The anterior cruciate ligament ( ACL ) is one of a pair of cruciate ligaments (the other is the posterior cruciate ligament) in the human knee. Both ligaments are also called cruciform ligaments because they are arranged in crossed formations. In a four-legged four-legged joint (analogous to the knee), based on its anatomical position, it is also referred to as cranial ligament of the skull . The anterior cruciate ligament is one of the four major knee ligaments, giving 85% of the holding strength to anterior tibial displacement at 30 degrees and 90 degrees of flexion of the knee.
Video Anterior cruciate ligament
Structure
ACL comes from deep within the distal femur notch. Its proximate fibers spread along the medial wall of the lateral femoral condyle. There are two ACL bundles: anteromedial and posterolateral, named after where the bundle is inserted into the tibia plateau. (The tibia plateau is an important weight-bearing area in the upper extremity of the tibia). The ACL attaches itself to the tibia interondyloid eminence, where it mixes with the anterior horn of the meniscus anterior.
Maps Anterior cruciate ligament
Destination
This attachment allows the ACL to withstand the anterior translation and medial rotation of the tibia, in relation to the femur.
Clinical interests
Injuries
ACL tears are one of the most common knee injuries, with more than 100,000 tears occurring each year in the US. Most ACL tears are the result of a non-contact mechanism such as a sudden change in the direction that causes the knee to rotate inward. When the knee spins inward, additional strain is placed on the ACL, because the femur and tibia, which are the two bones that articulate together form the knee joint, move in opposite directions causing the ACL to tear. Most athletes will require a reconstruction operation on the ACL, where a torn or broken ACL is completely removed and replaced with a piece of tendon or ligament tissue from the patient (autograft) or from the donor (allograft). Conservative treatment has poor results on ACL injuries because ACLs can not form fibrous clots because they receive most of the nutrients from synovial fluid that cleans reparative cells making it difficult for new fibrous tissue to form. The two most common sources for tissue are the patella ligament and hamstring tendon. Patella ligaments are often used, because the bone plugs at each end of the transplant are extracted which helps integrate the grafts into the bone tunnel, during reconstruction. This operation is artroscopic, which means that small cameras are inserted through small surgical pieces. The camera sends a video to a large monitor so that the surgeon can see the damage to the ligaments. If an autograft occurs, the surgeon will make larger chunks to get the required tissue. If an allograft occurs, in which the material is donated, it is not necessary because no tissue is taken directly from the patient's own body. The surgeon will drill a hole that forms a tunnel of tibial bone and femoral bone tunnel, enabling the new patient ACL graft to be guided. After the graft is pulled through the bone tunnel, two screws are placed into the tunnel of the tibial and femoral bones. Recovery time ranges from one to two years or more, depending on whether the patient chooses autograft or allograft. A week or so after an injury, an athlete is usually fooled by the fact that he is walking normally and does not feel much pain. This is dangerous because some athletes start continuing some of their activities such as jogging which, with the wrong movements or rounds, can damage the bones because the corruption has not been fully integrated into the bone tunnel. It is important for injured athletes to understand the significance of each ACL injury step to avoid complications and ensure proper recovery.
Treatment without ACL operation
ACLs can be treated without surgery with reinforcement and rehabilitation when the ACL is not completely torn and the knee is still stable or if the patient does not engage in activities requiring cutting and pivot or similar action. The mainstay of non-operative ACL treatment is the strengthening of the muscles around the knee, especially the hamstrings. Focused therapy that is supervised by a physical therapist can be an effective way to achieve this.
Anterior cranial ligament surgery is a complex operation requiring expertise in orthopedic and sports medicine. Many factors to consider when discussing operations include the level of competition for athletes, age, previous knee injuries, other sustained injuries, foot alignment and the choice of corruption. Sometimes, the stimulation of the body's natural ability to heal the original ligament, called the "healing response", is unreliable. More generally, the ligaments should be replaced by grafts from the tissue or tissue of patients themselves from corpses. The choice of graft can be confusing, requiring expert counseling from a doctor.
Rehabilitation is essential for any ACL operation; complete recovery and return to sports or other activities usually takes six to nine months. ACL surgical revision will take nine months to more than a year. During this time, the physical therapist should guide the patient through the rehabilitation process. Early rehabilitation, usually lasting about six weeks, focuses on maintaining full knee motion and preventing scarring. Rehabilitation of the second phase is directed to regain the strength of the knee. Finally, special rehabilitation activities are given. Rehabilitation programs may also consist of aggressive movements and weight-bearing exercises.
If doctors recommend surgery for ACLs, he may prescribe prehab before surgery, as many studies have shown that encouraging good movement before surgery will benefit patients during recovery.
A review of the Los Angeles Times 2010 of two medical studies discusses whether ACL reconstruction is recommended. One study found that children under the age of 14 who had ACL reconstruction fared better after early surgery than those who underwent delayed surgery. But for adults aged 18 to 35, patients undergoing early surgery followed by rehabilitation fared no better than those undergoing rehabilitation and subsequent surgery.
The first report focuses on children and ACL reconstruction time. ACL injury in children is a challenge because children have open growth plates at the bottom of the thighbone or thigh and at the top of the tibia or shinbone. ACL reconstruction will typically traverse the growth plate, causing theoretical risk of injury to the growth plate, short leg growth or causing the foot to grow at an unusual angle.
The second study is recorded in section L.A. Times that focus on adults. There were no statistically significant differences in performance and pain outcomes for patients receiving initial ACL reconstruction vs those receiving physical therapy with options for later surgery. This will show that many patients without instability, bending or giving way after a rehabilitation program can be managed non-operatively. However, this study demonstrates the need for more extensive research, limited to outcomes after two years and excludes patients who are serious athletes. Patients involved in sports require rapid cutback, rotation, twisting, or rapid acceleration or rapid deceleration may not participate in these activities without ACL reconstruction. This randomized control study was originally published in the New England Journal of Medicine.
ACL Injury in Women
Women have been known to suffer more frequent ACL injuries than men because of their ACL anatomical differences compared with men. Current research links this finding with several factors that are still being studied. The synovial joint through which the anterior cruciate ligament passes, along with the anterior cruciate ligament length, is significantly smaller in women than in men. This makes it more susceptible to damage because ACLs are exposed to higher levels of tension compared to men. Along with these aspects, women tend to use their quadriceps muscles more often than their hamstring muscles which puts additional strain on the ACL. In addition, quadriceps angles, or Q-angles, between the superior anterior iliac spine and the patellar ligament may favor the predisposition of ACL tears, as women often have wider hips than males. There is some evidence to suggest because women are known to have a larger Q-angle than their male counterparts, causing their knees to be bent inward so that they are more susceptible to ACL tears. [7]
Additional images
See also
- Reconstruction of anterior cranial ligaments
- Test the external drawer
- Anterolateral ligaments
- Lateral collateral ligament
- Medial collateral ligament
- Posterior cruciate ligament
- Triads are not satisfied
References
External links
- Photo anatomy: 17: 02-0701 in SUNY Downstate Medical Center - "Extremities: Knee Joints"
- Anatomical figure: 17: 07-08 at Human Anatomy Online, SUNY Downstate Medical Center - "The superior view of the tibia."
- Anatomical figure: 17: 08-03 in Human Anatomy Online, SUNY Downstate Medical Center - "The medial and lateral view of the knee joint and cruciate ligament."
- lljoints at The Anatomy Lesson by Wesley Norman (Georgetown University) ( antkneejointopenflexed )
Source of the article : Wikipedia
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