Anterior cruciate ligament surgery

A ligament is a fibrous cord that connects two bones together at the joint level. It guides and controls its movement until the day when the amplitude exceeds the limits of its elasticity and then arrives the sprain. The ligament is different from the tendon which attaches a muscle to a bone to transmit its contraction force. To fulfil its mission, the second must be more rigid.
The knee is the joint between the lower part of the femur and the upper part of the tibia. The sliding joint surfaces are covered with cartilage. Inside, two meniscus pads act as shock absorbers between the femur and tibia. Knee stability is ensured by the peripheral ligaments (internal and external), the muscular environment, the meniscus and the central pivot composed of the cruciate ligaments, one anterior and one posterior.
You can break your anterior cruciate when your ski spatulas move apart or cross. It also tears when your knee rotates violently during a change of support. This may be the case in football.
The anterior cruciate ligament may be ruptured as a result of trauma, sometimes resulting in chronic knee instability. These instability phenomena can occur during sporting activity or more simply during the movements of daily life in pivot or rotation.
There is no spontaneous healing of a ruptured anterior cruciate ligament.
This rupture leads to instability that varies according to the person and their activity, thus causing other lesions (meniscus, ligament and cartilage). The knee progresses earlier towards arthritic degradation of the knee.
The purpose of anterior cruciate ligament ligamentoplasty is to stabilize the knee, allowing sports and professional activities to resume and to protect it from arthrosic degradation too early.

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Prior consultation with the orthopaedic surgeon is essential.
A scanner or MRI will be requested to confirm the diagnosis of cruciate ligament rupture.
To avoid an accident of instability (knee that fails) when resuming sports activities, the decision to perform surgery is made, based on various parameters evaluated by the surgeon and his/her patient.
A knee that fails inevitably leads to a secondary tear in the meniscus which, combined with the rupture of the cruciate ligament, promotes osteoarthritis.
A short phase of adapted rehabilitation is often beneficial for a few weeks before the operation to prepare the knee.
You will be asked to fast, i.e. not to drink or eat anything after midnight before the operation.
A skin preparation will be carried out according to a well-established protocol including antiseptic whitewashes in order to limit the risk of infection.

Anterior cruciate ligament surgery under arthroscopy is performed under general anesthesia or under spinal anesthesia during a short hospitalization of 2 to 3 days.
In order to minimize blood loss, a pneumatic tourniquet is used to interrupt blood flow.
There are many surgical techniques and different types of techniques are performed according to each case. In order to replace the old anterior cruciate ligament, it is possible to use as grafts:
• Part of the patellar tendon (Kenneth Jones technique). The scar is therefore anterior in front of the patellar tendon by about 6 cm.
• Internal tendons (semitendinosus-gracilis double-bundle technique). The scar is located on the inner side of the proximal part of the tibia for 3 cm. Sometimes, an external reinforcement or return can be made in case of great instability.
In addition, a small incision in the anterior part of the knee provides access to an optical instrument (arthroscope) that is inserted into the joint. It is then filled with a liquid product in order to reveal almost the entire joint cavity and to allow its detailed study.
Joint structures (meniscus, cartilage, ligaments) must almost always be checked by palpation with a probe. This instrument is introduced through a second small incision. This incision also allows the introduction of the instruments necessary for the planned treatments (ligamentoplasty and regularization or meniscal suture if necessary).
The graft removed replaces the old ligament after femoral and tibial preparation. This graft is then fixed by different systems (resorbable screws, pins, endo-button…)
A redon will most often be put in place to avoid intra-articular hematoma.** The procedure takes about 1 hour.**

After the procedure, you will stay in the recovery room for a while to check that everything is fine, then return to your room when the anesthesiologist has given his/her consent.
Pain medication will be administered and anticoagulant treatment will be started for about fifteen days. You will also benefit from immediate cryotherapy to reduce the risk of post-operative hematoma.
The first check-up with your surgeon will take place 6 weeks after the operation.
Post-operative rehabilitation begins the next day with a full support walk and flexion work. The patient must walk with canes or under the cover of an articulated splint until a quadricipital lock is recovered. Driving can be resumed from the 1st month. The same applies to professional activity, but this recovery remains highly variable depending on the profession.
The resumption of sports in the axis is done in the third month. The resumption of contactless pivot sports is gradually taking place out of competition from the 6th month onwards. Contact pivot sports (football - handball - basketball - American football…) can be resumed from the 10th or even 12th month.

About Anterior cruciate ligament surgery

Complications:
• Infection of the joint
• Blood clots
• Hematoma
• Nerve injury
• Painful swelling
• Small injuries to joint cartilage….
Votre chirurgien vous donnera toute explication complémentaire.
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MEDICAIM organizes your entire stay for you: post-operative nursing care, biological follow-up, therapeutic, nutritional and psychological support.
Any additional questions? Ask your MEDICAIM doctor about it: careteam@medicaim.com
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