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.

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.

Ligament rupture

The shoulder joint is an extremely active joint with a wide range of motion. A large number of ligaments are attached to the area of this joint. Taking into account the location, injuries to the acromial ligament (ACL), damage to the sternoclavicular ligament, damage to the tendons of the short and long heads of the biceps and damage to the rotator cuff formed by the tendons of the supraspinatus, infraspinatus, subscapularis and teres minor muscles are distinguished.

The cause of rupture of the ligaments of the shoulder joint can be external rotation of the arm, a fall on an outstretched arm, a blow to the collarbone, or a sharp extension of the arm during a throw. The joint is swollen, deformed, its contours are smoothed. Bruising may be visible. Movements are limited. With ruptures of the biceps tendons, shortening of the biceps brachii muscle is observed when trying to bend the arm. Damage to the ligaments of the shoulder joint can be either complete or incomplete; with complete ruptures, the symptoms are more pronounced.

The diagnosis is made on the basis of the clinical picture and X-ray data of the shoulder joint, indicating the absence of bone damage. If damage to the labrum and complete ruptures of other ligaments are suspected, an MRI of the shoulder joint is prescribed. In some cases, arthrography and ultrasonography are used. If, using the above studies, it is not possible to establish the location and extent of the damage, the patient is referred to arthroscopy of the shoulder joint, which can be used as both a diagnostic and therapeutic method (for suturing the defect).

Treatment is often conservative. Young patients are given a cast for 3 weeks, older patients are immobilized using a wide scarf for 2 weeks. All patients are referred to physiotherapy (in the absence of contraindications). After stopping immobilization, it is recommended to perform special exercises to develop the joint. At the same time, for 1.5 months it is necessary to avoid forced movements, especially those repeating those in which the rupture occurred.

Surgical operations are indicated for complete, severe and repeated ruptures. The operation can be performed either classically, using open access, or through a small incision, using arthroscopic equipment. The ligament is sutured, immobilization is carried out in the postoperative period, physiotherapy, massage and exercise therapy are prescribed. The outcome of shoulder ligament rupture is usually favorable.

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.

TREATMENT

An isolated tear of the lateral or medial collateral ligament rarely requires reconstructive surgery. In these cases, conservative therapy is carried out, which consists of fixing the lower limb extended at the knee joint using a brace or plaster cast. However, many traumatologists prefer not to use external immobilization of the knee joint for an isolated rupture of the medial collateral ligament. Although there is an opposite point of view: external immobilization means should be used for any injury to the knee joint, accompanied by pain and symptoms of instability. Initial treatment for a collateral ligament tear is aimed at reducing pain and traumatic swelling. To do this, it is necessary to rest the injured limb and apply ice packs to the knee joint area. In case of significant injury, it is recommended to take anti-inflammatory drugs (diclofenac, aspirin, ketonal, etc.). When walking, you must use crutches until the lameness disappears.

To reduce pain in the acute period, the use of transcutaneous electrical nerve stimulation (TENS) may be indicated. After severe pain subsides and swelling decreases, physical therapy is added to the complex of conservative therapy. The purpose of physical therapy is to restore the normal range of motion in the damaged joint and restore the strength of the muscles of the limb (especially the quadriceps muscle located in the anterior region of the thigh). It has now been shown that early administration of physical therapy leads to a more rapid and complete restoration of knee joint function and a reduction in the overall duration of the rehabilitation period. If, after restoring muscle strength and joint function, the patient still has symptoms of instability, the patient must use external immobilization devices (braces) during physical activity. In some cases, the surgeon may offer you surgical treatment.

Surgical treatment is usually indicated for combined damage to the collateral ligament and other structures of the knee joint. Some surgeons believe that with a combined rupture of the medial collateral and anterior cruciate ligaments, surgery is necessary to restore the function of both ligaments. Other experts disagree with this opinion. They propose to perform anterior cruciate ligament replacement after a course of conservative treatment aimed at restoring the integrity of the collateral ligament. Time will tell which approach is optimal. During reconstructive surgery, a skin incision is made in the area of projection of the torn collateral ligament. If the ligament is torn off in the area of its attachment to the bone, then the ligament is fixed using metal fixators or strong synthetic threads. In case of a median rupture of the collateral ligament, the ends of the ligament are sutured to each other. With “old” ruptures, suturing of the collateral ligament is in many cases not possible due to the appearance of scar changes in the torn ligament. To eliminate instability of the knee joint in these cases, the torn collateral ligament is replaced with an autograft. What it is? An autograft is a piece of ligament or tendon that is taken from another location from a patient during surgery. In most cases, the tendon of the semitendinosus muscle, one of the muscles of the posterior thigh, is used as a graft. Recent studies have shown that harvesting of the semitendinosus tendon does not result in decreased lower extremity strength due to compensatory hypertrophy of other thigh muscles. The ends of the autograft are attached to the bone using metal screws or strong synthetic threads.

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.

2.What are the symptoms of a muscle tear?

Violation of the anatomical integrity of muscle fibers causes severe pain and an attempt to adopt a forced, gentle body position, in which the affected muscles are least stretched. Often the rupture causes convulsions that cannot be relieved for a long time. If the skin at the site of injury is not damaged, intense internal hemorrhage begins, which causes swelling and redness. The resulting hematoma may appear after some time in the form of an extensive bruise.

Motor activity in the affected area becomes impossible due to severe pain with any attempt to move. If the muscle bundle is completely torn, certain movements are simply impossible. With a partial rupture, the function is preserved, but the acute pain syndrome forces the victim to remain completely at rest.

Diagnosis of this injury is not difficult. The symptoms are obvious and pronounced. It may just be necessary to differentiate trauma from more severe disorders. If it is necessary to exclude a fracture, an x-ray examination is prescribed.

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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.

Breaking “crosses” - how to recover and how much it costs. We tested it ourselves

A Match TV correspondent explains what the most popular football injury and recovery from it looks like.

On September 30, 2021, while playing football, I tore the anterior cruciate ligament of my left knee
On November 14, 2021 I had surgery to reconstruct the ligament
On June 25, 2019, I ran the first seven kilometers (the doctor gave permission to run and play football on May 23)

How does injury happen?

Statistics say that every year 2-3 people out of a thousand suffer a cruciate ligament rupture. To do this, you can be a professional football player, like Igor Akinfeev or Alexander Kokorin. A fighter - like Khabib Nurmagomedov or Conor McGregor, or you can just play football with friends without trying too hard. I played football from the age of 10, exclusively as an amateur, and never once sought medical help, even when it was very painful several times. At 29 years old, I tore the anterior cruciate ligament in my left knee. I was playing in defense and wanted to clear the high-bouncing ball. I just needed to hit it with a volley, at a slightly unusual angle. Schematically, it was necessary to hit the same way as Zinedine Zidane hit, scoring against Bayer in the 2001/02 Champions League final, only with his right foot.

Watch on YouTube

I missed the ball and couldn't keep my balance. I was wearing new boots, the field was artificial, this gave excellent grip to the sole, and it turned out that my foot was firmly stuck into the lawn, and my body was spinning counterclockwise and a very large load fell on my knee. The knee twisted, as if it folded under you. The ligament is torn.

- Unfortunately, very often it simply depends on the angle that arises between the foot, thigh and lower leg - and all other factors play a secondary role. To put it simply, if the femur is at the wrong angle relative to the tibia, the foot is fixed rigidly and you apply enough force, the tension and tension of the ligament becomes critical, it may not withstand it and tear. This often occurs during a rotational movement. The posterior cross is often damaged in an accident,” explains surgeon Yuri Glazkov. “Yes, there are statistics that, for example, women receive such an injury more often. Due to the anatomy of the lower extremities, it is easier for them to get the same angle at which the risk of injury increases, but in general it is almost impossible to insure against this, especially if you lead an active lifestyle. I usually tell amateur athletes that this is, in principle, the price of our emotions from sports and our good mood.

How to tell if your cruciate ligament is torn

It feels painful, but it's definitely not the most painful injury you can get in football. There are three key features:

At the moment of injury, you can hear something clicking
The knee swells quite quickly
You stop feeling the stability of your knee joint

The last point is easy to explain, but dangerous to test. For some time after the injury, I remained on the field, the ball rolled towards me, I tried to kick it back, and at the moment when I hit the ball with my right foot, leaning on my left, there was a feeling that my left was going to fall apart under you right now. At the emergency room you may be asked, “Can you stand on this leg?” There is no difficulty in standing on your leg, but this does not in any way diagnose a ligament rupture. One of the simplest tests doctors do is the drawer test. Here he is in the video:

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How much does treatment and diagnosis cost?

Expensive. To get an operation, you will need to have an MRI scan - from 4,000 to 8,000 rubles.

The first set of medications to relieve swelling and pain is another 4000-5000.

If you cannot provide rest for your leg, you will be offered to move in an orthosis for some time - 4000.

To have a puncture (remove blood from a joint) at a private practice doctor - another 3000-5000.

After surgery you will need:

— anti-inflammatory drugs and drugs for the prevention of venous thromboembolism (omez, arcoxia) — 3,000 rubles;

- chondroprotectors, in my case Geladrink (useless, according to one of the doctors) - 3000;

- orthosis with adjustable bend angle - from 12,000 (and up to 45,000);

- several procedures, the most popular: injections of platelet-rich plasma (from 4000 to 10,000 per procedure - I did not do it) and injections of hyaluronic acid, in my case - three injections of 6500 per one.

You can also attend courses on electrical muscle stimulation (or buy a muscle stimulator - from 15,000), magnetic therapy and engage in rehabilitation procedures with a trainer.

In my case, the cruciate ligament injury without the cost of surgery cost me 58,000 rubles.

— If I had unlimited money, like a football player, what else could I do?

- In fact, there is not such a large set of procedures, and it all comes down to ensuring that your muscle becomes toned after restricting movements and the ligament takes root inside, grows with blood vessels and nerve endings. Both of these processes cannot be radically accelerated. That is why both football players and the person who trains himself will recover for about six months. Just a football player, due to the fact that he will only be engaged in recovery, can begin to get in shape earlier and do some exercises on the field and in the gym, says former FC Rostov doctor Valentin Belyaevsky. — The question is what level are you returning to? A football player can start playing in six months, you can run and squat with a barbell if you recover correctly.

In my case, exactly one and a half months passed between the injury and the operation (September 30 - November 14). On October 1 (exactly one day after the injury), I had to go on a business trip for two weeks, and to my surprise, three out of three very highly qualified doctors approved it: “The main thing is not to put too much stress on your leg.” Before the flight, they recommended injecting yourself with fraxiparine in the stomach to eliminate the possibility of thrombus formation. It does not hurt. After a business trip, while searching for a place where I could undergo surgery, at night I made myself a rather unusual compress: a mixture of Lyoton and Voltaren gels, on top of gauze soaked in vodka, on top of this with cling film and on top - an elastic bandage. And so you sleep.

Operation

In Moscow, private surgery costs on average from 80 to 140 thousand. In the most expensive Moscow clinic they will do it for 7 thousand euros. The cost of the operation by one of the main specialists in the world is estimated at 15-20 thousand euros. “Basketball players, for example, go to Finland and give away around a million rubles,” shared one of the Russian doctors. In Russia, a good private practice doctor performs at least a hundred cruciate ligament plastic surgeries a year.

“Two small punctures are made: a video camera is inserted through one, instruments are inserted through the other,” says practicing surgeon Yuri Glazkov. “The site of the injury is examined again. After this, another puncture or incision is made, which is a little larger, and one or two tendons are taken from the popliteal region. The tendon is folded in four and stitched with threads, obtaining what will serve as a replacement ligament (the average length of the cruciate ligament of the knee is 30 mm, diameter from 6 to 11 mm. - “Match TV”).

Then the place where the injured ligament was is cleaned. Those fibers that are not needed are removed with a special device: something like a vacuum cleaner equipped with a blade. But now we are trying to preserve as many fibers as possible from the damaged ligament in order for the vessels and nerves to grow better in the graft. Next, we make two canals in the femur and tibia (bones that are literally located above and below the knee. - Match TV), a new ligament is inserted into the canals and secured either with buttons or with screws. After this, stitches are applied. The operation usually takes about an hour.

In general, in Russia this method began to be mastered in the late 90s - early 2000s; there was a period when only a few people who were trained somewhere in Europe or the USA could operate this way. And so, before, if you received such an injury, then, firstly, your knee would be completely opened, and this is a much more difficult operation and recovery process, secondly, they would install a synthetic prosthesis, thirdly, they would use a completely different one type of fixation, previously for a long time nothing was used except metal screws"

The only bright spot in the whole story is that anterior cruciate ligament surgery can be done under a compulsory health insurance policy for 0 rubles. Or under a VHI policy, and then you will only have to pay the cost of the implants. The little things that will be used to attach the new ligament to the bones, the same metal screws of the past. Now they are made from a biomaterial that can literally grow to bones. The downside is that this is not the easiest operation, and there is a theory that not all doctors do it equally well.

Photo: © Rick Eglinton / Contributor / Toronto Star / Gettyimages.ru

I was given compulsory medical insurance at the Center for Traumatology and Orthopedics of the State Clinical Hospital named after. Semashko. You need to get an appointment with a surgeon, and he will refer you for surgery. Having received a referral for surgery, you need to take blood and urine tests and come to the hospital. You will be put in a ward and the next day early in the morning they will take you away to operate.

Before the operation, they give a sedative, phenazepam; during - another one is administered using a dropper. The anesthesia is spinal, the injection is given in the lumbar region, and after that you stop feeling your legs. Most likely, the sedative is given precisely for this purpose, because the feeling that your legs no longer obey you suddenly does not frighten you at all. At the same time, you move from the couch to the operating table in your arms, and the nurse throws your legs like the tail of a fish. Yes, that's exactly what it looks like.

https://www.instagram.com/p/BdNbatuFtIC/

Despite the fact that local anesthesia is not used, the sedative makes you want to sleep and you almost don’t remember the operation - for example, I never saw the surgeon himself, although I woke up several times. As they explain, a surgeon in a city hospital performs 7-8 operations a day, at least one of these operations is associated with damage to the cruciate, and the specialist only has the main part of the work - to take the graft, correctly place it in place of the torn ligament and secure it.

Then you wake up in the ward, there are stitches on your leg in five different places, sealed with a bactericidal plaster, your leg is packed in an “orthosis” that cannot be removed for the next 4-6 weeks.

After operation

Important! The debate about how to quickly start walking without crutches is exactly the same as the debate about Canon and Nikon or Samsung and Apple. Be prepared for this. Two most enlightened doctors with absolutely the same qualifications can tell you completely different things. One is that you need to walk with crutches for 1-2 weeks and give your leg maximum rest. Another is that you can almost immediately after the operation lean on your leg (my case) and start doing the simplest exercises - lying on your back, raising and lowering your straightened leg. In a private clinic, if you find an honest doctor, you may be sent home on the second day, indicating the required set of painkillers. They kept me in the government for 5 days. They said that the operation went almost perfectly, so the only medications were antibiotics and painkillers intramuscularly twice a day. At the same time, my friend told me how he lay with a high fever for another two or three days and didn’t even think about active recovery. The man in the ward after the same operation had a headache for three more days without stopping. The doctors said that it was necessary to lie down less after the operation.

It’s scary to step on your foot; it seems like the ligament will tear again. They say this is a standard feeling. Walking in a brace that keeps your leg strictly straight is incredibly uncomfortable. It’s hard to go down the stairs; walking on a straight leg quickly hurts your back.

After a week, the angle of the orthosis can be set to 30 degrees, after two - to 60, after three - to 90. After four weeks, the orthosis can be removed and you can start walking.

The stitches are removed after 10-14 days. From now on you can wash normally. Before this, only creativity and stretching help to wash.

In the first 4 weeks, your exercises are straight leg raises in different positions, bending the knee until it hurts. After this, it becomes more fun, you can spin a bike, swim in the pool, and work out your muscles. There are several courses on YouTube where the exercises are laid out by week:

One (possibly the best)
Two
Three
Four

Be prepared for the fact that purely psychologically it will suddenly become very bad. Four weeks after the operation, it is extremely uncomfortable for you to walk, uncomfortable to sleep (the orthosis is still quite cumbersome), inconvenient to wash, any changing of clothes takes a long time, and your leg may ache. At some point, complete apathy towards everything may appear, and you only think about the fact that people are coping with much more serious illnesses. You live by reference points: remove the stitches, remove the orthosis, achieve flexion of the leg to an angle of 90 degrees and full painless extension. In the first weeks after the operation, it is impossible to bend the leg 90 degrees; it seems that a small ball has inflated in the knee, which, when bent, presses on the joint from the inside and seems to be pushing it apart.

Recovery

“You will never recover normally on your own, you have no idea how hard you have to work,” one of the doctors who was most loyal to me told me verbatim. Now I’m almost sure that it was more likely to motivate. The biggest problems are for those who were injured without the habit/opportunity to exercise regularly. For example, going skiing once a year. Before the injury, I was able to train 5-6 times a week. After the injury, the same thing was required, only the training became easy, but tedious.

“Honestly, you can easily recover on your own if you have enough discipline, you just can’t imagine how many people give up on this as soon as they just start walking normally,” said the rehabilitator.

https://www.instagram.com/p/BzvgmZBhH09/

For the second or third month after the operation, I swam, rode a bicycle, pumped up my calves with rubber, squatted very carefully, hooking the rubber onto the horizontal bar, i.e., reducing the load on my legs, and did all possible leg lifts.

After the third month, I started training on block machines with low weights and a high number of repetitions. It’s scary that after 4 weeks in an orthosis, the muscle deflates and you get two legs of different volumes above the knee. Doctors talk about a vicious circle: a toned muscle takes the load off the joint, but a freshly operated joint does not allow you to do exercises that would tone the muscle.

Even at home, you can do a lot of exercises to restore coordination, bending on one leg, side steps with rubber, squats with alternating legs, balancing on an unstable surface. It is important here that the cruciate ligament is responsible for the stability of the knee joint, and its healing must be accompanied not just by muscle strength, but also by normal coordination of movements. Conventionally, you won’t have to learn to walk again, but you will have to learn to stand confidently on one leg. After about five months you begin to feel healthy. The only caveat: out of curiosity, I decided to try doing a workout every day for 42 days. And it worked. That is, 4 months after the operation, I spent the most intense training month and a half of my life. Six months later I went to see the surgeon and he said that the average patient's knee looked very good.

Nuances

It is almost impossible to insure against injury: the absence of excess weight and warming up are beneficial, but they will not play a decisive role.

“To put it simply, there is such a thing, proprioception, this is when your brain understands and feels how your body parts are located in space, even if it doesn’t see them. And, for example, good muscles can protect us from injury by preventing unnatural bends and angles in the joints. That is, at the reflex level, the brain gives the command to stop movement in a critical situation. In general, this system can be trained and improved, but at the same time, if you haven’t had enough sleep, are under severe stress, or simply feel bad, this process begins to work worse, and this defensive reaction slows down. And the brain may not have time to give the command to stop the movement,” says doctor Valentin Belyaevsky. I came to that same football game with a very athletic summer behind me, but completely unsettled on that particular day.

As in the case of plane crashes or apartment scams, only negative experiences become public. Conventionally, many people do not write on forums if the operation went well. Because of this, the effect is created that complications arise through one person. I called a lot of friends who had cruciate ruptures, and most had normal surgery and recovered.

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I asked advice from six fairly serious doctors (three of them had not seen an MRI), and at some point the vote was 2:2 whether to do the operation or not. There is a theory that penetration of a joint causes no less complications than living with a torn ligament. The opinion of a fairly authoritative doctor is that with a torn cruciate, you can live a normal life if you do not play sports. If you pump up your thigh muscles and go for preventive procedures, you can even train at an amateur level. Others, in response to this, very emotionally called this approach wrong and said that only surgery helps, especially if you are under 50 years old. In the same room as me was a young man who had been postponing ACL surgery for 10 years. As a result, he came to the surgeon with a complaint that his knee was periodically stuck in one position. It stopped bending and unbending.

You can invest endlessly in restoration and spend several hundred thousand rubles. For example, work with a rehabilitation specialist. My main expense was the purchase of a myostimulator (32 thousand rubles) - it tones the muscle, but allows you to do this without loading the joint.

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It's been 8 months since my surgery. When the knee bends strongly, there is a feeling that it behaves differently than before. I haven’t tried sprinting or jumping with a change of direction yet. You can run at a moderate pace without pain. The thigh muscles on the left and right legs are almost the same size. They say that it is better to give yourself 9-12 months before a difficult coordination sport if you are not a professional. After about a year, it makes sense to do a repeat MRI and look at the condition of the knee. The surgeon said that I could start playing football if I wanted. No desire yet. For now, I want to enjoy the stability of the knee joint while running and training outdoors.

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.

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.