The Anterior Cruciate ligament is one of four major ligaments in the knee. It controls both the anterior-posterior motion between the femur and tibia and rotation of the knee. The anterior cruciate is usually injured by twisting or hyperextending the knee. Many people feel a "pop" and develop swelling within 6 hours. Unfortunately, in most cases, it is usually accompanied by injury to other ligaments or cartilage.
Initial treatment is aimed at reducing pain, swelling and restoring motion. Sometimes in severe injuries immediate bracing is required.
The diagnosis is usually established by physical exam and X-ray. An MRI may be helpful in some circumstances. MRI is quite expensive and a good physical exam may provide all the information necessary for decision making.
For the long term, options for management of the anterior cruciate deficient knee include: non-operative management, arthroscopy and non-operative management or ligament reconstruction. The decision as to which alternative is best is usually based on symptoms, age, physical demands, activity level and extent of injury. Non-operative management will usually suffice for the older more sedentary patient, but for more active persons ligament reconstruction is usually preferable. Recurrent episodes of instability can lead to meniscal tears and articular cartilage injury. You should discuss what would be best for you with your doctor.
If non-operative management is selected an arthroscopy may still be necessary for the management of associated injuries. Once strength and motion are restored an anterior cruciate brace is then custom fit for activities above and beyond normal walking. Be sure to get prior approval from your insurance carrier as these braces may be very expensive.
Reconstructive surgery consists of grafting a new ligament into place. There are several different options including autografts and allografts each of which has both advantages and disadvantages. Patella tendon autograft is in my opinion the "gold standard" to which all ACL techniques are compared. Endoscopic techniques are commonly used and are usually associated with less pain and a more cosmetically pleasing result. Surgery may require an overnight stay in the hospital, 2-3 weeks on crutches and 6 months of rehabilitation. The rehabilitation protocol and restrictions are specific and based on the usual rate of healing of the graft. Failure to adhere to the rehab protocol may result in graft failure.
The success rate of this procedure in the literature is approximately 85%. As with any surgical procedure, or life in general, major complications can occur. Complications can include bleeding, infection, and blood clots amongst others, all of which can be life or limb threatening. Discuss this with your Doctor prior to proceeding with any procedure.
Links:
American Orthopaedic Society of Sports Medicine
