1, what is the anterior cruciate ligament, why will be injured? Yang is physically strong and is a well-known basketball player in his circle. A month ago, he sprained his left knee when he landed in a basketball game, when he heard his knee “pop”, his leg went weak and sat on the ground, then he developed joint swelling, pain, restricted movement and difficulty walking. Due to previous injuries in sports, Yang did not care too much, after more than 20 days of rest, the symptoms disappeared, he never took this small injury seriously. However, Yang found in the post-injury sports, his left knee always appear to “play soft leg” situation, can not force, and usually walking up the stairs also often can not make force, due to the weakness of the knee joint led to the gradual atrophy of Yang’s thigh muscles, which as an athlete he really can not stand, which makes him no longer dare to slow down, to the nearby hospital This was unbearable for him as an athlete, so he didn’t dare to slow down anymore and went to the nearby hospital for an examination, and the knee X-ray showed no significant abnormalities in the knee bone. The professor first asked him about the injury and his current symptoms, then had Yang lie on the examination bed and gave him a thorough physical examination: the “front drawer test” of Yang’s knee was found to be positive, and the “Lachman test” was found to be positive. He found a positive “Lachman test”, a positive “axial shift test”, and pressure pain in the knee joint. The professor ordered an MRI, which showed an ACL injury. The professor found that Yang had a clear history of knee sprain, swelling of the knee joint after the injury, and the left knee joint had the distinctive feature of “limp leg” after the sprain. The symptoms were mainly caused by the rupture of the ACL after the knee sprain, which in turn caused the instability of the knee joint. 2. Why did he feel better after the injury, but it got worse after a while? Yang then asked the professor, “Why did I feel better 3 weeks after the injury and could go to work, but after a few months of recovery, I felt that my knee joint was not working again, especially when exercising, my leg was always weak, and my leg would be swollen and painful after exercise? The professor replied that after an ACL injury, the first few weeks are the acute phase, because the knee is swollen, painful, and the knee movement is limited, and sometimes in the emergency room, the doctor directly recommends a cast, which can be inconvenient for the patient. After the acute phase, the hematoma is absorbed, the pain is relieved, and the joint can be moved, so the patient can walk and gradually return to work or school. This is because the anterior cruciate ligament failure has significantly weakened the anti-torsional ability of the knee joint and the stabilizing force that restricts the forward movement of the tibia, and the force of the quadriceps muscle will lead to excessive forward movement of the tibia during exercise, and the quadriceps muscle will not dare to make a force, thus appearing The performance of “playing soft leg”. Due to the pain and instability of the knee joint, a considerable number of patients have to give up their beloved strenuous activities such as soccer and basketball with pain; worse still, the quadriceps muscle develops disuse atrophy. Some patients who have recovered for a period of time can continue to play sports, but often re-injure themselves during sports, causing secondary injuries to the meniscus, collateral ligaments, and other important mechanisms of the knee joint. Studies have shown that medial meniscal injuries and knee degeneration are significantly more likely to occur in knees with ACL failure. 3. Why was it not diagnosed at first? Yang wondered why he was not found to have an ACL injury even though he went to the hospital after the injury and the doctor took a film? Professor answer: ACL injury after the chance of missing the diagnosis is higher. This is because, on the one hand, patients can still walk after the injury and lack the knowledge to do so, so they think they are well and do not go to the hospital; on the other hand, because ACL injuries are difficult to detect on X-rays and have to be combined with clinical examination and MRI to confirm the diagnosis, and in the acute stage, due to knee hematoma and pain, patients are often not able to cooperate with doctors to do clinical examination, so inexperienced doctors will The inexperienced physician will easily miss it. However, experienced sports medicine specialists know that in the acute phase of a torsional knee injury, if the joint is swollen and hemorrhagic, there is a 70% chance of an ACL injury, which can be diagnosed early with an MRI. If an MRI is not possible, after 3 weeks, when the hematoma is absorbed and the joint resumes movement, clinical tests such as the Lachman test, axial shift test, and drawer test can also help confirm the diagnosis. In some primary care hospitals, the diagnosis is easily missed due to the lack of appropriate equipment. So when the knee is obviously swollen and blood accumulates after a knee sprain, and a few weeks later there is instability of the knee joint during sports and playing soft leg, you should think of an ACL injury. 4, how to treat after an ACL injury? Xiao Yang dawned on him, no wonder his knee joint always has no strength, good thing he ran into an expert today, Xiao Yang hurriedly asked the professor what the next step is to treat. The professor’s advice was that arthroscopic ACL reconstruction surgery must be performed. Xiao Yang was nervous when he heard about the surgery. And expressed confusion, a small ligament injury to open surgery? The professor then explained: this is because the ligament injury, on the one hand, due to poor blood supply injury after conservative treatment is difficult to heal on its own, on the other hand, the ACL plays an important role in maintaining the stability of the knee joint, without the ACL knee in the movement is like riding on a horse without reins running, the movement leads to knee instability, and can easily lead to damage to the knee cartilage and meniscus and other important structures The majority of patients with ACL injuries are young and mostly sports enthusiasts, so only surgery can allow patients to return to sports and fundamentally improve their quality of life. And surgery should be done as early as possible, as studies have shown that ACL injuries over 6 weeks before surgery are associated with a 4-fold increase in the chance of medial meniscus injury compared to patients operated on within 6 weeks of injury. Therefore, younger patients should undergo minimally invasive surgical treatment sooner after an ACL injury to ensure maximum recovery. Those patients who delay surgery have a much higher chance of developing sequelae. 5.Can I have minimally invasive surgery? Despite the many benefits of surgery, many people are still filled with fear and anxiety. In fact, ACL surgery is not scary, its essence is just to take a tendon graft (can be their own or foreign body) to replace the torn ligament, in medical terms this is called “ACL reconstruction”. With the current advanced medical technology, the surgery can be done by making a few holes in the knee joint, with only a small incision at the tendon, so it is a minimally invasive surgery with little risk and an aesthetically pleasing wound, and the patient can usually be discharged in three to five days. Arthroscopic reconstructive surgery has many advantages: 1) Minimal trauma, as the arthroscopic surgery does not require opening the joint capsule, but only a few small incisions of a few millimeters to enter the joint. 2) Accurate diagnosis: Under the direct observation of the arthroscope, all kinds of lesions in the joint can be seen and diagnosed accurately. 3) Precise operation. The arthroscope is like a magnifying glass, which magnifies the structures in the joint and makes the operation more precise. 4) Complete treatment: Arthroscopic surgery can treat all aspects of intra-articular lesions through different angles of access, leaving no dead ends, while traditional incisional surgery can only treat the local part of the joint due to the limitation of the incision, easily missing the lesions. 5) Fast recovery, due to the small trauma, post-operative recovery is fast, the patient can take care of himself and be discharged from the hospital the day after the simple surgery, and the patient can be discharged from the hospital in 3-5 days after the complicated surgery, without blood transfusion. 6) Beautiful appearance, compared with traditional incision surgery, the incision is smaller and more beautiful, more easily accepted by beauty lovers. 6) Minimally invasive surgery, how is it done? The professor’s patient and careful explanation made Xiao Yang relax and decide to undergo the surgery after discussing with her family. The professor performed an arthroscopic ACL reconstruction surgery on Xiao Yang. During the surgery, the professor introduced the arthroscope into the knee joint through two small holes in the front of the knee joint, while probing the structures inside the knee joint with a special probe hook. The anterior cruciate ligament in the center of the knee was completely torn at the end of the femur, the ligament was atrophied due to prolonged tensionlessness, the synovial membrane in the knee was congested and edematous, and the meniscus in the knee was also damaged. The professor first sutured the damaged meniscus as quickly as possible, then made a small incision below the knee joint and removed two popliteal tendons to be braided and processed for use. First, the professor skillfully used a medical planer and plasma knife to clean up the hyperplastic and obviously congested and edematous synovial tissue, and using the most advanced technology available, preserved the stump of the original ACL, only the femoral stop of the ACL was exposed, and the two points of the internal femoral tunnel opening were predetermined, which was the first step of the surgery. The second step of the procedure is the creation of the reconstructed ACL bone tract in preparation for the introduction of the reconstructed graft. The tract is positioned with specialized positioning instruments and the tract is created according to the diameter of the braided tendon. The professor uses the most advanced anatomical double bundle reconstruction technique available, drilling two tunnels in each femur and tibia. This is a very important step in determining whether the reconstructed ligaments will stabilize the knee joint and function properly in the joint cavity, and requires a high level of skill and experience. The third step is the introduction of the prepared reconstructed graft along the bone tract. After the reconstructed graft is introduced into the bone tract with uniform force, the femoral end of the graft is fixed to the femoral surface by a pre-installed button plate, and after repeated pre-tensioning within the knee joint where the reconstructed graft is performed, the tibial end of the graft is fixed to the tibial surface with absorbable compression screws, and the excess can be reinforced by fixing it to the tibial surface with portal nails. The surgery was completed with one suture on each side of the posterior knee incision and three sutures in the longitudinal incision of the upper calf. The entire surgery took only about half an hour and went very smoothly. On the second day after surgery, Yang felt a significant reduction in his knee symptoms and was discharged from the hospital two days later to undergo rehabilitation with the assistance of a special brace according to the professor’s plan. 4 months later, Yang came to the professor’s clinic for a review and told him that he was basically cured. The weakness in his knee disappeared and he was able to jog and do other physical exercises, and his daily work and life were not affected at all. Xiao Yang is only one of the thousands of patients with cruciate ligament injuries that the professor has treated, and he is very satisfied with his recovery after surgery. The professor and his team are helping more patients to relieve their pain and improve their quality of life through the professional treatment of cruciate ligament injuries. 7.Can ACL injuries be prevented? Surgery is successful, after all, it is also an injury; the reconstructed ligament is good, but not as good as the one given by parents. We would like to remind you to avoid non-contact knee sprains in daily life, especially in sports. The following factors are involved in non-contact injuries of the ACL: 1) Landing on one leg with the full foot on the tibia holding the lower leg in place. 2) Small angle flexion of the knee near the straight position. 3) Knee valgus occurs. 4)When the quadriceps muscle fires, the hamstrings (mainly the biceps femoris) are not effectively counteracted, resulting in excessive anterior displacement of the tibia. The following measures are currently considered to help prevent ACL injuries: 1) Adequate warm-up before exercise. 2) Train the athlete to have adequate forefoot support time when landing, greater than 40ms, so that the tibia will move with the femur during the “probable injury time” to avoid excessive rotation and excessive anterior displacement. 3) Train the athlete to land with a relatively large knee flexion angle and to control valgus. 4) Train the athlete’s hamstring (mainly biceps femoris) strength to effectively oppose the quadriceps. 8, summary “early diagnosis, early treatment” is particularly important for ACL injuries. Many people (especially young people now) in the knee sprain, thought it was just a simple pain, swelling for a period of time, rest on it, until the pain and swelling disappeared, the phenomenon of the knee “playing limp” also did not cause attention, still with a knee brace and other protective gear for work or sports, so that the knee sprain The unstable knee joint continues to undergo abnormal wear and tear, causing damage to the cartilage and meniscus in the joint and accelerating the degeneration of the knee joint. Therefore, after a knee sprain, you should actively go to a major hospital for consultation and examination. If an ACL injury or other ligament injury is found to be compatible with the indications for surgery, you should undergo early arthroscopic minimally invasive treatment to perform ligament reconstruction surgery. After the surgery and systematic rehabilitation, the patient can basically recover the function.