In my daily work, I come into contact with many patients suffering from cruciate ligament injuries of the knee, and many of them complain to me that “they were misdiagnosed early on”, “they did not recover well from the surgery”, “can they I found out that most of the patients had been misdiagnosed early on. After careful communication I found that most of the patients did not have a good understanding of cruciate ligament injuries and their surgical treatment, and some patients who had undergone surgery even said to me, “I don’t know what it is, but I’ll operate if the doctor tells me to. I am not aware that the patient’s indifference to his disease is one of the main factors leading to his poor recovery. In this article I will introduce you to some of the most common doubts and basic knowledge that patients with cruciate ligament injuries need to know. First, is there a high probability of cruciate ligament injury of the knee? Is conservative treatment effective? With the increasing incidence of high-energy injuries such as car accidents, falls and bruises, the high incidence of knee cruciate ligament injuries has increased from athletes, adolescent school students and other groups to the general population “across the board”. According to incomplete statistics, patients with knee ACL injuries who are finally diagnosed and treated correctly by doctors in China account for only 5-10% of this number of patients, and the vast majority of patients do not face up to their “knee sprains” in the early stages, and patients who go to the hospital may also be treated by the emergency department or general orthopedic surgeons because the patient Patients who go to the hospital may also neglect further examination and treatment because the emergency department or general orthopaedic surgeon may also see “no fracture” on an X-ray. Since the cruciate ligament of the knee is the “load bearing beam” that maintains the stability and flexibility of the knee joint, it is difficult to effectively “repair” the knee once it is injured by its own blood supply alone, so most patients with a “torn” cruciate ligament of the knee are treated conservatively. “However, for ligament “strains”, the parenchymal fibers of the cruciate ligament are not completely ruptured, and most patients with intact collagen fiber bundles may benefit from early braking, cold therapy, etc., but the efficiency and longevity of the damaged ligament will be more or less effective in the future. However, the efficiency and longevity of the damaged ligament may be compromised to a greater or lesser extent. This is not to say that early immobilization in a cast or brace is not important, but these treatments are part of the “preparation” for surgical treatment: effective braking and cold therapy will promote the reduction of knee swelling and reduce the trauma response and promote the absorption of blood in the joint cavity. When should I have surgery after a cruciate ligament injury? Generally speaking, the cruciate ligament injury caused by severe trauma, car accident injury, sports injury and other severe “trauma” because of its post-injury joint hematoma, pain, skin damage, etc. We advocate temporary treatment of swelling, cold compresses, braking, etc., and wait for 1-2 weeks after the injury for the knee swelling and pain to improve before surgery, for the knee joint dislocation like In cases such as knee dislocation with multiple ligament injuries and posterior cruciate ligament injuries, the timing of surgery should be delayed until 2-3 weeks after surgery due to the more serious injury to the joint capsule. For old injuries with a previous “trauma history” of more than three months, we recommend immediate treatment of the cruciate ligament injury once the diagnosis is clear. For patients who have not taken the correct treatment after the injury and have severe atrophy of the muscles around the knee (commonly known as “thinning of the leg”), we recommend that they undergo about 3 weeks of thigh muscle strengthening training under the protection of a brace before surgery, in order to reduce the occurrence of weakness and poor recovery of the thigh after surgery. Which is more serious, ACL injury or posterior cruciate ligament injury? Is the treatment effect as good? In fact, for most patients with cruciate ligament injuries, the probability of ACL injury is higher than that of posterior cruciate ligament injury. This is because the posterior cruciate ligament is structurally abnormally thick and strong, and to tear it generally requires axial violence from front to back while the calf is sagging, and the probability of such trauma is “too coincidental”, and even a well-known knee arthroscopic surgeon overseas has less than 10 posterior cruciate ligament surgeries a year. But coincidentally, officially because China is a developing country, in the country, especially remote rural, mountainous, hilly areas and other geographical motorcycles and electric vehicles as the main short-distance transport. Such two-wheeled powered vehicles are prone to posterior cruciate ligament injuries in the event of a crash. So instead, we are exposed to a higher probability of posterior cruciate ligament injury. As mentioned above, the posterior cruciate ligament in normal people is very strong and sturdy, and once it is injured and undergoes arthroscopic posterior cruciate ligament reconstruction surgery, the graft material we choose often does not reach the anatomical strength of the original uninjured state, plus there is a special disadvantage of posterior cruciate ligament reconstruction “killer turn” (the specific mechanism is too I won’t go into the details of the mechanism), which makes posterior cruciate ligament rehabilitation more difficult than ACL reconstruction, which is commonly referred to as “less effective than ACL reconstruction” by most patients. However, after all, ACL reconstruction restores the stable structure of the knee joint, and the possible poor recovery after surgery is based on individual patient characteristics and the limitations of the current level of medical continuity, not to say that surgery should not be done, and there is no doubt that a significant number of patients eventually recover. Fourth, how is cruciate ligament injury treated surgically? What are the advantages of arthroscopic surgery? Based on existing scientific research, it is now the consensus of international and domestic scholars that once the cruciate ligament of the knee is ruptured, simple “suture” surgery is ineffective because the blood vessels in the injured cruciate ligament cannot be reopened after “suturing”, and the stump of the ligament that has lost its blood supply The stump of the ligament will soon die and become necrotic. Because of this characteristic, the mainstay of surgery for knee ACL injuries is currently arthroscopic ligament reconstruction. We use autologous tendons or allogeneic tendons as the graft material, which are woven and sutured to create a model of the knee ACL reconstruction and grafted into the joint cavity, then fixed with absorbable or titanium material to keep it firmly in place in the joint, with the ends of the tendon buried deep in pre-drilled “bone tunnels” in the thigh bone and calf bone. The entire procedure consists of a few small skin incisions. The entire procedure consists of only a few small skin incisions, which add up to about 4-5 centimeters. Arthroscopic knee ACL reconstruction surgery not only avoids the traditional 20-30 cm long incision, but also reduces unnecessary damage to the normal structures of the joint and reduces surgical trauma. At the same time, due to the “large field of view” of the arthroscope, a small incision can be used to show the whole picture of the injured knee on the monitor, and if the patient also has a meniscal injury or intra-articular cartilage injury, it can be treated together to avoid missing the condition. Patients have less pain after surgery and are willing to perform functional exercises early and recover quickly after surgery. V. Are there any after-effects after ligament reconstruction? Can it recover well? As mentioned above, existing ligament reconstruction techniques require “tendon-bone healing” of the grafted tendon and bone tunnel. Due to the physical factors of the patient (especially middle-aged and elderly patients with different degrees of osteoporosis), the condition of the transplanted tendon (some patients have very short and thin autologous tendons), the presence of “rejection” (mainly for allografts) in the early post-operative period, and the amount of post-operative joint activity, the post-operative recovery also varies greatly. There is a great difference in postoperative recovery. It is important to note that a successful ACL reconstruction is not the same as a perfect surgical outcome. During the long post-operative recovery period (4-6 months, possibly up to 9 months in some patients), there is a “crawling replacement” process where the transplanted tendon molts and then grows in. There is no “cure” or “surgical procedure” that can significantly accelerate this process, and likewise the growth of the reconstructed ligament may be affected by any external disturbance during this process. The most common sequelae associated with this process are limitation of knee mobility, persistent muscle atrophy, and ligament relaxation after transplantation. Generally speaking, there will be improvement by adjusting the post-operative rehabilitation program, using a chuck type brace for protection, etc. However, some patients have difficulty in significantly improving the above-mentioned conditions and remain dysfunctional, but this rate is very low, and through our clinical observation over the years, the patients who really recover poorly account for about 5-8% of the total patient population. VI. How to carry out postoperative rehabilitation correctly? If you are an athlete, firefighter, police officer, dancer, etc., who have high requirements for knee function, our rehabilitation program is often more aggressive, and the corresponding recovery process will be accelerated and faster. The recovery process will be speeded up and the function will be restored faster, but at the same time the probability of side effects is relatively high. If you are an office clerk, teacher, school student, or a housewife, with low physical fitness, especially muscle strength reserves, and do not require “immediate recovery”, our exercise program should be more moderate. Accordingly, the physical requirements of the patient are not high and the safety factor is high. Some patients have also asked me about the rehabilitation programs of different hospitals and doctors on the Internet, but they often differ greatly because the patient groups treated by these doctors may be different. You must communicate closely with your own primary care doctor, review your treatment and rehabilitation program at regular outpatient clinics and adjust it according to your recovery.