The injury of the Anterior Cruciate Ligament (ACL) is very frequent in sports, especially contact sports and sudden twists involving the knee. Currently, the rupture of the Cruciate Ligament has a very good prognosis and a magnificent recovery. We have examples of returning to sports at the same level or even better: in soccer , Xavi Hernández ; in basketball , Ricky Rubio ; in handball , Carlos Ruesga; or in football , Tom Brady .
The ligaments of the knee are divided into two:
- Cruciate ligaments : Anterior Cruciate Ligament (ACL) and Posterior Cruciate Ligament (PCL) (the latter with a lower incidence of injuries).
- Lateral ligaments : The internal lateral ligament (LLI) (most common) and the external lateral ligament (LLE).
The main problem with a Cruciate Ligament injury is that it hardly heals on its own. For this reason, it is necessary to have to operate ( knee arthroscopy ) for the most part . In contrast, the medial lateral ligament has a high healing rate on its own with conservative (non-surgical) treatment.
WHY DOES THE CRUCIATE LIGAMENT TEAR?
The most common mechanism of cruciate ligament tear is a sudden and uncontrolled knee twist . As the foot remains stuck on the ground or blocked by an opposing player and continues to turn the player’s body excessively, it causes this ligament to be unable to resist excessive traction and to break. In the event that this turn is too abrupt or other associated movements are produced, it can lead not only to the injury of the cruciate ligament , but also to break other structures of the knee ( menisci , cartilage , lateral ligaments …).
MRI with torn ACL
WHAT IS THE FUNCTION OF THE ANTERIOR CRUCIATE LIGAMENT (ACL)?
The ACL prevents the knee from “playing”. That is, it prevents the tibia from moving with respect to the femur from front to back, but above all it controls that the femur does not rotate on the knee. It is an important stabilizer of knee rotation , without it, or in the event of a Cruciate Ligament injury , the knee is “like dancing”.
ACL TEAR TREATMENT – ARTHROSCOPY
The vast majority of cases of injury to the Anterior Cruciate Ligament have to be operated on. As it does not heal on its own, the torn Cruciate Ligament must be replaced by another tendon, performing what we call a plasty. Currently, with arthroscopy it is possible to replace the ligament and the associated injuries with minimal incisions , which leads to a faster recovery, with less pain and with more precision in the treatment. Arthroscopy has revolutionized the treatment of sports injuries .
The most widely accepted in the international medical literature is to use in these cases other tendons of the patient, the most frequent are the patellar tendon and the hamstring tendons , to replace the broken ACL .
Arthroscopic Image of Cruciate Ligament Reconstruction with Hamstrings
HOW LONG DOES CRUCIATE LIGAMENT RECOVERY LAST?
In recovering from an arthroscopy for torn Cruciate Ligament , there has to be a balance between starting to mobilize very quickly but with the risk of the ligament “loosening”, or leaving it “still” for a long time to ensure healing. This last option will lead to more stiffness and more muscle atrophy.
The approximate recovery times for arthroscopy for torn Cruciate Ligament are:
- About 4-6 weeks walking without crutches; 2 months start bike;
- 3 months muscle toning exercises;
- 3-4 months start career
- Complete recovery is usually achieved in 5-7 months. It all depends on the state of the initial starting point and the previous state.
WHEN SHOULD A CRUCIATE LIGAMENT TEAR BE OPERATED?
In the event of a cruciate ligament tear or injury, it is neither better nor worse to operate early. What you should NOT do is operate the ACL in the inflammatory phase of the injury .
ACL injury in professional athletes
In professional athletes, the initial diagnosis is usually made immediately (in less than 24 hours with an MRI). Knowing that the cruciate ligament is not going to heal, the sooner you operate and the less inflammation occurs (both from the injury and from the surgery), the faster and better the recovery will be.
ACL injury in amateur athletes
In amateur athletes, the diagnosis of a torn cruciate ligament is delayed 1-2 weeks. At that time, we will be in the full inflammatory phase of the injury, with associated muscle atrophy. Given this, it is better for the patient to start a pre-surgical rehabilitation process to reduce inflammation and improve muscle tone. It is approximately 4-6 weeks after the ligament injury that surgery can be chosen . In the better conditions the surgery is reached , the faster and better the recovery afterwards.
CAN AN ANTERIOR CRUCIATE LIGAMENT TEAR OCCUR AGAIN?
Can I re- tear my Anterior Cruciate Ligament ( ACL ) when I have already had surgery? Unfortunately it can happen. We know cases of athletes such as goalkeeper Sergio Asenjo , Celta striker Giuseppe Rossi or Barça footballer Leire Landa .
And then, why does the plasty break again ? Can you have surgery again? And if so, is the surgery easier or more difficult? What type of plasty do I have to have, mine or from a donor? If you have recently had an arthroscopy or if, unfortunately, you have suffered a relapse , you may be asking yourself all these questions …
SHOULD I FEAR THE RE-RUPTURE OF THE CRUCIATE LIGAMENT?
Faced with surgery for an anterior cruciate ligament tear , all the questions that we have raised above come to mind suddenly. One is afraid of a relapse , of undergoing surgery again and that the knee “will not be the same again.” After all the sacrifice and what it costs to recover from a surgery of this type, it is not very encouraging to know that the cruciate ligament can be torn again , in fact, the plasty . And what happens then? Is there a real reason to worry?
JOINT NATIONAL CONGRESS OF THE SPANISH ARTHROSCOPY ASSOCIATION (AEA) AND THE SPANISH KNEE SOCIETY (SEROD)
What we can now say with certainty is that, if the ligament were to tear again , it would be a somewhat more complex injury than that resolved with the first surgery . In fact, we sports traumatologists also ask ourselves these questions and we discuss and debate them at the Joint National Congress of the Spanish Arthroscopy Association (AEA) and the Spanish Knee Society (SEROD) .