There are four main ligaments that prevent or limit abnormal movement of the tibia under the femur during movement (stability) of the knee. These are the anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament, and lateral collateral ligament. One or more of these ligaments can be injured during daily, work, and sports life, and each ligament injury has its own unique diagnostic, treatment, and natural history algorithm. Ligament injuries to the knee can cause significant loss of performance. The anterior cruciate ligament is the most frequently torn ligament and the most frequently treated ligament in orthopedic clinics. Sports positively impact the biological, psychological, and social makeup of humans. For this reason, people begin sports at an early age and continue sports until late in life. However, sports-related injuries and anterior cruciate ligament problems are increasingly common. The anterior cruciate ligament connects the femur and tibia within the knee joint. This ligament comes into play, particularly during movements that require high-capacity use of the knee joint, and the knee assumes a very important role. While the anterior cruciate ligament limits abnormal movements of the knee joint in many planes, its most fundamental function is; It prevents the tibia from moving forward or sliding under the femur.
How Does the Anterior Cruciate Ligament Rupture?
The mechanism of ACL rupture is generally a movement in which the knee flexes, rotates inward, and the leg angles outward simultaneously while the foot is stationary on the ground. ACL ruptures can often occur during sports activities such as football, basketball, and skiing, as well as in everyday or professional life. In adults, ACL ruptures most often occur in the body of the ligament, while in children whose growth spurts have not yet closed, the rupture occurs most often with a bone fragment at the attachment point of the ligament to the bone.
What Are the Symptoms of an Anterior Cruciate Ligament Rupture?
Serious strain immediately occurs in the knee. When the movement described above occurs in the knee, whether during sports, daily life, or work, a sudden snapping sensation and severe pain occur. The individual often falls to the ground, and a snapping sound can be heard nearby. A feeling of dislocation of the knee occurs. The athlete is usually unable to continue their sport. Due to bleeding in the knee, swelling occurs within the first 1-2 hours. Pain and swelling lead to limited movement in the knee, and limping can occur. Even if the knee is not treated, unless there is a mechanical knee problem (such as a displaced meniscus tear or a cartilage-bone fracture) that is locking the knee, the swelling, stiffness, and pain in the knee subside within a few weeks. Knee range of motion improves, the limp disappears, and the person returns to their daily activities as if they had a nearly normal knee joint. However, a feeling of emptiness and insecurity can occur in the knee, especially during sudden turns, decelerations, or jumping. When a person wants or needs to increase their activity level, the knee occasionally rotates and gaps. These rotational movements can lead to injuries, damage to healthy cartilage and menisci. In cases where the ACL is torn and menisci are not surgically removed, 80% of menisci are torn after one year. Today, torn ACLs can be reconstructed. However, except in exceptional cases, it is not possible to repair tissues such as menisci and cartilage. People with ACL ruptures can perform daily activities by strengthening their knees and developing their reflex pathways, and they can participate in sports activities, provided they are at a low level. However, rotational and flexion movements are possible in their knees. It is impossible for people with ACL ruptures to play sports such as football, basketball, handball, volleyball, or skiing at a high level, or to maintain a career or lifestyle that requires high-intensity knee use. If an athlete, or a person with a job or lifestyle that requires high-intensity knee use, continues to use their knee without the ACL, the development of an irreversible, secondary knee problem is inevitable.
What to Do at the Time of the Initial Injury
People who experience rotational movements, severe pain, and limited movement in their knees on the field or in their daily lives should assume they have a ligament injury or fracture until proven otherwise. Activities should not be continued. Loading an injured knee exacerbates the existing problem or causes additional injuries. The first step in such a knee injury is to relieve the knee joint of any weight. This means that the athlete or patient should avoid putting pressure on the injured knee, and if possible, they should be transported on a stretcher, or they should be transported to the hospital using crutches or by walking on one leg while supporting themselves under their arms. During this time, the patient should be bandaged and iced, but not too tightly, to help control swelling, bleeding, and pain. The patient should be referred to the nearest healthcare facility.