Rupture of the anterior cruciate ligament indicates a serious knee sprain. This injury is well known to footballers and skiers, but it can be found in many sports.
After an ACL rupture, a combination of extension splinting, ice and anti-inflammatory medication is required. Full support is allowed as long as it does not cause pain. After a classic radiological check-up which will eliminate the existence of a fracture, an MRI is important because it will allow a complete check-up of the knee and more particularly of the state of the menisci which are often affected in this type of accident. Rehabilitation sessions must be started quickly to avoid muscle wasting.
Surgical indications in emergency are very rare and most often if an operation is necessary, it can be carried out at least 6 weeks after the accident.
When to operate on a rupture of the anterior cruciate ligament?
The surgical indication initially depends on the age of the patient and the younger the patient is, the more ACL reconstruction surgery is essential to restore the knee to function as close to normal as possible.
Beyond the age of 30 to 40, the indication will depend on the instability of the knee, a possible meniscus injury and/or the sports activities you practice.
An ACL injury will lead to anterior laxity.
If this lesion is isolated, therefore without affecting the menisci or another ligament, it can be asymptomatic and perfectly controlled by good musculature.
If you do not practise risky sports, there is no surgical indication. The practice of sports in the axis (running, cycling, swimming) is allowed from 3 months after the accident.
If you wish to return to a risky sport, or if the ACL injury is significant, or if it is associated with other ligament damage or a meniscal rupture, surgery to replace the ACL with a ligamentoplasty is essential.
Simple, dangerous laxity in high-risk sports can become a complicated laxity of instability corresponding to knee dislocation.
This instability can sometimes lead to falls in everyday life and surgery may then be indispensable, whatever the age or the sporting activity.
Thus an instability of the knee that is resistant to rehabilitation will most often lead to surgery.
Modern ACL surgery
Modern ACL surgery is performed under arthroscopy, on an outpatient basis. It is painless and allows a very rapid resumption of walking. Driving can be resumed between 8 and 15 days, and professional activity, apart from certain activities that can lead to pivots, can be resumed in 3 to 4 weeks.
Sports activities in the axis are resumed around 2 months.
The resumption of risk sports in competition takes place between 9 and 12 months and depends above all on the quality of muscular recovery.
Of course the work with your physiotherapist is important and will allow you, in close collaboration with Dr. Puch, to go through all the stages.
What kind of operation can Dr. Puch offer you?
Depending on your clinical examination, the study of your radiological findings and your level of sport, different operations can be proposed.
The SAMBBA technique
In the vast majority of cases biological intervention will be proposed. This is the SAMBBA type ligamentoplasty developed by Dr Sonnery Cottet from Lyon. It is performed by a few surgeons in France, including Dr. Puch.
This particular technique has the advantage of being less aggressive, conservative and biological.
The main current techniques completely replace the ligament damaged by a graft which is either part of the patellar tendon, it is the intervention known as Kenneth Jones or KJ, or by using 2 hamstring tendons it is the right-internal semi-tendon (RIST).
In both cases, they are free transplants, that is to say transplants removed from the body, prepared and then grafted, most often replacing the entire ACL from which the fragments still present are then removed.
These are good interventions but quite aggressive and the graft which has been completely detached from the body will take some time to be re-habituated and regain good mechanical qualities.
The SAMBBA technique also uses hamstrings as a graft but only one tendon is used, the ST (the semi-tendon). It is not detached from the body and the graft is threaded through the remains of the old ACL which will be the real ligament sock of the graft.
The preservation of this real sock, which contains blood vessels and proprioceptive receptors, combined with the use of a single tendon not detached from its tibial attachment, makes the SAMBBA a unique technique.
Ligamentoplasty 3+2
In certain cases, such as old ACL rupture with great laxity, ACL rupture associated with damage to the anterolateral ligament, for professional sportsmen and women, etc : the SAMBBA technique may prove insufficient.
The 3+2 technique consists of reconstructing the ACL, often completely absent in these cases, associated at the same time with reinforcement or reconstruction of the anterolateral ligament.
This technique is, of course, more aggressive, but currently has the lowest rupture rates in the literature.
Recovery is nevertheless rapid, as you can see in this young sportswoman, who had an ACL rupture 2 years ago following a trampoline accident.
Kenneth Jones type ligamentoplasty
It is a technique using a free transplant, therefore completely detached from the human body. Approximately 9 to 10 mm of patellar tendon is removed with a fragment of patellar and tibial bone (see photos). This procedure is more aggressive than the use of hamstrings (RIST).