Cruciate ligament reconstruction

  • ACL arthroscopic reconstruction with ST implants
  • ACL arthroscopic reconstruction by BTB method

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The cruciate ligament is one of the elements stabilizing the knee joint. In chronic instability, due to excessive movement in the joint, it may become overloaded and consequently damage to other intra-joint structures (meniscus, joint cartilage). Therefore, an untreated anterior cruciate ligament injury poses a health risk to patients. After the ligament is damaged, the so-called anterior instability. The patient has a feeling of “escaping” the knee, uncertainty when changing direction of movement, trying to run.

The damaged anterior cruciate ligament is reconstructed using other tendon elements taken from the patient during the run-off. The choice of a transplant depends on many factors (including the above-mentioned condition of the articular cartilage). The two most common types of “material” we use are the patella proper ligament or the semi-tendon / semi-membranous tendon. After collecting the graft, we place it on the site of the ligament damage in the channels specially drilled for this purpose in the femur and tibia. We stabilize the graft with titanium screws or (in more advanced methods) bio-absorbable screws or special stabilizers (endobutton, retro-screw, cross-pin). The latest method is “double-bundle” involving the use of not one but two grafts, which, according to the authors, provides more anatomical stabilization.

The injury is diagnosed by an orthopedist on the basis of an interview collected from the patient and a physical examination. It may also be helpful to have an ultrasound or MRI scan of the knee joint. If a ligament rupture is found, arthroscopy of the knee joint is necessary. Arthroscopy allows us to assess not only the degree of damage to the ligament itself, but also to other intra-articular structures (isolating ligament damage is the rarest). The simultaneous evaluation of the articular cartilage determines the subsequent choice of the method of reconstruction.

Regardless of the method chosen, the surgical procedure is performed using the arthroscopic technique. Regardless of its implementation, postoperative rehabilitation is necessary, which is an integral part of the patient’s treatment. Early postoperative rehabilitation allows for a quick recovery and is usually started the day after surgery. It affects the reduction of the patient’s recovery time. In the first stage, the patient begins to walk with the help of elbow crutches with partial load on the operated limb and, under the supervision of the therapist, learns the appropriate isometric tightening of the thigh muscles.

After leaving the hospital, the patient remains under the constant supervision of the orthopedist for a period of 3 months, he continues exercises according to the diagram shown, which are of fundamental importance for the improvement of the knee. We pay special attention to the time between 6 and 10 weeks after the surgery. Then the transplant rebuilds itself and during this time it is biologically and mechanically the weakest. After the 10th week, we accelerate outpatient rehabilitation, allow for additional exercises (always under the supervision of a physiotherapist) and increase the intervals between checks at the orthopedist. Full recovery takes about 6 months, and the final evaluation of the stability of the transplant and its functions is performed about a year after the surgery. Proper rehabilitation and staying under the supervision of an orthopedist are as important to a good result as performing surgery.

About the procedure

The cruciate ligament is one of the elements stabilizing the knee joint. In chronic instability, due to excessive movement in the joint, it may become overloaded and consequently damage to other intra-joint structures (meniscus, joint cartilage). Therefore, an untreated anterior cruciate ligament injury poses a health risk to patients. After the ligament is damaged, the so-called anterior instability. The patient has a feeling of “escaping” the knee, uncertainty when changing direction of movement, trying to run.

The damaged anterior cruciate ligament is reconstructed using other tendon elements taken from the patient during the run-off. The choice of a transplant depends on many factors (including the above-mentioned condition of the articular cartilage). The two most common types of “material” we use are the patella proper ligament or the semi-tendon / semi-membranous tendon. After collecting the graft, we place it on the site of the ligament damage in the channels specially drilled for this purpose in the femur and tibia. We stabilize the graft with titanium screws or (in more advanced methods) bio-absorbable screws or special stabilizers (endobutton, retro-screw, cross-pin). The latest method is “double-bundle” involving the use of not one but two grafts, which, according to the authors, provides more anatomical stabilization.

Preperation

The injury is diagnosed by an orthopedist on the basis of an interview collected from the patient and a physical examination. It may also be helpful to have an ultrasound or MRI scan of the knee joint. If a ligament rupture is found, arthroscopy of the knee joint is necessary. Arthroscopy allows us to assess not only the degree of damage to the ligament itself, but also to other intra-articular structures (isolating ligament damage is the rarest). The simultaneous evaluation of the articular cartilage determines the subsequent choice of the method of reconstruction.

Convalescence

Regardless of the method chosen, the surgical procedure is performed using the arthroscopic technique. Regardless of its implementation, postoperative rehabilitation is necessary, which is an integral part of the patient’s treatment. Early postoperative rehabilitation allows for a quick recovery and is usually started the day after surgery. It affects the reduction of the patient’s recovery time. In the first stage, the patient begins to walk with the help of elbow crutches with partial load on the operated limb and, under the supervision of the therapist, learns the appropriate isometric tightening of the thigh muscles.

Precautions

After leaving the hospital, the patient remains under the constant supervision of the orthopedist for a period of 3 months, he continues exercises according to the diagram shown, which are of fundamental importance for the improvement of the knee. We pay special attention to the time between 6 and 10 weeks after the surgery. Then the transplant rebuilds itself and during this time it is biologically and mechanically the weakest. After the 10th week, we accelerate outpatient rehabilitation, allow for additional exercises (always under the supervision of a physiotherapist) and increase the intervals between checks at the orthopedist. Full recovery takes about 6 months, and the final evaluation of the stability of the transplant and its functions is performed about a year after the surgery. Proper rehabilitation and staying under the supervision of an orthopedist are as important to a good result as performing surgery.

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