|I THE INJURY
During the injury, the patient often hears a crack or a pop and
the knee gives way. The swelling is frequent either quickly after
the injury or the day after. Pain is often important when the injury
occurs. If the patient tries to stand up, he may feel instable.
II WHAT TO DO?
The diagnosis is brought up when listening to the history of the
injury. The orthopaedic surgeon will perform a physical examination.
He will perform manual tests on the knee to determine the amount
of instability that exists. The lachman test, anterior drawer test
and pivot shift test (to be compared to the unaffected size) are
exams he will use to see how much the tibia moves in relation to
the femur. (MORE)
The orthopaedic surgeon will look for an associated injury of the
lateral collateral ligament (lateral laxity) and quickly do a magnetic
resonance imaging (MRI) if the clinical examination is difficult.
No surgery in this acute phase, if there is no other injury to
the knee (lateral collateral ligament, locking of the knee by a
meniscal lesion) but icing, physiotherapy, drugs for pain relief
and exercises to strengthen the muscle of the thigh (quadriceps)
are to be continued.
The magnetic resonance imaging (MRI) is a non-operating procedure
that will confirm the diagnosis and assess the status of the ACL,
menisci, cartilage and the other ligaments. (MORE)
III WHO NEEDS RECONSTRUCTIVE SURGERY?
Most patients are able to resume normal daily activities a few
weeks after injury. The decision as to whether or not to operate
on an ACL tear is dependent on several factors such as the age of
the patient, the activity level of the patient (both recreational
and occupational), the expectations of the patient, the ability
and willingness of the patient to participate in post-operative
rehabilitation, the degree of laxity of the joint, and any other
associated injuries to the knee.
It is necessary to consider surgery
- If there are associated lesions (meniscus)
- If the patient wants to go on playing football, handball, etc...
In the other cases, if after six to eight weeks, despite the physiotherapy,
the knee continues to give way when pivoting and if there is a laxity,
it is appropriate to consider the reconstruction of the ligament.
After surgery, most people can get close to a return to normal
function if the procedure is without complications and the post-operative
physiotherapy protocol is adhered to. Return to high level of competition
may be difficult in high-demand sports.
Some older patients do not need reconstruction if they do not participate
in pivoting and cutting activities and if their knee is stable in
It is proven by many studies that instability of the knee leads
to early degenerative osteoarthritis.
Docteur Jean Etienne Perraudin,
last updated 1 September 2012