Rupture of the anterior ligament of the knee, what to do and who to believe?

Some numbers …

  • 75% of ruptures of the anterior cruciate ligament occur during sports practice.
  • 16,000 ruptures of the anterior cruciate ligament occur per year in France when skiing.
  • The average age of onset is 30 years.
  • The rupture of this ligament is 2-6 times more common in women

The different types of mechanism driving a ruptured anterior cruciate ligament.

– By hyperextension

This is the shot of the mechanism in vacuum

– Rotational

This is the mechanism of the support change football or skis crossing

– By hyper flexion

This is the mechanism of the heel / buttocks during a fall

How to diagnose?

– The interview:

  • Type of mechanism of injury
  • Perception of a slam at time of injury with sometimes the perception of a “hyper movement”
  • Can be painful sometimes with little opportunity to continue with some sports still the sensation of “crazy leg”.
  • Perception game in the knee and / or inability to take a free support on it.

– The examination by the doctor

  • Sometimes joint effusion
  • Evidence of abnormal movement in the knee
  • Reproduction by the practitioner of a knee instability

– Radiological examinations:

  • radio eliminates fracture
  • MRI allows to visualize the state of the anterior cruciate ligament.

What to do with a ruptured anterior cruciate ligament?

“Doctor, will I be able to resume football without to have surgery? “
“They told me I was too old to have surgery?
“After how long will I be able to race again? “
“Is it true that in case of rupture
in part, the operation is not necessary? “

– No ACL is unstable!

Although with a ruptured ligament, it may be that the patient is not hampered in daily life and in the practice of some sports, not efficiency of the latter will generate a game in the knee will cause premature wear of the knee .

– So what to do?

Two possibilities, either surgical repair of the ligament (ligament =) or physiotherapy (= functional treatment).
This surgery the interest to come closer to what the front knee injury. But suites are long and require great motivation and an important work of post-operative physiotherapy. In doing so, the resumption of sport will be between 7 ° and 10 ° months after ligament.

The only physical therapy, enables the recovery of sport from the 3rd month but does not always redo, sports such as rugby, football, handball, Basket Ball.

– Should I have surgery or do some physio?

In any case, there is no urgency to operate unless there is a breach of other ligaments.

The decision must answer two questions.
The first is the short-term; simple physiotherapy she will allow me to practice my favorite sport in good conditions?
The second is the long term; simple physiotherapy she will allow me to limit the osteoarthritic lesions in 20 or 30 years?
Of course, everything is decided case by case but schematically we can offer this:

  • unsportsmanlike and not feeling of instability and Physiotherapy annual medical supervision
  • Sports patient and motivated

Depending on the sport and the existence of associated risk factor of osteoarthritis: surgery or physiotherapy

The doctor told me I had a partial ligament injury, what should I do?

– What is a partial ligament injury?

Recently, with the contribution of MRI, made increasingly early, we were able to highlight ligament ruptures that were not complete. As a simple fraying of a big hemp rope, the ligament just seems distended without complete rupture.
With many usual, the practitioner may also consider this diagnosis in its review; There is a game in the knee, but less than if there was a complete rupture.

– What are the implications?

Imagine a rectangular room with a big rope taut hemp one meter above the ground between two opposite walls.
Now imagine that you give a scissor kick to the rope. We are in the case of complete rupture. The two cut ends fall down, and have no chance to heal because they are far from each other. Now imagine with a knife, you cut your rope partially so as to leave only a few hemp fibers. We are part of a partial rupture. In this case our rope remains tense and the two cut ends will be able to heal because still close to each other. The few fibers of the ruptured ligament using tutor for this spontaneous healing of the ligament.
Therefore, any doubt of a partial lesion of the anterior cruciate ligament, you have to give two to three months to let the chance of a spontaneous healing, which, if it occurs helps regain full functional capacity of this ligament.
In this case, we will confirm this healing to the 2 °, 3 ° month by a medical examination and if necessary the implementation of a new MRI.

Doctor Regis BOXELE. – 2 décembre 2013.