ANTERIOR CRUCIATE LIGAMENT – OVERVIEW

It has associated its name with high-performance athletes, as a result of a fall from height, a sharp change of direction, or a direct knee collision, but anyone involved in sports, even on an amateur level, may suffer such an injury, without, of course excluding the option of the result of an accident. We are talking about the rupture of the anterior cruciate ligament, one of the most severe and frequent knee injuries, often with a long recovery period. The anterior cruciate, along with the posterior cruciate, the medial collateral and the lateral collateral ligaments, are basic knee stabilisers. Its primary role is to prevent the tibia from sliding forward in relation to the thigh – in fact, it provides 90% stability to the knee. It diagonally crosses the joint and connects the posterior part of the femoral bone base with the upper part of the tibia.

DIAGNOSIS

Most individuals who have suffered a rupture of the anterior cruciate ligament describe that they heard a “popping” or “cracking” sound, and then their foot went off or got stuck. Deep pain and swelling in the knee are the first signs, and, depending on the damage, the knee joint range of motion is limited and instability is observed. The diagnosis is mainly performed through the guidance of the clinical picture, which will show how stable and functional the knee is. An auxiliary but critical role in identifying the other knee lesions (meniscal rupture, cartilage lesions, etc.) is played by the magnetic resonance imaging. The evolution of the machines, and thus, the better imaging of knee pathology, has resulted, in recent years, in proving that the rupture of the anterior cruciate ligament does not have to be complete. In cases of partial ruptures, a detailed history and a thorough examination shall indicate the correct recovery, and the necessity or no necessity of surgery. Nowadays, the specialized techniques that have been developed enable us to arthroscopically repair the broken segment of the ligament only, and keep the healthy one intact.

WHEN IS SURGERY REQUIRED?

However, in cases of complete rupture, always taking the patient’s age, sex, occupation, and sports practice into account (and given that the anterior cruciate ligament cannot heal on its own and its function cannot be restored), surgical treatment is, usually, a one-way option. The doctor shall use an autograft (from the patient themselves) to repair the ligament, in order for the knee to become stable and functional again.  

PERSONALISED APPROACH FOR THE TREATMENT OF THE ANTERIOR CRUCIATE LIGAMENT RUPTURE

Modern, arthroscopic surgery refers to a personalised approach in the case of rupture of the anterior cruciate ligament. The specialised, modern surgeon is called upon to decide if surgery is required, and since they believe it is actually required, they then have to decide what type of implant they will use to treat this injury. At the MINISCO^TM Athens Center of Orthopedics, we personalise this option according to the patient’s age, activities, somatometric and anatomical characteristics through the magnetic resonance imaging, the elasticity of the joints, the athlete’s position (e.g. goalkeeper or center back) etc. The personalised approach to the rupture of the anterior cruciate ligament is something that makes perfect sense, since it is not possible for a graft to “fit” all patients. A common practice is the one where the orthopaedic surgeon always applies the same graft to all patients (the one they are familiar with, which, on the basis of studies that have been conducted is usually the hamstring graft). Contrariwise, at the MINISCO^TM Athens Center of Orthopedics, we apply the personalised approach for the treatment of the severe injury of the rupture of the anterior cruciate ligament, in order for each patient to “wear” the graft which suits them best, in order to recover from their injury and overcome this unfortunate moment of the injury, forever.

Common autograft-obtaining areas:

• Segment of the patellar tendon
• Hamstrings
• Segment of the quadriceps tendon

Depending on the graft we choose for each patient, we also proceed to customised postoperative rehabilitation protocols, always in cooperation with the physiotherapists and rehabilitation coaches we work with, aiming at the safe and prompt return of the patient to their everyday life and at the sports activities they practice.