HEALTH MATTERS
By: Dr. Charles Gatt
|
"A direct blow to the knee is one of the most common ways for the Anterior Cruciate Ligament to be injured." Charles |
As the largest and most complex joint in the body, the knee
is key to leg movement and is often a common injury site. People who engage in
certain athletic activities such as football, soccer, basketball, volleyball,
and skiing risk injuring the Anterior Cruciate Ligament, or ACL. Fortunately,
today’s surgical procedures and rehabilitative regimens enable people to regain
full use of the knee despite the injury.
In order to function properly, the knee relies on four ligaments
and other muscles and tendons. These ligaments, which act more like rope than
a rubber band, are positioned on the sides and center of the knee.
The two ligaments on the sides of the knee are the Medial Collateral
Ligament (MCL) and the Lateral Collateral Ligament (LCL). The two crossed ligaments
in the center of the knee are the Anterior Cruciate Ligament (ACL) and the Posterior
Cruciate Ligament (PCL). The ACL connects the front part of the shin bone (tibia)
to the back part of the thigh bone (femur) and keeps the shin bone from sliding
forward.
A direct blow to the knee is one of the most common ways for
the ACL to be injured. Those who play football, soccer, or who fall while skiing
risk sustaining a direct hit on the knee. When this happens, the knee is forced
into an abnormal position that results in the tearing of one or more knee ligaments.
The majority of ACL tears, however, occur without direct contact
between the knee and another surface. Non-contact injuries, which are common in
skiing, basketball and volleyball in addition to football and soccer, happen when
a player is planting the foot and cutting; landing on a straight leg; jumping,
or making an abrupt stop.
Initial symptoms of an ACL injury include moderate pain and
an audible "pop." This injury prevents an athlete from continuing to play because
of pain and instability. Within several hours, the knee joint will swell (effusion)
and become stiff, making walking difficult.
A physician will often be able to examine the knee and identify
which ligaments are injured, although further evaluation with an MRI or arthroscope
may be necessary to completely evaluate the injury. After the first two days,
the swelling will resolve and the pain will lessen, but the knee will continue
to feel unstable and loose, as if it will buckle or give out.
Interestingly, there is a three times higher incidence of this
happening to women compared to men, making this a hot topic of research.
Treatment depends on a number of factors, such as the extent
of the injury; whether the patient is a recreational or competitive athlete; if
there are associated injuries, and the amount of abnormal knee laxity, or looseness.
Typically, for the recreational athlete, the first step is six
to eight weeks of rehabilitation. Knee rehab begins with exercises to help restore
full range of motion, followed by strengthening exercises for the muscles around
the knee. A return to sports with or without a brace is allowed only afterward.
This may be followed by a brace, and after leg strength, balance,
and coordination have returned to near normal, the patient may return to sports.
If the patient is unable to participate in daily activities due to instability
or a feeling of instability, surgery may be necessary.
The competitive athlete usually requires surgery to return to
sports that involve cutting and jumping. Because the ligament cannot be repaired,
arthroscopic surgery is necessary to reconstruct the ligament.
This same-day surgery, which has a 90 percent success rate,
is done by taking a graft from the patellar tendon, hamstring tendons, or allograft
(cadaver tissue). This tissue is passed through drill holes in the thigh bone
and shin bone, and then anchored in place to create a new ACL. Over time, the
new ACL regains its blood supply and cells and becomes a living ligament anchored
to the bone on each end.
After surgery, the patient will undergo extensive rehabilitation
and will require the use of crutches for up to two weeks. Typically, the patient
will be able to return to full sports participation after six months.
Because the knee is such an integral part of the body’s ability
to move, rehabilitation of the knee requires time, dedication, and hard work.
Within time, though, the knee will regain function.
Dr. Charles Gatt is an orthopedic surgeon on staff at The Medical Center at
Princeton. This article was prepared in collaboration with Lorraine Seabrook.

