the condition of the knee joint is assessed in a new way using the same diagnostic tests. If during this period there are no signs of instability, the treatment is considered successful and the doctor allows the orthosis to be removed, and also recommends gradually increasing the load during exercise therapy. At the same time, a decrease in the physical capabilities of the knee is absolutely normal. To fully restore its normal functioning, it will take several more weeks, during which it is important to systematically train the thigh muscles.

But if, 3-5 weeks after the injury, pain still persists and there are other signs of instability of the knee joint, including slipping, buckling of the lower leg, surgical intervention is indicated. Surgery will also be indicated in cases of development of chronic anteromedial instability, when after removal of the orthosis and apparent positive dynamics, the functions of the knee are not fully restored after several weeks.

ACL plastic surgery

The cruciate ligaments are under constant tension, so applying sutures to restore their integrity is ineffective. Only in case of a Segond fracture is the integrity of the bone restored by fixing the torn fragment. For reconstruction, plastic surgery is performed using an autograft, that is, using the patient’s own tissues. This is usually the semitendinosus tendon. The efficiency of such operations is high. After completing rehabilitation measures, functionality is restored. However, plastic surgery is not required in all cases.

The need for it is based on:

results of analysis of the intra-articular cavity, the absence of pronounced consequences of inflammation in the joint with extensive fibrosis and adhesions;
presence of knee instability and other functional disorders;
sports activity (the desire to return to sports with certain expected intense loads).

Plastic surgery is not performed immediately, but some time after the injury. However, it is not worth postponing the operation for a long time, since instability causes microdamage to the articular cartilage, which can result in the development of arthrosis. The key condition for surgery is the absence of internal inflammation. Preparation for surgery includes conservative treatment methods. Then plastic surgery is performed using the autotransplantation method. The rehabilitation period after such an operation is very important, and compliance with the recommendations of a rehabilitation physician plays a significant impact on the recovery process.

treatment without surgery

treatment without surgery
If the cruciate ligament is slightly damaged, treatment without surgery is possible. It includes conservative measures, the duration of which depends on the severity of the injury.

Typically, medications (non-steroidal analgesics, vitamins) and physiotherapy (electrophoresis with medications, mud therapy) are used.

For the entire period of treatment, it is imperative to ensure functional rest for the knee joint.

Rehabilitation

After arthroscopic plastic surgery, the patient goes home on the day of surgery. It is recommended to apply cold to the knee for 24 hours and immediately fix the leg with an orthosis. Then they begin to perform exercises, which are given with a gradual increase in load. Physical therapy is a set of exercises developed individually for each person. At first, the exercises are performed when visiting a clinic, then independently at home. Mechanotherapy - exercises on simulators are given in a later period of rehabilitation. Physiotherapeutic procedures, including electromyostimulation, magnetic therapy, and electrophoresis, also provide significant assistance. After arthroscopic surgery, recovery is faster and easier than after open knee surgery.

Forecast

The vast majority manage to fully restore the functionality of the limb after treatment and rehabilitation, and athletes are able to return to training. However, this is a rather slow process and takes about six months on average. It is important to adhere to the recommendations of specialists and not to provoke new injuries.

This patient suffered an ACL and collateral ligament injury 2.5 months ago. In this video, he is undergoing conservative treatment for anterior cruciate ligament injury. Subjectively, the knee is stable, but we continue to use various rehabilitation tools, such as flossing.