Cruciate ligament injuries are among the most common injuries of the knee and occur most frequently in athletes (professional and non-professional). The anterior and posterior cruciate ligaments (ACL and PCL, respectively) have an important role in stabilizing the knee during dynamic movements. Any injury to these ligaments compromises the stability of the knee but also affects general mobility and of course performance (and even participation) in a sporting activity. The usual treatment for cruciate ligament tears is surgery, for which there are various options available for the best possible results in each case.
The anterior and posterior cruciate ligaments cross within the knee joint, connecting the femur to the tibia. The anterior cruciate ligament prevents the tibia from sliding too far forward relative to the femur and controls excessive rotational movements. In contrast, the posterior cruciate ligament prevents the tibia from sliding backwards. Together, they maintain rotational stability of the knee and are extremely important in sports (or other activities) that involve running, jumping or sudden changes in direction.
Mechanisms and causes of cruciate ligament tears
Cruciate ligament injuries are often caused by:
- Direct impact, such as a blow to the knee in contact sports or accidents.
- A sudden change in direction or speed, which is common in sports such as football, basketball and skiing.
- Sudden deceleration, which may often be accompanied by a rotational movement.
The anterior cruciate ligament is particularly vulnerable to non-contact injuries due to the biomechanical forces exerted in various sports activities. In contrast, injuries to the posterior cruciate ligament more often result from direct impacts, such as a fall on a bent knee or an injury in a car accident.
Cruciate ligament injuries: symptoms and diagnosis
The characteristic symptom in cruciate ligament injury is a "popping" sound at the time of injury, followed by pain and swelling. Instability, or the sensation that the knee is "giving way", is another important symptom, especially in anterior cruciate ligament injuries. Diagnosis usually involves a physical examination with various manipulations, such as the Lachman test to assess the condition of the anterior cruciate ligament and the anterior and posterior drawer test for the anterior and posterior cruciate ligament respectively. MRIs are necessary to confirm the diagnosis and also to evaluate the extent of the injury, such as possible damage to the menisci or cartilage.
Surgical rehabilitation options
To regain full functionality and prevent secondary complications, surgery is usually the appropriate treatment option. The type of surgery chosen usually depends on the joint involved, the extent of the injury and the patient's activity level.
- Autograft
One option for surgical repair of the ACL is the use of autologous tissue, such as the patellar tendon, the hamstrings or the quadriceps tendon. The choice each time depends on a number of factors, such as the patient's age, activity level and the specific sport they play. Autografts are preferred for their lower rejection rates and better integration into the host tissue. Personalized protocols that are implemented, offer superior results.
- Allografts
Allografts, donor-derived tissues, are usually reserved for elderly patients or for those undergoing corrective revison surgery or for patients with multiple syndesmotic injuries. Although they reduce the time of surgery and eliminate the morbidity of the donor site, they carry some risks of disease transmission and may take longer to integrate, affecting recovery and return to sporting activities.
- Synthetic grafts
Synthetic grafts were a popular option in previous years, however, due to their reduced success rates and more complications, they are now preferred occasionally and in specific scenarios where biological grafts are not appropriate.
Postoperative care and rehabilitation
Rehabilitation after cruciate ligament surgery takes time and emphasis should be placed on restoring functionality, strength and stability of the knee. Initial postoperative care focuses on reducing swelling, managing pain and regaining range of motion. Subsequent phases include strength training, proprioception exercises and gradual return to activity protocols, which are adjusted according to the individual's progress and specific sporting requirements.
Cruciate ligament injuries: prevention tips Tips πρόληψης
Prevention is particularly important, especially for athletes who are prone to these injuries. Training to improve technique, enhance muscle strength and flexibility, as well as proper warm-up and the use of appropriate equipment for each sport, has been shown to significantly reduce the incidence of cruciate ligament injuries. Specifically the training protocol of FIFA (FIFA 11+), offers a well established and proven prevention measure for anterior cruciate ligament injuries
Surgical options for cruciate ligament injuries are aimed at restoring knee function, returning athletes to their pre-injury performance levels, and preventing injuries in the long term.
To learn more about the surgical options to treat cruciate ligament injuries, contact us at 6943903343 (secretariat) or 6949196061 (doctor) and at orthopedikos-papagiannopoulos.gr and make an appointment.
