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Recent Medical Video

Anterior crusiate ligament rupture - Arthroscopic treatment Print E-mail

In order to see a video relating to the arthroscopic rehabilitation of anterior crusiate ligament rupture, press here.

The knee joint is a complex articulation, which connects the femoral to the tibial bone. A lot of factors contribute to the stability of the knee joint among which the crusiate ligaments of the knee (anterior crusiate ligament ACL – posterior crusiate ligament PCL). The main stability factor that prevents the anteroposterior (back and forth) movement of the tibia in relation to the femur is the ACL.

How is the ACL being injured?

The ligament is usually being injured when a tremendous strophic force is applied upon it, during an accident (fall, road accident, etc) or sport activities (soccer, basketball, ski, etc). ACL rupture is usually accompanied by meniscal lesion.

How does a patient which suffered ACL rupture feel?

A patient with ACL rupture feels intense pain, great joint edema (swelling) of the knee, knee joint instability and inability to walk.

Which is the treatment of ACL rupture?

Worldwide, the treatment of ACL rupture is basically surgical. The ligament is substituted by a graft received by the patient himself or by artificial graft.

Preoperative evaluation of the injured knee.

Every patient with strophic injury of the knee should be examined by an orthopaedic surgeon who will clinically certify the ACL rupture and order the necessary paraclinical control that includes simple x-rays, magnetic tomography (MRI) as well as blood tests.

 Magnetic tomography in which ACL rupture is visible


The time in which the operation should occur depends on any collateral injuries (lateral ligament ruptures, meniscal ruptures, etc).

Arthroscopic reconstruction of ACL rupture

After the preoperative control is completed, the patient enters the clinic and the operation is scheduled. During arthroscopy, through small skin holes (5mm each), a video camera is inserted into the injured knee as well as specific arthroscopic tools, optical control is carried out and the lesions are properly dealt with.
To continue with, the knee is being prepared in order to receive the ACL graft.
After that, the graft is received by a nearby tendon structure of the patient, it is inserted and placed in position by a specific arthtroscopic technique and it is stabilized.
The operation lasts 1-1.5h and is carried out by general or epidural anesthesia.

What king of graft is used?

The graft that can be used may derive from the patient himself (ex. part of the patellar tendon, the posterior femoral muscles’ tendons, the quadriceps tendon), or it may be an artificial graft.

The advantage of the artificial graft is the lesser time of rehabilitation, while of the patients’ own graft (autologous graft) is its full incorporation in place, which demands though a longer period of rehabilitation. The selection of the graft depends on the patient’s age, as well as his professional needs and it is a result of common decision between patient and orthopaedic.

In our practice we usually suggest and use patellar tendon autologous graft which gives satisfactory primal postoperative stabilization as well as perfect ulterior results.


 

The positioning of the patellar graft has the greatest importance in the functionality of the joint. 

 

Postoperative period after surgical rehabilitation of ACL.

After the operation the patient remains in the clinic for 1-2 days and immediately begins knee kinisiotherapy and weight bearing – walking with the assistance of knee splint and cratches. Along his exit from the clinic he receives full and detailed written instructions about the physiotherapy and exercise schedule that must be followed and returns in sort periods of time for his condition’s follow-up.
 

15 days postoperatively, the knee extension is complete…

…while flexion outreaches 90 degrees.


One month postoperatively, the patient may walk without cratches and has almost complete range of motion.


In 2-2.5 months postoperatively, the patient may jog, drive and return to work. In 4-6 months he may return in full sports activity.
 

Full range of motion, 2 months postoperatively

Arthroscopic reconstruction of ACL rupture is the method of choice in international medical bibliography with very high success rates.

 
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