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Ligament reconstruction

In these cases, the patient suffers acute pain in the knee accompanied by a “crackling” sensation or noise. In the first few minutes, the knee becomes swollen as it fills with blood from the torn blood vessels of the ligament. The majority of patients cannot continue practicing sports due to pain, instability or the sensation that the knee "gives", which generally prevents unloading on that leg.  


In the weeks following the injury, the knee may stabilize but since torn ligaments rarely heal satisfactorily, the joint will feel “vulnerable” and the knee is likely to give way under stress. The patient may also suffer pain, edema and stiffness, particularly if other structures such as the joint surfaces or menisci have been damaged. These conditions are predominantly seen in young, active patients who practice sports, but they can affect people of any age and due to any type of accident, such as a fall at home, a sports injury, or a traffic accident.


Rupture of the anterior cruciate ligament is a serious knee injury, which has become an extremely common problem due to increased leisure time and sports practice. It is estimated that around 100,000 anterior cruciate ligament injuries occur worldwide per year exclusively associated with skiing and other contact sports.


Due to the marked increase in demand for surgery, extensive research conducted over the past 20  years has considerably improved surgical techniques.


The anterior cruciate ligament (ACL) is an important, resilient structure that is impossible to truly “replace.” Even after the most effective surgery, the knee will never be “like new.” There are often associated cartilage (articular surface) injuries that can be shaved, or in which self-repair can be promoted using the “bone marrow stimulation” technique (microfracture, small holes drilled into the exposed bone) in surgery. to promote the growth of cartilage repair cells from bone marrow stem cells). This may require additional arthroscopic surgery in the future. However, there is no doubt that recurrent knee instability is a very severe and disabling symptom for which current techniques are 90 – 95% effective.

If the ligament is not reconstructed, especially in young, active patients, the knee is likely to continue to “give way,” causing more damage, leading to more invasive surgery, and accelerating the onset of degenerative osteoarthritis. Studies have shown that more damage to the menisci and articular cartilage significantly increases the risk of developing painful arthritis in the future. Surgery does not always prevent this from happening as it may be an inevitable consequence of the severe knee injury already suffered. However, it is reasonable to think that the stabilizing effect of surgery will reduce further damage to other structures within the joint.

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Most surgeons use autologous tissue to replace the ACL since  It is less likely to cause long-term problems. Using the latest minimally invasive replacement techniques, Dr. Lisandro Carbó uses the body's own hamstring tendons (they can be felt as firm cords on the back of the knee or along the inner thigh) to reconstruct the ACL. Other options to replace the damaged ligament are the use of autologous patellar tendon graft or even cadaveric graft.


The use of 2  (of the original 4) hamstring tendons to reconstruct the ACL is associated with lower rates of anterior (patella) pain and later onset of arthritis compared to other techniques. The vast majority of reconstructions use autologous hamstring tendon grafts obtained from the same leg that is being operated on. Occasionally, you may need to use the tendons of the “healthy” contralateral leg and, in very rare cases, you will have to resort to sterilized ligament tissue from other 'donor' obtained through a tissue bank certified by INCUCAI.


It is also important to highlight that to give stability to the new ligament, various systems are used that allow it to be fixed to the bone until the “ligamentization” (healing) process is complete. Currently, fixation systems such as biodegradable buttons or screws are used.


The intervention performed is not always the same as that of other patients with “anterior cruciate ligament rupture” and the scars may also vary. It is a “major” surgery and is not free of potential complications. The most common complications after ACL reconstruction are knee stiffness, pain in the anterior part of the knee (related to scarring), failure of the replacement graft (this can occur with any type of tissue grafted into the body ), persistent edema, lack of sensation in the calf, infection and thrombosis (clots). 

The incidence of the last two complications is small, usually  less than 1% of cases. Surgery will only be recommended after a careful analysis of the risks and benefits of your case, and it is important to understand that the operation is intended to reduce instability (the knee that "gives way") and relieve other symptoms such as edema and pain.  ;

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