The knee has 4 main ligaments ligaments: two lateral ligamentsand two central ligaments that “cross” each other and are called the cruciate ligaments.
For each knee, we have an anterior cruciate ligament (ACL) and a posterior cruciate ligament (PCL).
In the vast majority of casesit is the anterior cruciate ligament that breaks.
A poorly controlled poorly controlled twisting or excessive extension of the knee can cause a rupture of the cruciate ligament. It is therefore a trauma. It is sometimes accompanied by a cracking sound.
The rupture occurs when the muscles around the knee are not not sufficiently toned and alert and alert at the time of injury.
Here are the three situations causing rupture of the anterior cruciate ligament:
It is not uncommon to see breaks on harmless, non-violent falls.
Following this traumatic movement, the knee becomes inflated. This is completely normal, it is a natural physiological process that participates in the healing process.
The pain is often sharp and instantaneous. It usually refers the person for medical advice and additional tests. However, it can sometimes be more moderate, so the doctor is not always consulted.
Most often, we find the classic symptoms of inflammation :
Once the inflammatory phase is over, other symptoms appear such as a feeling of instability. The knee will appear particularly unstable during sports activities.
If in doubt, consult a competent physician who will be able to guide you to the right course of action.
The ligament does not always rupture completely. Sometimes only certain fibers are injured. We then talk about partial rupture.
In this case, the ACL is still very fragile and could rupture completely during a future trauma.
A specific rehabilitation is necessary to improve your muscular capacities. The knee is less well stabilized by the ligaments, so it must be better maintained by the muscles!
The X-ray shows the condition of the bones and cartilage. It allows to know if there is, or not, a associated bone fracture associated.
THE MRI or CT scan are used to observe the state of the ligaments (cruciate ligaments or lateral ligaments) and the menisci.
Once the diagnosis is made, the following questions must be answered:
To answer this question, GNRB testsKT1000 or Telos are more and more used. They accurately measure the degree of knee laxity (laxity of the tibia in relation to the femur) and indicate whether or not surgery is necessary.
1/ The menisci
The internal meniscus is more often affected than the external meniscus. During the operation of the cruciate ligament, the surgeon can then intervene on the damaged meniscus.
2/ Collateral ligaments
The medial collateral ligament (more frequent) or external can also be affected (sprain). Total ruptures of these ligaments are extremely rare.
3/ The cartilage
During the trauma, the cartilage is sometimes strongly impacted which can cause lesions (cracking, slight cracks…)
The principle of the surgical operation is to replace the ruptured cruciate ligament with a tendon.
Several surgical techniques can be considered:
DIDT and DT4 are the most common techniques currently used. They use the hamstring tendons.
The operations are, most of the time, performed under arthroscopy. The surgeon makes small openings through which he slides a camera and tools to operate. The scars are discreet and the postoperative care simplified.
The surgical procedure takes less than an hour and is performed under local or general anesthesia. This is a routine operation. The return home is possible the same day or the next day.
After the operation, the knee remains painful for 1 to 2 weeks. You will walk with canes and a splint for 2 to 3 weeks.
When an unstable knee is heavily used (pivot sports), it risks premature wear (cartilage arthrosis and meniscus degradation).
From time to time, on a false movement, a dislocation (subluxation) can be felt.
In the long term, these instabilities can lead to a general degradation of the cartilage and the periarticular structures.
After an operation or a functional treatment (rehabilitation) (rehabilitation), the knee should not suffer from instability.
This considerably reduces the risk of premature knee wear in the long term.
This insensitivity often worries patients but is not at all troublesome in the long run. This is caused by the section of small nerve endings during the operation. Sensitivity returns most often with time.
These signs are quite common after knee surgery. Time and rehabilitative work will allow a stable and perfectly mobile joint to be found.
During the operation, bleeding can occur around the joint and down the leg. Depending on their size, it will take one to four weeks for the hematoma to disappear completely.
These complications are quite classic and not serious.
Some complications require a medical visit in emergency :
Our advice: Watch carefully for the following clinical signs during the first 10 days
after the operation :
Fortunately, these cases are rare but should be known before an operation. If in doubt, do not hesitate to call a doctor.
The surgeon replaces your ruptured ligament with a strong tendon.
Immediately after the operation, this neo-ligament is not innervated (it sends little or no sensory information), and not vascularized (absence of artery-vein blood network). The body will slowly assimilate it as an integral part of the body. It will progressively innervate and vascularize it.
In total, its complete transformation takes nearly 3 years. Its structure is then stronger than the old ligament!
You will regain a strong knee but the full recovery process takes time.
Fortunately, you don’t have to wait 3 years to resume your sports activities! The day after the operation, the ligament is still very strong.
This resistance decreases during the first three months after surgery. This is a period during which you must remain vigilant and attentive. A bad fall could affect your transplant.
Once this period has passed, the mechanical strength of the ligament gradually increases. You still need to undergo serious rehabilitation to return to sport in good conditions.
The ligament is considered sufficiently strong one year after the operation to resume competitive sports.
In the long term, if you have followed your rehabilitation rigorously, you will no longer think about your knee and you will be able to practice your sports activities as before.
There is no no emergency to operate on a cruciate ligament. It is possible to wait several months or years. Professional athletes undergo surgery without delay because they want to return to competition as soon as possible. However, if you are not a high level athlete, it is better to wait for the knee to deflate and that the inflammation decreases.
Going into surgery with a swollen, painful knee that lacks mobility and strength makes the post-operative aftermath more difficult.
If you practice a pivot sport (skiing, tennis, soccer, basketball, handball, etc.), the operation is highly recommended.
If you practice a sport such as cycling or swimming, your knee will be less stressed in rotation. The risk of instability is therefore lower. A functional treatment (rehabilitation without surgery) may be sufficient.
In some people, a cruciate ligament rupture causes very little instability because the knee remains well supported by other anatomical structures. For them, the operation can be questioned.
The GNRB test test allows to quantify this instability.
An unstable knee will wear out more quickly over the years. This is why the operation is strongly recommended for people under 30 years of age. After the age of 50, the decision to operate is less systematic.
If the meniscus is injured in addition to the cruciate ligament rupture, then surgery is more strongly recommended. Depending on the type of lesion, it may be worthwhile not to wait too long before operating.
In summary, each of these four parameters must be taken into account when deciding whether or not to undergo surgery. Don’t hesitate to consult several specialists to make a decision. Once again, no rush !