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Crushed anterior knee ligament: treatment and recovery

Neus Vives

January 16, 2019

Any lesion of the LCA needs to diagnose it well and follow a good treatment, in order to recover its function and the evolution of the knee in the long term.

The ACL is an internal ligament of the knee, which is not touched or seen at first sight but has a basic role in the functioning of the knee of this joint. It is a small, very strong ligament that unites the femur with the tibia, preventing the tibia from moving forward and giving stability to the knee. Any lesion of the LCA needs to diagnose it well and follow a good treatment, in order to recover its function and the evolution of the knee in the long term.

How does the injury occur?
The vast majority of injuries (70-90%) are produced by an indirect mechanism, that is, by a forced evil of oneself, 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 supported or when braking abruptly after running.
Sports with the highest incidence of cross ligament injuries include soccer, basketball and skiing, and it has been shown that women are more likely to injure themselves than men because of the anatomical characteristics of the bones.

Can it be prevented?
In order to prevent these injuries there is no specific exercise, but it does help you to have a good quadriceps muscle that will not cause so much ligament traction.

How can we treat it?
The treatment can be surgical (repair of the break) or conservative (boosting muscles). In general, complete and unstable injuries are involved, especially in young people who do sport. The partial, stable or elderly lesions are treated conservatively and with little physical activity.
In any case, this is a decision that must be taken individually, as there are many factors that determine it.
In order to continue doing sport of competition, it is advisable to operate by placing a plastique of ligament by means of any arthroscopic technique.
With conservative treatment, that is, without repairing the breakdown of the ACL, an active life without functional limitation can be made compensating for the lack of stability with a good quadriceps muscle. It should be noted that the lack of ligament without muscle compensation can lead to risk of rupture of the meniscus and the appearance of degenerative joint knee processes (between 60% and 90% of patients in 10-15 years of injury).

How do we do the recovery?
Any recovery of an ACL injury usually requires a minimum of 9 months to return to full physical activity.
The rehabilitation process differs in three phases according to the objective of improvement:

1. Acute Phase: 1-2 weeks
Objectives: Control the inflammatory process, reduce pain, allow the repair of tissues, prevent atrophy and maintain physical fitness.
Treatment: Cryotherapy, electrostimulation, flexo-extension assisted exercises, isometric quadriceps and hamstrings exercises. You can also do some aerobic exercise if possible.

2. Recovery phase: 2-8 weeks
Objectives: Recover passive and active normal joint mobility, improve muscle control and balance, restore normal flexibility, improve strength and muscle resistance, re-educate self-esteem.
Treatment: It will work with exercises of progressive toning, elasticity and balance.
In these first two phases we will take into account that many exercises can be done in the water, where the impact is much lower and works without overloading.

3. Functional phase or Readaptación to the sport activity: 4-6 months
Objectives: Increase of the strength and resistance of the leg, improve neuromuscular control, improve functional deficits and prevent recurrences. Continue to train strength and flexibility.
Treatment: It works with specific exercises of power and muscular resistance and following the exercises of propioception, and the most specific part of each sport with fieldwork. It is indicated to return to the sport activity when there is no joint pain or stroke or stiffness, if there is no joint laxity and when the difference in strength between the injured leg does not exceed 10-20%.

ACL injuries have greatly improved in recent times, both at the functional level and in the comfort of the patient. The surgical technique is becoming more and more perfected, and the subsequent recovery coordinated with a good multidisciplinary team (physiotherapist, sports technician and doctor) is essential in order not to have sequels in the future.

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the author

Neus Vives

Head of the Claror Cartagena Health Department

Medical specialist in Physical Education and Sports Medicine (UB)

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