The anterior cruciate ligament is one of the structures that connects the femur and tibia bones in the knee joint. This ligament, which is very important for the normal function of the knee, is the most important structure that prevents the tibia bone from displacing abnormally forward. Anterior cruciate ligament injuries are in the first place among the injuries that occur during sports and cause athletes to stay away from sports for more than 4 weeks. Anterior cruciate ligament injuries are followed by internal meniscus and internal lateral ligament injuries. It has been determined that approximately 200 thousand anterior cruciate ligament injuries occur annually in the United States. This frequency is expected to increase with the increasing interest of the society in sports. Although there are no healthy data in our country, it is estimated that around 3 thousand anterior cruciate ligament injuries occur annually. How do anterior cruciate ligament injuries occur? Anterior cruciate ligament injuries usually occur during sudden rotation on a fixed foot. It often happens during a movement the athlete makes himself. More rarely, anterior cruciate ligament injuries may occur following direct blows to the knee, traffic accidents, falls from a height, and industrial accidents. In this case, injuries of the posterior cruciate ligament, lateral ligaments and meniscus can also be added to the anterior cruciate ligament injuries. Due to the structural features of female athletes, anterior cruciate ligament injuries are more common than male athletes. In adults, injuries may be in the form of rupture of the ligament from the body, while in children, the injury may be in the form of a piece of the ligament rupturing from where it sticks to the bone. What are the symptoms of anterior cruciate ligament injuries? During anterior cruciate ligament injury, severe pain occurs with a sudden rupture sensation in the knee. Some athletes may hear the sound of the bond breaking and often fall to the ground. Swelling occurs due to rapidly developing bleeding inside the knee joint. The athlete usually cannot continue the sport and has to quit the competition. Due to pain and swelling, movement limitation occurs in the knee and limping occurs. Some athletes may feel their knees getting out of place. Swelling and pain in the knee joint subsides within a few days-weeks. Knee movements are gained and limping disappears. However, this time, a feeling of emptiness and insecurity arises in the knee, especially in sudden turns, sudden deceleration and while descending the stairs. In the knees with anterior cruciate ligament rupture, sports such as swimming and cycling can be done; However, it is not possible to do sports such as football, basketball, handball, volleyball, skiing with sudden jumps, turns and accelerations at a high level. If the athlete wants to continue these sports without an anterior cruciate ligament, the risk of new injuries and increased damage to the knee is very high. First aid at the field edge in anterior cruciate ligament injuries Anterior cruciate tear should come to mind in every athlete who has severe pain and swelling after a sudden rotation movement in the knee. Immediate application of ice to the knee and wrapping an elastic bandage will reduce swelling and pain. The athlete should not be allowed to return to the competition. The athlete must leave the field without putting weight on the involved leg and use crutches until a definitive diagnosis is made. Treatment options in anterior cruciate ligament injuries The treatment of anterior cruciate ligament injuries is surgery in individuals who are young, do sports or have an active lifestyle. Surgical treatment may not be performed in patients of advanced age who do not have a high activity level, do not do sports and do not have complaints such as gap and insecurity in their daily life. It was recommended to wait until complete growth and then perform surgical treatment in children whose growth is incomplete. However, nowadays, after seeing irreversible meniscus and cartilage injuries of the knee in children without surgical treatment, the needle has shifted to performing surgery at an earlier age. If non-surgical treatment is chosen, muscle strengthening programs are recommended to reduce the feeling of insecurity and emptiness in the knee, and protective knee pads can be used in sports that are challenging. However, when there is severe strain, neither of them can prevent the knee from dislocation and additional injuries to the knee can occur. How is anterior cruciate ligament repair performed? In adults, the anterior cruciate ligament is often torn by splitting the fibers in the body. It is not possible to repair the ligament in the form of a fringed tissue, and the ligament must be repaired with a new tissue during surgery. The tendons of the muscles around the knee are often used for ligament repair. The most commonly used tissue for this is the patellar tendon, located in the anterior part of the knee and taken with a bone block at both ends. The second most common tissue is the tissues known as hamstring tendons located at the back of the knee. There is no bone block at the ends of the hamstring tendons. Post-operative period Postoperative hospital stay may vary between 1-3 days. It is possible to stand up with crutches after the anesthesia wears off. Knee movements are started on the same day or the next day and it is aimed to be able to bend your knee up to 90 degrees. It may be necessary to protect the knee from overload by using crutches for several weeks after surgery. Full knee movement should be gained within three weeks. If the patient's own exercises are not sufficient, they can be applied in the presence of a physiotherapist and athletic trainer. It takes 6 weeks for the placed graft tissue to boil to the bone tunnels. After this period, normal walking and driving is possible. It takes one year for the implanted tissue to fully mature and firm, but it is possible to start sports activities after the 5th month.
