Torn cruciate ligament

Before surgery :

Most often after a sports accident the patient presents a painful and swollen knee. After a first phase of immobilization in a splint, the diagnosis of cruciate ligament rupture is confirmed by examining the knee, TDM or MRI (the cruciate ligament is invisible on simple X-ray).
To avoid an accident due to instability (knee giving away) when resuming sportive activities, the decision to proceed with surgery is made, according to the different parameters assessed by the surgeon and his patient.
A « knee that gives away » inevitably leads to a side meniscal tear which, in association with a cruciate ligament rupture can easily lead to arthritis.
A short phase of well adjusted rehabilitation over a few weeks before the operation is often profitable to get the knee ready.

The aim of this procedure is to replace the torn cruciate ligament by a tendon removed from the same knee without open surgery.
The removal of the tendon is of no consequence on the final performances of the knee joint.
The harvested tendon is :
– Either the patellar tendon located under the kneecap (the procedure is then called Kenneth-Jones type ligamentoplasty)
– Or the goose’s foot tendon (pes anserinus tendon) located in the interior side of the knee. The procedure is then called ligamentoplasty by DIDT (sample taking of 2 tendons) or by TLS (a new technique that enables to harvest just one tendon).

It is possible to resume walking with a splint within the days following the operation but supported by crutches for 3 to 6 weeks.
Rehabilitation is an important phase :
– It will start at the clinic by working on a machine that provides automatic mobilization of the knee (Kinetec ® at the Saint-Privat clinic), then will be extended at the end of stay in a rehabilitation centre or a physiotherapist during the first 45 days at a minimum
– It should be slowed down for a few months to be started again at the beginning of sportive activities, between the 4 th and 9 th month after surgery.
A sick leave of about 10 to 60 days is useful according to professional activities.

Computer assisted technology allows to set the new cruciate ligament into very precise and optimum position to recreate the initial anatomy as best as possible. This technique is still being evaluated and used in certain special conditions.