Cruciate - key points
Submitted by admin on March 13, 2008 - 8:24pm.
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There are a number of key points you need to understand to make sense of cruciate surgery. The cruciate ligament is a complex structure, and surgery requires a specialist. If the new ligament is poorly positioned, stiffness may result, or the new ligament may even break. A cruciate ligament is not simply like a piece of string. Take a look at this illustration which demonstrates how the fibres are attached (imagine the knee is cut vertically through the notch, and you are looking at the ACL from the side). Not only do the ends of the ligament splay out to gain a wide contact surface, but the ligament itself has a twist in it, allowing a complex mechanical action which cannot be simulated by any graft. A graft needs to be placed in a line where it acts most efficiently, no getting too slack or too tight as the knee bends and straightens - surgeons call this the 'isometric point' - and complex jigs are used to place the graft in the optimal position. |
The problem is instability, not pain
A torn ligament is not painful once the initial trauma of the injury settles. It is INSTABILITY which is the key problem. Associated pain is usually due to other structures which were damaged at the time of the injury or even secondary to the injury.
Torn PCLs get missed!
The anterior cruciate ligament (ACL) contributes more to the stability of the knee than the posterior cruciate ligament (PCL). Many PCL injuries are missed at first visit to a clinician, and even if left they contribute much vaguer symptoms than neglected ACL tears.
The PCL is more complex to repair than the ACL.
Proper rehab is critical
The cruciate ligament is subject to enormous mechanical torques, and a healing graft needs to be cared for until it strengthens up. The rehabilitation protocol is very important.
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