The anterior cruciate ligament (ACL) is a ligament located between the femur and tibia, responsible for the stability of the knee joint. Rupture of the ACL can make the knee unstable, preventing it from performing more demanding daily or physical activities and increasing the risk of further joint damage (meniscus and cartilage).
Patients with formal operative indication are those who intend to practice sports that contain the mentioned movements (Football, snow skies, handball, tennis, dance, etc.). Also all patients who have symptoms of instability (feeling of failure or insecurity) in activities of daily living.
Generally, surgery should not be performed immediately after injury as it increases the risk of joint stiffness and postoperative pain. Physical therapy may be required 2 to 6 weeks before surgery for the knee to regain mobility and nearly complete muscle mass.
ACL reconstruction, or ligamentoplasty, is intended to anatomically reproduce the damaged ligament and is a technique performed by arthroscopy (through the introduction of a camera and specific instruments through small skin incisions).
To replace the ACL, tendons of the knee region are used, obtained by complementary incisions of about 6 to 10 cm (OTO: 1/3 central of the rotulian tendon or IT: semitendinosus and internal rectum in the proximal antero-internal aspect of the leg. ), introduced into tunnels in the femur and tibia and fixed to the bone by suspension devices or screws (titanium or absorbable), sometimes associated with the metal clamp. All of these systems are biocompatible and require no removal, allowing nuclear magnetic resonance.
At the same operative time and by the same technique, associated injuries of the menisci (suture / repair or partial resection) and articular cartilage are treated. In some cases, it may be necessary to add a reinforcement of ligament stability with an extrarticular procedure (anterolateral ligament).
This surgery is usually performed with locoregional anesthesia, depending on the patient’s wishes and the evaluation in Anesthesiology consultation.
Possible but rare complications include sensory changes in the area of scars, joint stiffness, infection and neurovascular injury.
Physical therapy is extremely important to the end result of the surgery. The work of amplitude gain, muscle strengthening and joint balance training are the main factors that prevent the rupture of the new ligament.
Postoperative support of the operated lower limb is limited to 50% of body weight for 2 to 4 weeks in the OTO technique and 4-6 weeks in the reconstruction with IT. Flexion is limited to 90-110 degrees for about 4 weeks. The “new ligament” is in a particularly fragile period between 4 and 12 weeks, so all activities should be performed with care.
The total recovery time for resuming sporting activities usually ranges from 6 to 9 months.