Primary Anterior Cruciate Ligament Repair:
The anterior cruciate ligament is one of the four main groups of ligaments that provides the strength of our knee, and if it tears there is a significant restriction of knee functions and a feeling of insecurity against the knee.
Anterior cruciate ligament tears seen in one in 1000 people every year usually require surgical treatment. Since it is mostly in young and active people, surgical treatment is required to return to the desired activity level. In the absence of surgery, the knee may return and the meniscus may tear. If the meniscus tears, cartilage damage begins and knee osteoarthiritis becomes more likely in later years.
Do classical anterior cruciate ligament operations fail?
No. After a successful operation, a person who has an anterior cruciate ligament can return to his/her sporting life like many professional athletes.
Surgical treatments are currently performed in two ways. The first and widely performed is anterior cruciate ligament reconstruction surgery. The other is suturing the ruptured anterior cruciate ligament, in other words, closuring the surgery.
Classical anterior cruciate ligament reconstruction or primary repair?
If you need to review the advantages and disadvantages between these two methods:
Reconstruction of the anterior cruciate ligament, as the name implies, is the reconstruction of the anterior cruciate ligament. In this operation, another ligament or tendon that we aim to serve as an anterior cruciate ligament is removed from the site and inserted into the knee. This surgery has been performed for many years with very successful results, but as mentioned, a similar tissue will replace the anterior cruciate ligament. There is no standard method for this surgery, which we know the long term results. According to their knowledge and experience, doctors use hamstring tendons, patellar tendons, Quadriceps tendons or allografts during anterior cruciate ligament reconstructions. However, none of these tissues is the same as the anterior cruciate ligament.
With the help of advances in technology, primary anterior cruciate ligament repair has now become possible, and many studies have shown that it has had more than 5 years of successful results.
Although primary anterior cruciate ligament repair is not a new topic in orthopedic literature. Repair of ACL was tried many times during 1970-1990 when reconstruction was not developed, unfortunately it was not successful.
Especialy In 2013, with the development of the Dynamic Intraligamentary Stabilization (DIS) technique, the repair of the ruptured anterior cruciate ligament became possible with more successful results.
Is primary repair a smooth operation?
The advantages and disadvantages of anterior cruciate ligament repair operations, which are currently being performed in many countries, are as follows:
The primary advantage of primary anterior cruciate ligament repair is the recovery of the original anterior cruciate ligament. The structure of each ligament in the body and the combination of collagen are different. No ligament is the same as the other. In anterior cruciate ligament reconstructions, a ligament or tendon taken from another part of the body can never be histologically or shape-like as the anterior cruciate ligament itself. Therefore, the anterior cruciate ligament should be protected as much as possible.
The second important advantage is that there is no need to take a ligament from another part of the body. As is known, each ligament has a duty.
The disadvantage is that it requires a second operation six months after the operation and the screw that has been placed is removed and the place is filled with ready bone.
According to the literature, who underwent primary repair operations with 90% success.
Can primary repair be performed to all anterior cruciate ligament ruptures?
To perform these surgeries, no more than three weeks have elapsed from the anterior cruciate ligament ruprure and the ligament should be ruptured from the upper part. In general, 80% of the anterior cruciate ligament ruptures upper third part , and this can be seen on MRI. If the ACL ruprutes from the middle part, which is about 20% probability, it is unfortunately not suitable for repair.
Is it true that anterior cruciate ligament surgery is not performed in the first three weeks?
This widely known idea is no longer accepted by the literature. The exception to this information is that anterior cruciate ligament and other ligaments injury in the same knee, in other words, if there is a multiple ligament injury, it would be a more appropriate time for surgery after 10-15 days.
The preservation of each original tissue in the body is often desirable and we must try to preserve our original anterior cruciate ligaments as much as possible. Therefore, it is necessary to consult an early doctor visit if you have anterior cruciate ligament rupture.