An anterior cruciate ligament tear can be referred to as a tear in one of the ligaments of the knee that connects the bone of the upper leg with that of the lower leg. The anterior cruciate ligament maintains the stability of the knee. Injuries vary from mild, for instance a small tear, to grievous, for instance when there is a complete tear of the ligament or when there is separation of the ligament and part of the bone with the rest of the bone. With no treatment, the damaged anterior cruciate ligament has less ability to control movement of the knee, and there is a more likelihood of the bones to rub against each other. This is referred to as chronic anterior cruciate ligament deficiency. The abnormal movement of the bone can as well injure the tissue (cartilage), which covers the bones ends and may cause trapping, as well as tearing of the pads (menisci), which cushion the joints of the knee. This injury may result in osteoarthritis.
At times other ligaments of the knee or parts of the knee are as well damaged. This includes cartilage like the menisci, or knee joint bones that can be broken. The anterior cruciate ligament can be damaged if the knee joint is bent towards the back, bent sideways or twisted. The probability of damage is more if over one of these movements takes place concurrently. Contact can as well result in injury of the anterior cruciate ligament.
An injury of the anterior cruciate ligament often takes place during sports. This can take place when an abrupt force hits the knee as the leg is straight or slightly bent and while the foot is firmly planted on the ground. This can as well take place when one is changing direction speedily, landing from a jump, or slowing when running. This type of injury is common in skiing, soccer, football, as well as other sports that involve lots of jumping, weaving, or stop-and-go movements. Missing a step on a staircase or falling off a ladder are other possible causes. Just as any other part of the body, the anterior cruciate ligament gets weaker as age progresses. It is for this reason that a tear occurs more easily in individuals who are 40 years of age and above.
When compared for activities, there is greater anterior cruciate ligament injury prevalence in females than in males. About half of patients with anterior cruciate ligament injuries also have meniscal tears. In acute anterior cruciate ligament injuries, there is a common tearing of the lateral meniscus. On the other hand, in chronic anterior cruciate ligament tears, there is a common tearing of the medial meniscus. Incidence has been estimated, in the only study on anterior cruciate ligament injuries prevalence in the general population, as 1 case out of 3,500 people, leading to 95,000 new ruptures of anterior cruciate ligament each year.
The significance of the anterior cruciate ligament has been stressed in athletes who need to be stable in cutting, kicking, and running. The anterior cruciate ligament -deficient knee has as well been linked to raised rate of degenerative modifications, as well as meniscal damages. It is for these reasons that about 60,000-75,000 reconstructions of anterior cruciate ligament are carried out each year in the United States.
When one has an acute or sudden anterior cruciate ligament injury, they typically know when it takes place. One may hear or feel a pop, causing the knee to give out, and ultimately leading to a fall. The knee swells, becomes painful or unstable for an individual to go on with any activity.
An injury of the anterior cruciate ligament can result in small or medium tears of the ligament, a total tear of the ligament also referred to as rupture, a detachment of the ligament from the upper or lower leg bone also called avulsion, or a detachment of the ligament, as well as part of the bone from the rest of the bone also termed as avulsion fracture. When either of these takes place, the bone of the lower leg undergoes an abnormal forward movement on the upper bone, with a sense of the knee buckling or giving out.
In order to restore of activity, as well as stability, the expected long-term success anterior cruciate ligament’s reconstruction rate is between 75-95%. The current rate of failure of reconstruction is 8%, a factor that may be ascribed to arthrofibrosis, graft failure, or recurrent instability. Options of treatment ought to be customized to a preoperative activity level of the patient. The levels of activity include Level I that includes pivoting, hard cutting, and jumping, Level II which includes side-to-side sports or heavy manual work, Level III, which encompasses noncutting sports and light manual work, as well as Level IV, which involves sedentary activity with no sports.
For diagnosis of anterior cruciate ligament injury, the best recommended physical examination test for its detection is the Lachman test. Magnetic resonance imaging can be essential in patients who are young in whom physical examination is impossible due to swelling, pain, as well as lack of cooperation.
Nonsurgical treatment may be considered for patients who get involved in level III or IV activities. For individuals who get involved in the others should be regarded as surgery candidates. On top of that, surgical consultation should be considered on any young athlete with potential complications arising from recurrent instability (Steckel, Musahl, & Fu, 2010).
Nonoperative treatment can as well be taken into consideration in patients who are elderly or in athletes who are less active who may not be getting involved in any pivoting type of sports such as cycling and running. Arthroscopy may as well be taken into consideration for candidates who are poor for reconstruction but possess a mechanical block to a variety of motion.
In general, it is recommended that surgical intervention be held up at least 3 weeks after the injury in order to avoid the arthrofibrosis complication. The techniques of surgical repair may be grouped into three groups, namely extra-articular repair, primary repair, as well as intra-articular repair. Primary repair is not encouraged except for bony avulsions that are in most cases seen in teenagers. Since the anterior cruciate ligament is intra-articular, the ends that are ligamentous are subjugated to synovial fluid that does not help in ligamentous healing. Extra-articular repair, in general, entails an iliotibial tract tenodesis. This can preclude a pivot shift though it has not been demonstrated to lower anterior tibial translation. Intra-articular anterior cruciate ligament reconstruction has turned into the criterion standard for anterior cruciate ligament tears treatment (Duquin, Wind, Fineberg, Smolinski, & Buyea, 2009).
Reference Lists
Duquin, T. R., Wind, W. M., Fineberg, M. S., Smolinski, R. J., & Buyea, C. M. (2009). Current trends in anterior cruciate ligament reconstruction. J Knee Surg., 22(1), 7-12.
Labella, C. R., Hennrikus, W., & Hewett, T. E. (2014). Anterior Cruciate Ligament Injuries: Diagnosis, Treatment, and Prevention. Pediatrics.
Steckel, H., Musahl, V., & Fu, F. H. (2010). The femoral insertions of the anteromedial and posterolateral bundles of the anterior cruciate ligament: a radiographic evaluation. Knee Surg Sports Traumatol Arthrosc., 18(1), 52-5.
Suomalainen, P., Moisala, A. S., Paakkala, A., Kannus, P., & Järvelä, T. (2011). Double-Bundle Versus Single-Bundle Anterior Cruciate Ligament Reconstruction: Randomized Clinical and Magnetic Resonance Imaging Study With 2-Year Follow-up. Am J Sports Med., 39(8), 1615.
