The anterior cruciate ligament is particularly important for the stability of the knee, as it prevents the dislocation of the tibia during anterior translation or external rotation forces.
The anterior cruciate ligament can be torn by rotational injuries with the knee slightly flexed, as well as by a violent hyperextension or hyperflexion of the knee.
The tear is often accompanied by meniscus and/or lateral ligament injuries.
The clinical symptoms include pain, edema (hemarthrosis), stiffness or a feeling of instability. Extended knee instability may cause additional problems to the menisci and the articular cartilage. Some claim that a non-repaired anterior cruciate ligament tear is the beginning of the end for the knee.
The treatment of choice is arthroscopic repair (using a camera and special microscopic tools through 2-3 very small incisions, 5-7 mm each, and a small incision to harvest the graft).
There are different options in terms of selecting a graft:
- Hamstring tendon graft
Widely used in most of the hospitals abroad. It is advantageous mostly because of the very small incision required for the harvest and the fact that there is no postoperative pain and little to none donor site morbidity.
- Patellar tendon graft
Theoretically it has the best integration, but it involves large incisions, postoperative pain and potential donor site morbidity.
- Donor graft (heterologous / cadaveric)
These types of grafts are gaining ground both in the US and in Europe. Their advantage is the painless postoperative course and the lack of donor site morbidity.