Rupture of the anterior cruciate ligament of the knee (PCOS)

The anterior cruciate ligament (PCOS) is the main ligament that keeps the knee stable during movement. It is most often damaged in active people: athletes, military, teenagers. Such an injury requires accurate evaluation and effective treatment. In Mashtaler Ortho&Trauma Clinic, we follow proven protocols and restore joint stability in every case.

What is the anterior cruciate ligament and why is it important?

The anterior cruciate ligament connects the femur and tibia and stabilizes the knee joint when bending, rotating and walking. It passes inside the joint obliquely, forming, together with the posterior ligament, a “cross”, hence the name.

The function of the PCD is to restrain excessive anterior displacement of the tibia, especially with a load on the leg or a sudden change in direction of movement. Estimates American Academy of Orthopedics, PCV provides more than 85% stability of the knee in front displacement.

PCV rupture is one of the most common injuries in sports orthopedics. In the United States, it is performed every yearmore than 100,000 reconstructions of this link. This is a frequent reason for visiting young patients, which is confirmed by Mashtaler Ortho&Trauma's own statistics.

What are the causes of anterior cruciate ligament rupture?

PCV rupture occurs when the load on the bond exceeds its anatomical strength. The mechanism of damage is usually sudden, associated with uncontrolled movement of the foot, impact or fall.

Injuries in sports

Most often, the ligament is torn during dynamic sports: football, basketball or skiing. A typical situation is a sudden stop or turn of the body with a fixed foot. There may not be a blow at all. The gap occurs due to improper landing or change of direction with torsion.

Domestic and road injuries

Not all ligament injuries are sports-related. We diagnose PCB ruptures also after falling from the stairs, sliding on ice, hitting the knee on the front panel of the car. Such a blow can cause not only damage to the PCV, but also concomitant damage to the meniscus or cartilage.

Sudden movements, stops and turns

The classic cause of rupture of the PCV is a sharp stop or change in the direction of movement, when the leg is fixed and the body rotates inertially. This is typical not only for sports, but also in everyday life — when dancing, jogging or climbing stairs.

Anatomical or physiological risk factors

In addition to external causes, there are internal risk factors:

• increased angle between the thigh and lower leg (more often in women);
• narrow intercostal notch in the femur;
• weakness of the hip muscles or insufficient rehabilitation after previous injuries;
• hormonal fluctuations.

Risk of rupture of PCV in women4 to 6 times higher than in men. A significant proportion of appeals are also caused by improper rehabilitation after hip muscle injuries. This is a key factor in re-breaking.

What are the symptoms of rupture or injury to the PCD?

Damage to the anterior cruciate ligament has a fairly typical clinical picture. Specialists of Mashtaler Ortho&Trauma clinic record a similar sequence of symptoms in acute rupture in the vast majority of cases. These manifestations make it possible to distinguish the rupture from other injuries of the knee joint even before MRI.

Acute pain and “clicking” sound during injury

Patients often describe sharp pain at the time of injury, accompanied by a palpable crunch or “click” in the knee. The sound is caused by a sudden rupture of the fibers of the ligament. In many cases, a person can name the exact moment of damage.

Those affected usually say: “as if something had cracked”, “as if the rope had cracked”. This is one of the important diagnostic markers of acute rupture of PCV.

Swelling of the knee during the first hours

After an injury, hemarthrosis, which is a buildup of blood in the joint, usually occurs quickly. The knee begins to swell literally within 2-4 hours.

If the edema develops very quickly, this indicates significant internal damage (usually PCOS along with cartilage and meniscus). According to our observations, severe edema with hemarthrosis often accompanies a complete rupture.

Feeling unstable or “failing” the knee

Characteristic complaint: “the knee goes forward”, “fails when walking”, “there is no support”. This is a manifestation of mechanical instability of the knee joint, which loses its main stabilizing structure - PCV.

Especially dangerous are situations when the patient tries to walk or do household chores again - instability can lead to repeated trauma or rupture of the meniscus.

Restriction of mobility and soreness under load

Against the background of swelling and pain, the amplitude of movements in the knee decreases. Attempts to bend or fully extend the leg cause acute pain, especially when stepping on the limb.

In many patients with rupture of the PCD, functional load on the leg becomes impossible during the first 12 hours after the injury. The knee “jams” or loses control.

How to distinguish a rupture of the PCD from other knee injuries?

An accurate diagnosis is possible only after examination by a doctor. But even before the visit, you should pay attention to a few practical signs characteristic specifically for rupture of the PCD, and not other damage to the knee joint.

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In medical practice, the following clinical tests are used for primary evaluation:

• Lachman test;
• test of the front drawer (anterior drawer);
• pivot shift test.

These manual techniques have more than 80% accuracy in the absence of severe swelling. Combined with anamnesis and MRI results, they provide even greater accuracy.

How to act if you find symptoms that look like a rupture of the PCV

After a knee injury with characteristic symptoms of rupture of the PCD, it is important to act correctly before consulting a doctor. Specialists of Mashtaler Ortho&Trauma clinic recommend remembering the RICE protocol:

• Rest (resto). Stop the load on the leg, fix the knee.
• Ice (ice). Apply ice or cold compress for 15—20 minutes every 1—2 hours.
• Compression (compressione). Elastic bandage to reduce swelling.
• Elevation. Raise your leg above heart level to reduce blood flow.

If necessary, you can take ibuprofen or diclofenac - these drugs reduce pain and inflammation. But the main thing is not to strain the leg. Attempts to “diverge” the joint or continue the activity only aggravate the damage to the anterior cruciate ligament.

When should you not delay and see a doctor?

We emphasize: not all knee injuries require immediate surgery, but each of them requires an accurate diagnosis. There are clear signals when going to the orthopedist can not be postponed:

• at the time of injury, a click or crunch was heard;
• the knee quickly swelled (within 4 hours);
• there is instability or fear of a full load on the leg;
• the mobility of the joint decreased sharply;
• there was a blockage or jamming when bending.

Patients are sometimes treated only 2—3 weeks after injury. During this time, complications may appear - for example, concomitant damage to the meniscus. Then the treatment is more difficult and often no longer complete without surgery. If you come in the first days, the path to recovery will be easier and less traumatic.

How is the diagnosis of rupture of the anterior cruciate ligament?

Examination by a traumatologist at Mashtaler Ortho&Trauma clinic includes several stages:

1. Anamnesis. We specify the mechanism of injury, the presence of a click, the development of edema, the age and level of activity of the patient.
2. Physical examination. Clinical tests are carried out (Lachman, Pivot Shift, Drawer). If the condition of the tissues allows — they give high sensitivity.
3. Visualization. If necessary, the specialist directs the patient to additional examinations. X-rays exclude fractures of the femur and tibia. MRI of the knee joint shows not only rupture of the PCV, but also concomitant lesions of the meniscus, cartilage, and swelling of bone tissue.

The images clearly show whether it is a complete or partial rupture, or whether there are displacements of the ligament residues that affect the treatment plan.

How is anterior cruciate ligament damage treated?

The treatment approach depends on the type of rupture (partial or complete), the age of the patient, the level of activity and the presence of instability of the knee joint. At Mashtaler Ortho&Trauma, we always evaluate all these factors before making a decision.

Conservative (non-surgical) treatment

With partial ruptures or a low level of activity, conservative treatment of anterior cruciate ligament rupture is possible. It includes:

• individually selected orthosis;
• reducing the load on the knee;
• a course of physical therapy to strengthen the muscles of the thigh and lower leg;
• anti-inflammatory therapy.

Patients without clinical instability can return to everyday life after 6 weeks of rehabilitation. At the same time, a control review is needed to return to sports to rule out hidden instability.

Surgical treatment (surgery)

With complete rupture of the PCD, especially in young patients and athletes, surgery is the gold standard. In Mashtaler Ortho&Trauma Clinic we perform arthroscopicPVC plastic— we replace the torn ligament with a graft — from the tendon of the semi-tendon or quadriceps muscle of the thigh. If there is inflammation in the collection site or the patient has contraindications, we use an allograft — a donor tendon.

The operation is performed under regional anesthesia and sedation, lasts about 60 minutes, and after a few hours the patient can get out of bed with a retainer.

Rehabilitation after surgery

Rehabilitation is a critical stage after surgery. In our clinic, it is carried out in stages:

• 0—2 weeks: control of pain and swelling, gradual recovery of movements;
• 2—6 weeks:knee stabilization, isometric exercises;
• 6 weeks and beyond: strength training, work on coordination;
• after 4-6 months:return to sports and active lifestyle (under the supervision of a doctor).

Is PCF fully restored?

Most often - yes, but subject to the doctor's recommendations. Success of complete recovery after surgery with individual rehabilitationis more than 90%.

However, a complete anatomical restoration of the ligament does not guarantee an automatic return to the sport. To avoid tearing again, we check muscle balance, stability and strength. The risk of re-injury without sufficient rehabilitation increases 2—3 times.

In most cases, patients return to an active lifestyle 9—12 months after the injury, and to professional sports only after control functional testing.

If you feel pain or instability in your knee after an injury — contact us

Damage to the anterior cruciate ligament is not only pain, but also loss of control of movements. Do not wait until instability leads to the destruction of cartilage or meniscus. In Mashtaler Ortho&Trauma Clinic we carry out a full course of treatment:

• clinical diagnosis;
• surgical or conservative treatment;
• rehabilitation under the supervision of experienced specialists.

Sign up for a consultation by phone or leave a request on the website. Timely treatment will ensure a speedy recovery with minimal health consequences.

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