Anterior Cruciate Ligament Injury
February 22, 2010
The anterior cruciate ligament, or ACL, is one of four major knee ligaments. The ACL is critical to knee stability, and people who injure their ACL often complain of symptoms of their knee giving-out from under them. Therefore, many patients who sustain an ACL tear opt to have surgical treatment of this injury. An ACL tear is most often a sports-related injury. ACL tears can also occur during rough play, mover vehicle collisions, falls, and work-related injuries. About 80% of sports-related ACL tears are "non-contact" injuries. This means that the injury occurs without the contact of another athlete, such as a tackle in football. Most often ACL tears occur when pivoting or landing from a jump. The knee gives-out from under the athlete when the ACL is torn. Female athletes are known to have a higher risk of injuring their anterior cruciate ligament, or ACL, while participating in competitive sports. Unfortunately, understanding why women are more prone to ACL injury is unclear. The diagnosis of an ACL tear is made by several methods. Patients who have an ACL tear often have sustained an injury to the knee. The injury is often sports-related. They may have felt a "pop" in their knee, and the knee usually gives-out from under them. ACL tears cause knee swelling and pain. On examination, your doctor can look for signs of instability of the knee. These special tests place stress on the ACL, and can detect a torn ligament. An MRI may also be used to determine if the ligament is torn, and also to look for signs of any associated injuries in the knee.ACL tears do not necessarily require surgery. There are several important factors to consider before undergoing ACL surgery. First, do you regularly perform activities that normally require a functional ACL? Second, do you experience knee instability? If you don't do sports that require an ACL, and you don't have an unstable knee, then you may not need ACL surgery. The is also a debate about how to treat a partial ACL tear. If the ACL is not completely torn, then ACL reconstruction surgery may not be necessary. Many patients with an ACL tear start to feel better within a few weeks of the injury. These individuals may feel as though their knee is normal again, but the problems with instability may persist. The usual surgery for an ACL tear is called an ACL reconstruction. A repair of the ligament is rarely a possibility, and thus the ligament is reconstructed using another tendon or ligament to substitute for the torn ligament. The are several options for how to perform ACL surgery. ACL reconstruction surgery uses a graft to replace the ligament. The most common grafts are autografts using part of your own body, such as the tendon of the kneecap (patellar tendon) or one of the hamstring tendons. Other good choices include allograft tissue, which is donor material. Repair surgery generally is only used in the case of an avulsion fracture (a separation of the ligament and a piece of the bone from the rest of the bone). In this case, the bone fragment connected to the ACL is reattached to the bone. ACL surgery is done by making small incisions in the knee and inserting instruments for surgery through these incisions (arthroscopic surgery) or by cutting a large incision in the knee (open surgery).ACL surgeries are done by orthopedic surgeons. Many orthopedic surgeons use arthroscopic surgery rather than open surgery for ACL injuries because it is easy to see and work on the knee structures, it uses smaller incisions than open surgery, it can be done at the same time as diagnostic arthroscopy (using arthroscopy to determine the injury or damage to the knee), it may have fewer risks than open surgery. Arthroscopic surgery is performed under spinal or general anesthesia. During arthroscopic ACL reconstruction, the surgeon makes several small incisions-usually two or three- around the knee. Sterile saline (salt) solution is...
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