Anterior cruciate ligament: the best options for its rupture.
What is the "anterior cruciate ligament"?
The anterior cruciate ligament is one of the elements of the knee that suffer more ruptures and the numbers go up when we see the statistics of the athletes. This injury happens when the knee suffers a twist where the waist is not aligned with the affected leg, it usually happens in several sports (judo, wrestling, football, karate, skiing) but it is also of an unpredictable nature, since accidentally placing the foot into a hole can have a bad shock and produce a ligament rupture. There are two types of ruptures, complete and partial, in the first one all the fibers of the ligament suffers a total break and in the second it suffers a small rupture but still maintaining its structure, it is as if a cable was a bit broken but still fulfills its function halfway. Well, with the ligament it happens very similar fulfilling its mission to stabilize the knee but halfway.
What to do if you have the anterior cruciate ligament broken?
The answer is very subjective I personally recommend surgical options, since in this way, athletes can return to their usual practice, by retaking the previous levels of training they had, without damaging the knee in the long term. Surgical options vary in a wide range of techniques, but in order to understand and know the purpose of the surgery, we will talk a little bit about that. The surgery, although it chooses a specific technique, always consists of constructing or reconstructing a new ligament since it will not regenerate.
What is used for the reconstruction of the anterior cruciate ligament?
For this case of the rupture of the ligament, three types of grafts are used to replace the old ligament, each one with its own advantages and disadvantages.
Allografts are grafts taken from an external entity and are almost always grafts taken from corpses, but this option has a number of complications since this graft has to go through several tests to know that it is not contaminated with any disease and in a certain way the body may reject this new graft,but within the advantages we can find that the recovery time after the surgery is much less than the recovery time of other grafts.
The autografts as the name says, are grafts taken from the same patient or injured but the type of autograft can vary and have characteristics that make them unique.
I would like to start with the autograft better known as Bone-patellar tendon-bone (BTB) this is how it's called the ligament replacement technique that removes the patellar tendon graft where the ends of the graft will be composed of bone. This type of graft is one of the most practiced by the traumatology community and is recommended to athletes for its hardness and flexibility and low rate of re-ruptures, although as a disadvantage the donor area is left weakened and may suffer injuries, according to some investigations.
Another method that is used is the replacement of the broken ligament by the hamstring muscles that are in the anterior part of the leg. This technique is increasingly used, it has very good hardness (more than BTB), but the disadvantage is that when extracting from the hamstring muscles the person also loses aroundf 10 and 15% of strength of flexibility,
since hamstrings are responsible of this strength, when a portion is extracted this way, they lost part of the strength they had before, although some studies have verified that the muscles are regenerated 6 years after the surgery. This technique is not recommended for athletes.
Finally there are prostheses of syntactic or artificial ligament and we can see a large market and many brands but according to several studies the most recommended is the LARS (Ligament Augmentation Reconstruction System). This is a synthetic ligament whose mission is to imitate the old ligament through its new material of polyethylene terephthalate, the advantages of this novel technique is that it does not affect any other part of the body since nothing is extracted.The recovery time after surgery is shorter. The complications may be that sometimes the body rejects the material and this leads to various difficulties.
