23.10.2020
The complex structure of the knee joint includes the anterior cruciate ligament (ACL), which stabilizes it, prevents excessive forward movement of the tibia, and anchors the lateral tibial condyle. If the movement is too intense, it can rupture, which will lead to destabilization of the knee and, as a result, the inability to move normally. Arthroscopy of the anterior cruciate ligament is performed to diagnose and treat the injury. This minimally invasive surgery is highly complex, but is an effective way to restore limb mobility and prevent premature wear of the joint.
When is anterior cruciate ligament reconstruction performed?
The indication for surgery is a partial or complete rupture of the cruciate ligament caused by excessive displacement of the knee joint - for example, due to fractures, dislocations or simply too intense movements with a sharp change in the direction of movement of the limb or its twisting.
Most often, such injuries are observed in athletes, dancers, stuntmen, and military personnel, since in everyday life high-amplitude movements are rarely performed by humans.
The symptoms of a torn anterior cruciate ligament depend on the severity of the injury - depending on the force applied, individual fibers, most or all of the anterior cruciate ligament may be damaged. At the time of injury, a cracking sound of torn connective tissue is often heard, but this is not a specific sign, since a similar effect accompanies ruptures of other tendons. This injury is also accompanied by the following symptoms:
- intense pain in the knee joint, intensifying when trying to stand on the injured leg;
- instability of the knee joint, manifested in excessive mobility of the lower leg, a feeling of loss of support when moving;
- swelling of the joint and surrounding tissues and hemarthrosis - blood entering the joint cavity, which externally manifests itself as a bluish swelling in the knee area.
With micro-tears of individual fibers of the ligament, as a rule, only pain in the joint, swelling and limited mobility are observed. The joint remains stable, so the patient can move independently. When the ligament is completely torn, stability is lost and the support ability of the injured leg is impaired.
The location of the injury may also vary. In particular, a separation of one of the two bundles of the ligament is isolated, while the severed end enters the articular cavity and manifests itself with symptoms similar to a meniscus injury. A Segond fracture is also possible, in which the ACL is not torn in the middle part, but at the point of attachment to the tibia with separation of its fragment.
Features of knee joint orthoses with stiffeners
- The product limits the mobility of the knee joint and relieves it, thereby creating favorable conditions for recovery.
- The brace helps to better absorb vertical loads on the lower limbs caused by walking.
- The use of a knee joint orthosis with stiffening ribs can reduce the level of pain, eliminate swelling and inflammation, increase the level of comfort and improve well-being.
- The products have virtually no contraindications, so they can be used daily at the time when necessary.
- Unlike plaster casts and other bandages, you can put on a knee brace with stiffeners yourself without the help of a bandage specialist.
- In the production of products, high-quality medical materials are used, such as elastic knitwear, neoprene, plastic and metal in the stiffening ribs.
- Some models are equipped with a silicone ring that protects the kneecap from mechanical injury.
- How to buy a knee orthosis with stiffeners
In some cases, when symptoms of injuries and diseases occur, the doctor prescribes treatment with an orthopedic product. If you have not yet consulted a doctor, we advise you to do so.
First, before purchasing, determine the correct size of the product. To do this, each product card in the Allorto online store catalog contains a size table. If the size and model are known, add the product to your cart and proceed to checkout. If you have any questions, please call our contact center. Operators will help you choose a product and also tell you about the advantages of our delivery within the Russian Federation.
Preparation for anterior cruciate ligament arthroscopy
Before surgery, a patient with a suspected torn anterior cruciate ligament must undergo a course of medical examinations so that the doctor can make an accurate diagnosis and determine the extent of the damage.
Inspection.
At the first appointment, the surgeon will ask you questions about the injury, how you feel when moving the injured leg, and walking. During a visual examination, he will assess the external condition of the knee joint, the presence of such characteristic signs as swelling and bruising.
Physical examination.
Because anterior cruciate ligament rupture is characterized by excessive mobilization of the knee joint, a series of tests are performed on the injured leg to identify this symptom. Their essence is that the doctor mechanically acts on the lower leg, causing it to move forward or sideways. If this cannot be visually recorded, an artometer device is placed on the leg, measuring joint mobility with millimeter accuracy. A physical examination makes it possible to make a diagnosis and assess the extent of damage, but can only be carried out before the formation of swelling or after its subsidence, since manipulations with a damaged and inflamed knee are quite painful.
Radiation diagnostics.
X-rays, CT and MRI for anterior cruciate ligament rupture are used as additional methods to exclude other injuries, such as fractures, meniscal tears, etc. If visual examination, palpation and joint mobility tests provide enough information, radiation diagnostics is not necessary.
General medical tests are also prescribed - urine and blood tests (Rh factor, coagulation, infections), electrocardiography, consultation with a therapist and other specialists (if there are any disorders). This is necessary to exclude contraindications to surgery, such as intolerance to anesthesia components, acute vascular diseases of the lower extremities, cardiac pathologies, mental and neuromuscular disorders.
Knee orthoses with stiffeners
In case of severe injuries and disorders in the knee joint, when additional fixation is required, doctors recommend the use of knee joint orthoses with stiffening ribs.
These elements create additional support, acting as a power frame, increasing the efficiency of the product. The knee joint is actively used by a person throughout his life. This important unit of the musculoskeletal system is responsible for bending the legs when walking and jumping, absorbing loads and transferring weight to the lower leg and feet. It is thanks to him that we are able to walk, run and jump. Therefore, it is important to protect joint health before problems arise.
Overfatigue of the musculoskeletal system, wear and tear of joints due to increased physical activity, as well as age-related changes in the structure of cartilage tissue can lead to degenerative diseases such as arthritis and arthrosis. Also, under the influence of these factors, the risk of injury, for example, sprain or dislocation, increases.
Performing arthroscopy of the anterior cruciate ligament
A rupture of the anterior cruciate ligament is complicated by the fact that the connective tissue regenerates slowly. Its fragments can grow together with each other or with other ligaments and even provide stability to the joint, but the strength of the connection will be low. With increased physical activity, the weakened tissue can tear again, which prevents people with a self-healed ACL from continuing to engage in professional sports or other work that involves intense movement. Conservative treatment of injury often does not give the desired effect, as does suturing torn fragments.
If it is necessary to restore the full functionality of the anterior cruciate ligament, its plastic surgery (reconstruction) using a graft is prescribed. The operation is performed arthroscopically, that is, through 2-3 small (0.5 cm long) incisions in the skin of the knee.
Transplant preparation.
A new ACL is most often made from the patient's own tissue—usually the middle third of the patellar ligament or hamstring tendon. Alternatively, donor tissue can be used. The ends of the future ligament are secured in metal pins with which it will be attached to the bones.
Preparing the joint.
One arthroscopic puncture is made in the knee, through which irrigation fluid is injected into the joint cavity. It expands the space between the joint elements, improving visibility and providing more space for surgical manipulations. Next, an arthroscope is inserted into the puncture - an instrument in the form of a thin tube with a miniature camera at the end. With its help, the doctor observes the operated area through a monitor screen. An arthroscopic instrument is inserted through the second puncture in the knee to remove the remains of the torn ligament.
Restructuring of PKS.
Two holes are drilled in the cleaned articular surfaces of the femur and tibia. Metal graft pins are inserted into them, after which all instruments are removed, and a suture is placed on the arthroscopic punctures. Immediately after the operation, an orthosis (external bandage) is installed on the operated knee joint. It is necessary to immobilize the limb until the knee heals.
If the ACL rupture was accompanied by a Segond fracture, transplantation is not performed. Instead, the torn bone fragment with a ligament is fixed in its original place until it grows back.
Arthroscopy of the anterior cruciate ligament of the knee joint takes place in a hospital setting under general or local anesthesia. The procedure itself takes on average 1-2 hours, depending on the degree of damage.
Knee ligament ruptures
The lateral or collateral ligaments prevent the tibia from moving laterally. There are two of them: external and internal. These tight bundles of fibers stretch along both sides of the knee joint. They tear mainly when there is excessive lateral deviation of the thigh or tibia.
There are also two cruciate ligaments. They are located in the very depths of the joint and prevent the tibia from moving in the anteroposterior direction. Despite the fact that the cruciate ligaments are often comparable in thickness to the little finger, they often tear. The cause may be a sharp blow to the shin or its displacement.
How is a torn knee ligament treated?
Loss of ligament function leads to instability of the knee joint. The injured knee “slips” while walking and can repeatedly shift to one side or another. Even minimal instability overloads the joint and stimulates the development of arthrosis. Therapeutic tactics for ruptures are implemented in several options:
- Surgical treatment. This is especially true for ruptured cruciate ligaments that do not heal on their own. The most common procedure is arthroscopic reconstruction. During surgery, the ligaments are repaired through small holes in the knee joint.
- Conservative treatment. If surgery is refused or there are contraindications to it, the ligaments can be treated in orthoses. The emphasis is on activating the muscles that stabilize the joint. Special exercises and physiotherapy are prescribed.
Rehabilitation after arthroscopy of the anterior cruciate ligament
After the operation, there is a long (4-6 months) rehabilitation period, during which you will need to follow the instructions.
For the first month after surgery, you will be in a rehabilitation center. Your knee joint will be supported in a cast or brace until the graft is fully healed. During this period, physiotherapeutic procedures such as rubbing, compresses and massage are indicated.
After the first month, the knee brace will be removed and you will be allowed to do rehabilitation exercises. Under the guidance of a doctor, you will gradually increase the load on the operated leg, while strictly monitoring indicators of its mobility and muscle control.
6 months after the operation, if all instructions are followed, you can return not only to normal life, but also to sports or other professional activities. The prognosis is usually positive - 90% of all those who undergo arthroscopic ACL repair completely restore the functionality of their knee.
Types of knee braces
Today there are 3 types of knee joint bandages:
- soft bandage - fixes the joint, resembles an elastic bandage, but practically does not slip or unwind. It's lightweight and made from knit fabric to support your knee.
- reinforced bandage - consists of synthetic material, durable, elastic, can adapt to your anatomy (the so-called “memory effect”), does not cause discomfort. Plus, the skin in such a bandage literally breathes. And it is called reinforced because of the straps and stiffening ribs for greater fixation and support of the joint.
- orthoses and splints - this is a more rigid version of a reinforced knee brace; it includes elements made of metal, plastic, and hinges. They are more durable, have a greater fixing effect and are used as directed by a doctor.