Anterior Cruciate Ligament Injury

What is the anterior cruciate ligament?
The cruciate ligaments are located on the inside of the knee joint and run diagonally between the thigh bone and the shin bone. Each knee joint has two cruciate ligaments, anterior and posterior.

What does the anterior cruciate ligament do?
The cruciate ligaments prevent the knee joint from sliding excessively forward and backward, allowing the knee to rotate around its axis in a balanced manner. The anterior cruciate ligament prevents the knee from sliding forward and the posterior cruciate ligament prevents it from sliding backwards. There are also external lateral and internal lateral ligaments that provide strength to the knee joint. However, these ligaments are very rarely injured. The anterior cruciate ligament is the most commonly injured ligament.

What happens when the anterior cruciate ligament is torn?
Because the anterior cruciate ligament prevents the knee from sliding forward, there is a feeling of unloading and insecurity in the knee joint in the event of injury and afterwards.

How does the anterior cruciate ligament tear?A tear occurs when the body rotates on the knee while the foot is stationary and a “pop” sound can be heard, like the sound of a rope snapping. It usually occurs in sports that require sudden stops and turns, such as soccer, basketball or skiing.

What happens after an anterior cruciate ligament tear?

In the absence of an anterior cruciate ligament, the knee joint is out of balance, which increases the load on the meniscus and cartilage structures in the knee, and as a result of unbalanced loading, wear of the knee joint, i.e. calcification, develops.

What are the symptoms of a torn anterior cruciate ligament?
When there is a rupture of the anterior cruciate ligament, there is a serious bleeding inside the knee and swelling of the knee occurs. In addition, knee pain, limitation of movement, inability to fully straighten the knee, feeling of insecurity, limping gait are observed.
Since there is usually not much walking due to pain, the complaint of knee dislocation is not common. Sometimes patients may mention a “popping” sound during the injury.

In the later stages;
inability to run
inability to play sports
feeling of insecurity in sudden jumping, stopping and turning movements,
a feeling of ejaculation when descending stairs.

What happens if an anterior cruciate ligament tear is not treated?If the anterior cruciate ligament tear is left untreated, active sports cannot be practiced and irreversible damage such as meniscus and cartilage injury will occur due to an increase in knee sprains and knee imbalance in cases of strain.
It is known that meniscus and cartilage damage will not occur by repairing the anterior cruciate ligament.

How is an anterior cruciate ligament tear diagnosed?

If a tear has occurred during the initial injury, the knee joint will be very painful due to swelling and tightness. Because of the pain, some specific tests cannot be performed during the examination. The injured person cannot be fully examined and the patient is asked for an MRI to visualize the knee joint with the suspicion of an anterior cruciate ligament tear.
Special tests can be performed in patients who present in the late period and the diagnosis can be made with these examinations.

How should an anterior cruciate ligament tear be treated?

Successful results are obtained with surgical treatment with developing surgical techniques. It has been observed that non-operative treatments are not beneficial in young patients and it has been accepted by scientific authorities that surgery is the best treatment option for patients. The most important criterion for deciding on surgery in middle-aged and older patients is active sports activity. Non-surgical methods can be tried in middle-aged patients who do not engage in active sports and lead a sedentary life.

How does an anterior cruciate ligament repair work?
The ruptured anterior cruciate ligament cannot be repaired by suturing, with some exceptions. Today, anterior cruciate ligament repair surgeries are performed closed (arthroscopically). For repair, another ligament is used instead of the ruptured ligament for transplantation. A ligament taken from the patient’s own body (autograft) from another area is used for transplantation. Generally, fibers from the posterior inner thigh muscle (hamstring) are used. The removal of these fibers does not cause a problem in the person. Since the loss of these fibers in professional athletes will cause a decrease in performance, transplantation is performed using tendons/fibers taken from cadavers.

How long will I stay in the hospital after anterior cruciate ligament repair surgery?
What to Expect After Anterior Cruciate Ligament Repair Surgery?
Anterior cruciate ligament repair surgery takes approximately one hour / one and a half hours. Inpatient care is usually sufficient for one day. The patient is discharged the day after the operation. The patient can stand up and step with a special knee brace (angle-adjustable knee brace) after surgery.

If meniscus repair or cartilage repair has been performed, the patient is allowed to walk with crutches but should not step on his/her foot. Patients who are discharged are started knee exercises on the same day with the knee brace and with the changes made in the angle-adjustable knee brace every week, full knee range of motion is achieved in the 6th week and physical therapy exercises are started to provide full muscle strength. Those who frequently do desk work can return to work in the 3rd week and those who frequently do standing work can return to work in the 6th week. In the 3rd month, they can start jogging and in the 6th month they can return to active contact sports (such as soccer, basketball).