What Is Anterior Cruciate Ligament Surgery?
Anterior Cruciate Ligament Surgery: During knee movement, the femur (thigh) rolls over the tibia (shin) bone. The anterior cruciate ligament is one of the key structures that prevents the tibia from sliding forward. It runs from the front to the back between the femur and tibia and is essential for the proper movement of the knee, along with the posterior cruciate ligament.
What Are the Functions of the Anterior Cruciate Ligament?
The anterior cruciate ligament coordinates knee movement and prevents dislocation of the knee joint by stabilizing it at specific points during movement. This allows for safe continuation of activities.
How Does the Anterior Cruciate Ligament Tear?
The anterior cruciate ligament typically tears in two ways. The first is through traumatic sports (such as football, skiing, basketball, etc.) due to sudden twisting movements on a planted foot or from a direct impact to the knee. This can happen during sudden stops, changes in direction while running, or landing after a jump. Patients often present with rapid swelling, sharp pain, and limited mobility. The second type is non-traumatic anterior cruciate ligament injuries, which develop gradually with increasing pain over time, characterized by knee pain and walking difficulties without sudden swelling.
How Is Anterior Cruciate Ligament Injury Diagnosed?
Diagnosis of suspected anterior cruciate ligament injury can usually be made through a physical examination with specific tests. However, X-rays and MRI scans are performed to assess any accompanying injuries and confirm the diagnosis. MRI is very accurate for diagnosis.
Who Is a Candidate for Anterior Cruciate Ligament Surgery?
The anterior cruciate ligament does not heal on its own; therefore, surgery is typically a reconstruction procedure rather than a simple repair. Indications for surgery include:
- Individuals planning to continue sports
- Patients with multiple ligament injuries
- Cases involving meniscus tears
- Those experiencing sudden giving way or twisting of the knee during daily activities
- Recommended surgery for young individuals with anterior cruciate ligament injuries
If you feel instability in your knee, which prevents you from engaging in sports like running or skiing, surgery is suggested for patients under 55 years of age with anterior cruciate ligament injuries.
Pre-Surgery
Patients begin rehabilitation after necessary evaluations before surgery. The swelling in the knee must subside, and full range of motion and strengthening of the quadriceps muscle are recommended. This period typically lasts 2-3 weeks after the injury.
Before surgery, an anesthesiologist evaluates the patient and discusses the anesthesia method, which may be general (fully asleep) or spinal (only numbness from the waist down). The appropriate method is determined in consultation with the anesthesiologist. If you’re taking blood thinners, you may need to stop them or switch to other medications beforehand.
During Surgery
During anterior cruciate ligament surgery, the knee is positioned at 90 degrees. Two small incisions are made on either side of the lower knee to assess the internal structures with an arthroscope. Damaged ligaments, menisci, and cartilage are documented. A 2-3 cm incision is then made on the upper inner part of the tibia to obtain a graft for reconstruction. The graft is placed into prepared tunnels and secured with appropriate tension. The surgery typically lasts 45 minutes to 1 hour.
Post-Surgery
After surgery, pain is managed, and ice is applied to the knee. Patients generally stay overnight in the hospital. The following day, they are encouraged to stand up using crutches. Strengthening and range of motion exercises begin immediately for the quadriceps muscle.
Patients usually use crutches for about 15 days and can resume simple daily activities afterward. Office workers can return to work after 15 days. The goal is to achieve full range of motion in the first two weeks, followed by strengthening exercises for the next six weeks, and balance exercises for 6-12 weeks. Patients typically start light running by the third month and can return to non-contact sports (like swimming) within 6-8 months. Contact sports (like football or basketball) are generally recommended only after one year, except for elite athletes.
Rehabilitation for patients with concomitant meniscus tears may vary depending on whether the tear is repaired. If the meniscus is repaired, weight-bearing is restricted for about one month, and motion beyond 90 degrees is not allowed for the first four weeks. After six weeks, patients start strengthening exercises while bearing weight. If the meniscus is removed instead of repaired, standard rehabilitation for the anterior cruciate ligament follows.
Risks of Surgery
As with any surgery, there are risks such as infection and bleeding. The risk of infection is about 0.1%. To minimize complications, antibiotics are administered before surgery, and some medications may be changed if necessary.
Your overall health, existing conditions, and medications may present additional risks. Your doctor will provide information on these.
In summary, anterior cruciate ligament reconstruction carries risks similar to other surgeries, including infection and bleeding. The infection risk is approximately 0.1%. Antibiotics are given preoperatively to prevent complications, and medication adjustments may be made as needed. Some patients may experience slight numbness in a small area on the front of the knee.
Q&A
The anterior cruciate ligament is torn, but I currently have no pain. Do I still need surgery?
The anterior cruciate ligament is crucial for knee movement. It not only prevents forward sliding of the tibia but also allows for reflexive muscle control during movements. Not experiencing problems during controlled movements does not mean you won’t face issues during uncontrolled movements, such as going down stairs or sudden turns, which could damage your menisci and cartilage. Recent guidelines recommend surgery for patients under 55 who engage in recreational sports despite having anterior cruciate ligament injuries.
Can other injuries be treated during anterior cruciate ligament surgery?
During arthroscopic surgery, potential injuries to the meniscus or cartilage can be addressed. Your doctor will inform you about these considerations before surgery.
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