Anterior and posterior cruciate ligament injuries

Anterior Cruciate Ligament:

It prevents displacement of tibia toward the front under the femur. It's the ligament that is damaged most in case of falling from height and sport injuries. When anterior cruciate ligament is torn, it does not self-heal. Therefore ligament taken from another part of the body in placed into the joint arthroscopically and anterior cruciate ligament reconstruction is made.ACL tears substantially occur as the result of changing direction suddenly, sudden slowing down while running and skiing, turning of knee while landing after jumping and direct impact on the knee. Patients say that they heard a noise or releasing of the knee during tearing. At very first moment after the tear, generally there is a difficulty in putting pressure on it and after that pain and swelling starts on the knee.

A person with torn ACL:

• Feels slight instability while walking.
• Feels the instability in the knee more while on the stairs and running.
• Realizes thinning of quadriceps.
• Feels increasing sense of disbelief towards his/her knee as the result of reducing deep sense and muscle weakening and uses knee cautiously.
• Stays away from sportive activities.
• Knee turns again and meniscus is torn.

First aid:

Resting, ice-pack, support bandage and the leg must be kept up.

If it is not regarded seriously, it may cause meniscus tears, cartilage lesions in the future and osteoarthritis in long term.


Surgical Methods:

It can be treated by making ligament transplant instead of the torn one. There 2 types of ligaments that can be used for ligament transplantation. The first one is the ligament obtained from the person's own body (autograft) and the second one is the ligament obtained from a cadaver (Allograft). There are 2 types of Allografts which are dry graft and fresh-frozen grafts. 

Autografts are frequently used today as they have less problems in terms of compatibility to body and less endurance. However some athletes use allografts for not weakening current structure. 

Autografts are obtained from different parts of the body and tendons from the Hamstring are frequently used today.

Hamstring tendons are placed into the bonny tunnels opened inside the knee joint and attached to the bone by using different methods with Arthroscopic method (closed surgery). There are many different materials for fixing the tendon to the bone and the method to be used depends on the experience of your doctor.

Anterior Cruciate Ligament is composed on two bundles anatomically. Therefore double bundle reconstruction techniques have been developed for anterior cruciate ligament surgeries and had become one of the popular subjects of knee surgery until recently. It is shown in medium and long term follow-up results that, it does not have a substantial advantage when compared to single bundle repair techniques and rates of complication are higher. Still, there are knee surgeons defending double bundle repair technique today.

Posterior Cruciate Ligament:

Main function of the posterior cruciate ligament (PCL), which is one of the most important ligaments that ensure stability of the knee joint, is to prevent posterior translation of tibia under femur. Its secondary function is to help rotational and varus-valgus stability of the knee.

In consideration of the fact that tension power of PCL is about two times of ACL, it is considered as the primary stabilizer of the knee. In knees with clinical PCL impairment, functional instability in knees is felt mostly while going down a ladder. Single PL injuries in the body can be followed without surgery.

PCL injuries and all cruciate/collateral ligaments injuries combined with PCL require surgical treatment. While the autograft options that can be used in reconstruction are hamstring, patellar tendon and quadriceps tendon grafts, allografts that can be used as achilles tendon with or without bonny block, tibialis anterior tendon, patellar tendon, quadriceps tendon and hamstring tendons.

Injury Mechanism:

PCL injuries mostly emerge after direct traumas from anterior to tibia proximal. While isolated tears are more in low energy traumas such as sports injuries, multiple ligament injuries are more frequent in high energy traumas such as traffic accidents and industrial accidents. In consideration of this mechanism, frequently seen PCL injury mechanisms are motorcycle accidents, "dash board" injuries and falling when the ankle is at plantar flexion and knee is at 90 degrees flexion.

Surgical Treatment:

In PCL bone avulsions, GIII isolated injuries and all multiple ligament injuries, surgical treatment is indicated. Unlike the medial injuries together with anterior cruciate ligament, conservative results of combine PCL and medial injuries are worse. Therefore if either of ACL, medial collateral ligament or postero-lateral corner injuries is at present with PCL, all components of the instability must be fixed with surgical treatment. In combines ligament injuries, it is appropriate to perform surgical treatment about 2-3 after the injury in terms of both preventing liquid leakage outside the joint due to capsule injuries and reducing the risk of arthrofibrosis. In isolated PCL injuries on the other hand, it is necessary to decide on the necessity of surgical treatment after assessing the amount of instability and function loss remain after applying conservative treatment and passing the painful period of the knee.