Treatment of anterior cruciate ligament injuries of the knee:
Anterior cruciate ligament injury is an important stability structure of the knee joint and can produce significant anterior and rotational instability of the knee joint after injury. If the ACL injury is not properly treated, it can lead to damage to the articular cartilage, meniscus and other major structures on top of the knee instability, resulting in early onset of knee degeneration and osteoarthrosis, thus aggravating the knee damage and seriously affecting the motor function of the knee joint. Because ACL injuries are common, serious and can cause secondary damage to the knee joint, their diagnosis and treatment are difficult and demanding, and as medical technology continues to advance, so do the techniques and concepts of ACL reconstruction surgery.
In our daily work, we find that many patients have some knowledge about ACL injuries, but since most of this information comes from the Internet, it can be considered mixed, sometimes making patients and their families feel confused and at a loss. When working in outpatient clinics and wards, patients often ask several questions (whether they should operate, when to operate, which procedure, which graft, etc.), and doctors sometimes get bored with the repetitive questions. So on these questions, let’s also understand the latest international advances and views on the subject (based on the common answers, the answers are divided into three categories: radical doctors, conservative doctors and sensible doctors).
1. Should I have surgery to reconstruct the ligament after ACL rupture?
Radical doctors: Surgery is necessary because failure to do so can lead to degeneration of the articular cartilage and meniscal damage.
Conservative doctors: Surgery is not required. As long as you do not participate in strenuous sports, you can have surgery if you feel instability even in daily activities.
Dr. Wise: The decision should be made on a patient-by-patient basis.
Patients who need surgical treatment for ligament reconstruction.
(1) Young patients should be treated surgically as early as possible.
(2) Those with repeated sprains.
(3) Those with joint instability.
(4) Patients with meniscus injury.
(5) Patients with 1-2 cartilage injuries.
Patients who do not require ligament reconstruction surgery
(1) Elderly patients without significant joint instability.
(2) Patients who have had ligament rupture for many years and have very serious cartilage damage and deformed joints.
2.Which is better, arthroscopic surgery or incisional surgery?
Arthroscopic surgery is less traumatic and quicker to recover after surgery, so of course it is better! But you must find an experienced surgeon!
3.When is the best time for surgery?
Radical doctors: the sooner the better!
Conservative doctors: If it does not affect walking, you do not need surgery.
Wise doctors: Generally, surgery should be performed after the acute period (1-3 weeks), when the swelling of the joint has subsided and the joint can be fully flexed and extended.
4.What kind of tendon should be chosen as a replacement for the ACL reconstruction?
Radical surgeon: artificial ligament or allograft tendon.
Conservative surgeon: only autologous tendon.
The wise surgeon: simple ACL rupture usually uses either autologous, artificial or allograft tendons to reconstruct the ruptured ligament. In the case of revision surgery (failure of the first surgery, or re-rupture of the ligament after surgery), allograft tendons may be required due to widening of the bony tract. In addition, multiple ligaments ruptured at the same time usually require the use of allograft tendons for repair (autologous tendons are not enough!) .
5. What are the risks and sequelae of ACL reconstruction surgery?
Radical surgeons: There are no risks.
Conservative doctors: There are risks such as infection, joint ankylosis, and various anesthesia and surgical accidents.
Wise doctor: Infection is a possible complication that comes with any surgery. According to a large number of clinical studies both at home and abroad, the infection rate is generally below 0.5%. In regular hospitals, there are strict principles and norms of aseptic operation, and the possibility of infection can be further reduced by preoperative and postoperative use of antibiotics and postoperative attention to recuperation. Joint ankylosis and adhesions are usually caused by untimely and incorrect post-operative rehabilitation. Early post-operative ACL reconstruction (day 2) should be followed by joint flexion and extension exercises instead of prolonged cast immobilization. Only if the correct rehabilitation exercises are adhered to, joint stiffness will not occur.
An experienced team of surgeons (operator, assistants, anesthesiologists, nurses, and rehabilitators) can minimize the risks and complications of surgery without undue concern.
In general, we recommend that young and middle-aged patients with ACL rupture should undergo surgery after the swelling and pain have disappeared and joint mobility is generally normal, using arthroscopic dissection and reconstruction of the ACL.