During the past decade, the anterior cruciate ligament (ACL) has become a familiar term. The ACL is the main stabilizer of the knee joint during abrupt change in direction. With the increase in sports participation, injury to the ACL has become one of the most common sports injuries.
The operative treatment has evolved from open procedures to arthroscopically performed outpatient procedures with early weight bearing.
The knee becomes unstable while abruptly changing direction. Many authors have stated that the ACL injury is career ending for the athletes. Ireland calls this a "heart attack of the knee."
Unlike other ligaments about the joint, the ACL passes through the joint and is surrounded by joint fluid. Other ligaments heal by scar formation This fluid is designed to dissolve and prevent blood clotting within the joint.
Without blood clot, scar tissue does not form. The result is that the ACL rarely heals in continuity.
There is an increased risk of meniscal and cartilage injury after ACL injury. With time the knee with torn ACL will embark on a course of progressive degeneration leading to early arthritis.
Hence, until surgery it is advisable to wear some sort of knee brace to protect and stabilize the knee joint.
The ACL will not heal itself and it is not possible to repair a torn ACL. Hence, an alternative tissue (graft) must be used to replace it. There are 3 main types of grafts available:
A) Using the patient's own tissues (auto graft), B) Using another person's tissue (allograft) and C) Using artificial material such as LARS. Using the patient's own tissue is by far the preferred way to reconstruct the torn ACL.
The operative treatment has evolved from open procedures to Key – Hole technique. Key-hole technique is more beneficial because of small incision, less bleeding & pain and faster recovery after surgery.
Bone patellar tendon and hamstrings tendons are the two graft options available for reconstructing the ACL.
Hamstrings graft is ideal because the knee pain while kneeling down, patella fracture and patello-femoral arthritis are some of the worried problems associated with bone patellar tendon graft.
The results after ACL reconstruction are quite pleasing as it is one of the operative procedures with very positive outcome.
Patients who were into sports and discontinued playing because of ACL injury can eventually go back to sports and have a normal knee function and sports career after ACL reconstruction.
One can jump, run and do day to day activities like a normal person without any restrictions.