We explain the recovery phases in the breaking of the anterior crossed ligament

Neus Vives

3 October, 2012

The rupture of the anterior crossed ligament is very common among people who practice contact sports such as soccer or skiing. To overcome this type of injury, a surgical intervention and a subsequent phase of rehabilitation are required divided into three stages.

The anterior crossed ligament (LCA) is located within the knee joint, so that from outside we can not see or touch it. It is a small but very strong ligament that unites the femur with tibia and prevents it from moving forward, giving stability to the knee. Once it is broken it can only be repaired with surgery and a good subsequent rehabilitation.

Anatomy
Everyone has heard about the occasional cruciate ligaments of the knee and many know who they have operated; even so, there are concepts that are still mixed. Within the knee there are two crossed ligaments, the anterior (LCA), which goes from the central part of the tibia to the external femoral cavity and from the front to the back, and the posterior (LCP), which goes from the back of the tibia to the internal femoral stomach The function of these ligaments is to stabilize the knee in the anteroposterior sense and to a lesser extent in the rotation of the joint.
During the daily life, the LCP supports a stronger tension than the LCA, except when we lower stairs and, on the other hand, the fractures of the second are much more frequent.

With this broken ligament an active life without functional limitation can be made, compensating for the lack of stability with a good quadriceps muscle, although athletes are advised to take the surgery to return to the sporting activity. Lack of ligament can lead to risk of breakdown of the meniscus and the appearance of degenerative joint knee processes (between 60% and 90% of patients after 10-15 years of injury).

Mechanism of injury
The vast majority of injuries, between 70% and 90%, occur through an indirect mechanism, that is, due to their own forced gesture, without any contact or contact with another person or object. The break occurs when you set the foot to the floor and make a sharp turn of the knee (external rotation) leaning inwards (valg). For example, when jumping and falling with the knee poorly leaned or when braking abruptly after running.

The sports with the highest incidence of cross ligament injuries are soccer, basketball and skiing. It has also been seen that women are more likely to injure themselves than men because of their anatomical characteristics.

In severe direct traumatisms on the outside of the knee or in the strongly energetic indirect, a more serious combined injury can occur: the breakdown of the internal lateral ligament, the internal meniscus and the ACL, called the O'Donoghue triad or triad unfortunate

Diagnosis
In order to diagnose an ACL break we base ourselves on physical and clinical examination: an inflated and bloody knee in the interior (hemarthrosis), instability of the joint that the patient notes (a feeling that fails) and that appears in the specific tests of previous instability (Lachman test) and the internal rotational stress.

Complementary tests, such as magnetic resonance imaging, are useful when deciding on surgery, as it reports exactly possible associated lesions of menisc and cartilage and the type of breakdown of LCA, although it may give false negatives as more time has passed since the accident.

Treatment
Surgical treatment is most advised in most cases. The situations in which it would not be indicated are in the elderly and with little physical activity and in knees in which the degree of instability is minimal. If there are associated meniscus or cartilage injuries, it is better to do an early treatment and repair all the structures at the same time. The most common surgery is the arthroscopic one, in which, without opening the joint, three small incisions are performed on the skin to introduce a visor and instrumental into the knee and repair the ligament. This technique involves very little surgical aggression and a lot of precision.

The surgical technique consists in the reconstruction of the ligament with a graft that can be from the body (autologous) or tissue bank, from a donor and preserved by freezing (cryopreserved plates) or drying (lyophilized plastics) . The graft can be obtained, whether it is a donor or a stomach, from the central part of the ligature with two bony pituitary tablets at the ends (bone tendon technique) or from the tendons of the internal and semitendinal muscles. Plastic is made to go through bone tunnels practiced in the femur and tibia and is fixed with implants that are usually titanium metal (interferential screws) or reabsorbable material. When the tendon is placed with the correct orientation and tension, the rehabilitation begins and after five or six months of the intervention the tendon adopts the characteristics of a ligament.

Rehabilitation
Whether you use a technique or another the after-surgery of an ACL injury are between six and nine months of recovery. The rehabilitation differs in three phases of three months. The first phase consists in recovering the joint balance, above all, and doing muscular isometric work. In the second phase, propulsion, progressive muscle toning works and the smooth running begins. In the third phase, the person is gradually incorporated into the specific sports activity, initially without contact.

Rapid participation in physical activity stimulates the metabolism, vascularization and recovery of the new ligament to obtain strength and size, as well as normal ligament, although it is advisable to return to competitive sports practice Wait more time to prevent the subsequent onset of osteoarthritis in patients undergoing surgery. The joint cartilage is not completely complete again until two years after the intervention.

With the improvement of the surgical technique and above all with good rehabilitation, the results of lesions of the anterior crossed ligament have improved greatly from the functional point of view as well as the comfort of the patient.

the author

Neus Vives

Head of the Health Department of Claror Cartagena

Medical specialist in Physical Education and Sports Medicine (UB)

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