Treatment: ligamentoplasty

What is the anterior cruciate ligament?

A ligament can be compared to an elastic band. The anterior cruciate ligament (ACL) is located inside the knee joint.

Why is it called "cruciate"? It is two ligaments - the anterior cruciate ligament and the posterior cruciate ligament - that cross each other to perform the same function: to maintain the connection between the tibia and the femur, to which they are attached, and thus stabilize the knee during flexion and extension of the knee or during rotation of the leg.

Thus, the anterior cruciate ligament prevents the tibia from shifting or rotating too much concerning the femur, which could cause the components of the knee joint to be ejected from their place.

Rupture of the cruciate ligament

Causes

The rupture of the anterior cruciate ligament occurs more generally in a young and athletic person, especially if he regularly solicits his knee by pivoting while practicing sports such as soccer, skiing, basketball, or combat sports...
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The patient will have had a trauma to the knee due to a blow or have heard a sudden cracking sound, or the knee will have buckled under their weight after a sharp pivot or upon landing a jump.

Symptoms and consequences

The knee will be unstable, painful, swollen, blocked, and challenging to walk. After an X-ray, which will help determine the diagnosis, a magnetic resonance imaging (MRI) scan will refine the diagnosis, as it allows to see inside the knee. It will thus be possible to confirm (or deny) the rupture of the anterior cruciate ligament and to look for the presence of other likely lesions such as meniscus or peripheral ligament lesions.

It is good to know that a ruptured anterior cruciate ligament will not heal independently, even if the knee is immobilized. In many cases, the patient will keep an unstable knee that will give way under them; they will be hampered in the movements of daily life, will not be able to do any more sports, and will also risk future damage to the meniscus, damage to other ligaments, degradation of the cartilage and, in the long run, osteoarthritis.
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Surgical intervention is therefore necessary so that the knee regains controlled laxity and joint stability and can function fully. In this case, the surgeon will perform a reconstruction of the anterior ligament, also called ligamentoplasty, associated with managing secondary injuries.

Qu'est-ce qu'une ligamentoplastie ?

Just before the operation, the surgeon will check the precise anatomy of the patient's knee and its lesion using an ultrasound. This will allow him to adapt his work by performing, for example, a lateral reinforcement guided by ultrasound.

Ligamentoplasty consists of replacing the ruptured ligament. This operation can be done in a minimally invasive way, thanks to arthroscopy. Indeed, there is no need to open the knee joint, which avoids damaging the muscles and allows an accelerated post-operative recovery.

Surgical instruments are inserted through other small incisions and remove a piece of a tendon near the damaged knee (the patellar tendon) or a tendon from the thigh. This piece of the tendon will replace the ruptured ligament. A micro-camera is inserted into the knee through a small incision, allowing visualization of the ruptured ligament.

It is then inserted into two small bone tunnels in the femur and tibia. The surgeon then fixes the tendon with resorbable screws or cortical supports - a system that attaches the tendon graft to the hard part of the femur, called the cortex.

If necessary, any damage to the meniscus is treated simultaneously. The tendon from which the removal was done will heal quickly. This operation usually lasts 30 minutes and is performed as an outpatient surgery (entry in the morning and exit in the evening).