Anterior Cruciate Ligament Injury

Damage to the anterior cruciate ligament, which is the strongest ligament of the knee, is especially common in football-related injuries. Sports involving sudden stopping and changing direction, jumping and stepping on the ground are risky in this respect. In addition to football, the anterior cruciate ligament can be injured in basketball and ski athletes.

A cracking sound may be heard from the knee at the time of anterior cruciate ligament injury; this sound may indicate that the ligament is torn or broken. Complaints such as swelling and feeling loose in the knee may occur; putting a load on that leg can cause pain.

Depending on the severity of the injury and the person’s activity level, treatment may be physical therapy exercises or surgery. Physical therapy is also required for returning to daily life after surgery.

Anterior cruciate ligament injury may pave the way for the development of osteoarthritis ( joint calcification ) in later years .

Symptoms

  • A smack or cracking sound from the knee at the time of injury
  • Severe pain that interferes with continuing activity
  • Rapid swelling
  • Decreased range of motion of the joint
  • Feeling of slack in the knee, feeling of falling into space when weight is applied

Reasons

Ligaments or ligaments are strong fibers that connect one bone to another. The anterior cruciate ligament is one of two ligaments that cross each other in the middle of the knee (the other is the posterior cruciate ligament). It strengthens the knee joint by connecting the thigh (femur) bone to the shin (tibia).

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Anterior cruciate ligament injuries can occur in sports that require knee loading:

  • Slowing down and changing direction while running
  • Don’t turn with your feet on the ground
  • Abnormal stepping on the ground after jumping
  • Dead stop
  • Events such as a direct blow to the knee may cause partial or complete rupture (total rupture) of the ligament.

In mild injuries, the integrity of the ligament is preserved, and only a strain-induced injury (sprain) can be seen.

Who Happens?

Women are more prone to anterior cruciate ligament injury than men. Anatomy, muscle strength or hormonal differences may play a role. Those who engage in football, basketball, gymnastics and skiing are at risk. Poor conditioning increases the risk of injury. Using unsuitable shoes and sports equipment, playing on artificial ground instead of real grass are other negative factors.

Performing the training and exercises correctly, strengthening the hamstring muscles, providing the muscle balance in the leg, strengthening the core muscles including the abdomen, groin and hips, using the right techniques in jumping, turning and cutting maneuvers reduce injuries.

Diagnosis

During the physical exam, the doctor will evaluate your knee for swelling and tenderness. He checks the stability of the knee joint by performing various maneuvers and sees whether pain occurs. The anterior drawer test is an examination method used to evaluate anterior cruciate ligament damage. In general, the medical history and physical examination are sufficient to make the diagnosis, but imaging methods are also used. X-ray film allows to see problems such as fractures that may occur due to trauma. MRI (MR) imaging allows evaluation of soft tissues, including the anterior cruciate ligament and menisci. Ultrasonography can show soft tissue injuries and edema, especially in muscles and tendons.

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Treatment

The first-line treatment for trauma-related injuries to the knee is rest, cold application, compression (tightly wrapping with an elastic bandage), and elevation of the knee above the heart level.

It may be necessary to use a knee brace and crutches for a while to avoid overloading the knee. Only physical therapy may be sufficient for people who are not very active, who do sports for hobby and health, or who are engaged in sports that do not force the knee. Physical therapy aims to reduce pain and edema, strengthen muscles, normalize joint movements, increase functional stability and reduce the risk of re-injury.

Anterior Cruciate Ligament Repair Surgery

Professional athletes who want to continue sports; especially in sports involving jumping, cutting and turning movements, those who have more than one ligament damage or meniscus with ligamentSurgery is recommended in the treatment of those who have damage and if the knee leaves itself during daily work due to injury. In most ligament ruptures, it is not possible to bring the ends of the ligament together and stitch it together. Instead, the ligament is rebuilt (reconstructed). Generally, surgery is performed with a closed technique (arthroscopic). During the surgery, the damaged ligament is removed, and a tendon taken from a different part of the person is placed in its place. This tissue that is replaced is called a graft. For this purpose, patellar tendon and hamstring tendon grafts are most commonly used. The quadriceps tendon may also be selected. Each graft source has its own advantages and disadvantages. It is possible to return to sports with a well-planned physical therapy after surgery. In physical therapy, the focus is primarily on a muscle-strengthening program so that the joint can achieve its normal range of motion and protect the new ligament. The load on the ligament is gradually increased. In the final phase of rehabilitation, the focus is on functional goals. It takes time for the ligament to regrow. The safe return to sports can take from six months to a year.

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