espa logo

Anterior cruciate ligament rupture. Should I have surgery or not?

What is a ruptured anterior cruciate ligament?

The anterior cruciate ligament is one of the four major ligaments of the knee. It is an intra-articular ligament and connects the lower extremity of the thigh to the upper extremity of the tibia. Its main function is to prevent the anterior slip of the tibia in relation to the thigh. Despite its high strength and stiffness, rupture of the anterior cruciate ligament is the most common ligament injury of the knee (40-50% of ligament injuries of the knee). It often occurs in athletes of high demands (football, skiing, basketball) as a result of falling from a height (jump), abrupt change of direction or immediate boredom of the knee.

What are the symptoms of this condition?

Rupture of the anterior cruciate ligament is manifested by severe pain. The swelling that follows, results in limited range of motion of the knee and lameness. The patient usually describes a characteristic “crack” sound during the injury and the feeling that “his foot is gone”.

How is it diagnosed?

The diagnosis of anterior cruciate ligament rupture is made by the correct taking of the history, with the correct and detailed clinical examination and the imaging examination with magnetic tomography.

How is it treated and when do we choose the surgery?

As the anterior cruciate ligament does not heal and its function is not restored, the treatment must be surgical. Conservative treatment with muscle strengthening of the area is recommended only in older patients who do not have the feeling of instability, do not have concomitant injuries or will stop intense activities.

The purpose of the surgical treatment is to reconstruct the anterior cruciate ligament, to restore the stability and functionality of the knee and finally to enable the patient to regain full activity at the desired level. In addition, anterior cruciate ligament plastics protect the knee and significantly reduce the risk of injury to the menisci, joint surfaces, and progression to osteoarthritis. Anterior cruciate ligament plastic surgery is performed arthroscopically.

In other words, we replace the anterior cruciate ligament with a tendon graft from the patient himself. Common implant options are the hind thighs, the patellar tendon and the quadriceps. The choice of implant is made taking into account various factors (age, sport, sex, occupation) while the most common in the international literature is the posterior femoral implant. With the use of special technological equipment and special surgical tools, the plastic of the anterior cruciate ligament is made through two incisions of 5 mm and an incision 1.5 cm more distal to receive the implant. In the case of a partial rupture of the anterior cruciate ligament (rupture of one of the two ligaments) it is recommended to preserve one beam and reconstruct the other.

Do you need hospitalization for this operation?

The preoperative examination is usually done a few hours before the operation. The patient is discharged the same day and does not need to stay in the hospital for treatment.

The complication rate of this operation is less than 1%, when it is performed by specialized orthopedic surgeons.