Injuries and Instability of the Knee
The cruciate ligament is a major ligament deep inside the knee that holds the thigh bone stable on the shin bone. It is a common injury in athletes, but can occur on the job site, getting out of a truck, just running and stopping suddenly, or twisting. At the time of injury, the patient will often feel or hear a tearing or popping sensation. Often, at the time of the injury, the knee will buckle. After the injury, it will swell and be painful and often it will lock. There will be weakness and loss of motion. If not treated, frequently the pain and swelling initially get better. The problem is that the knee will continue to give out and buckle when trying to pivot or stop suddenly. Continuing buckling often leads to damage to the meniscus and arthritis. Injuries to the cruciate ligament are often associated with injuries to the meniscus (the cartilage separating the bones that helps with weight transfer as well as stability).
Symptoms
* Giving out
* Buckling
* Pain
* Lack of confidence in knee
* Locking
* Weakness
Treatment
Nonoperative
This is possible if a patient is willing and able to limit physical activity so the knee does not give out. And, provided the patient does not have a meniscal injury, this type of treatment can work. One problem that arises, however, is that each time the knee gives out, there is a risk of damaging the meniscus, and meniscal damage often leads to arthritis.
Operative
Most ACL injuries are treated by surgery. There have been big advances in surgical techniques since the middle 1980s. After this kind of surgery most people can resume their preinjury level of physical activity, work and recreational/sporting activities. However, this is a major surgery and the knee is never quite as good as new.
In most patients, repair is achieved by reconstruction of the torn ligament. At the time of surgery, an arthroscope is introduced into the knee, and a check is made for damage to any other structure. If there is a torn meniscus, it will either be repaired or, if appropriate, a small piece removed. Then, the cruciate ligament is reconstructed, usually using a piece of the hamstring tendon or patella tendon, which is screwed into place.
Generally, a patient will spend the night after surgery in the hospital. You can walk on the knee right away, but most people use crutches the first few days. It is very important to do exercises in the postoperative period, and it takes 5 to 6 months to resume regular sporting activities. It is possible to repair the meniscus, but the majority have the torn portion excised.
Check these links for more information concerning specific types of knee problems:
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Chondromalacia patella
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Other causes of knee pain
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Anterior cruciate ligament
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Other ligament injuries
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Advantages of arthroscopic surgery
