The anterior and posterior cruciate ligaments are very important as they stabilize the knee joint. Both these cruciate ligaments make the joint stable and are configured in such a way so that the knee is flexible at more than 90 degrees. The knee is one of the most complex joints in the body as it connects the femur to the tibia in the lower leg. It is also connected with the four ligaments together. The medial and lateral collateral ligaments prevent side to side motion of the femur across the tibia. The anterior and posterior cruciate ligaments (ACL & PCL) are complex ligaments.
The anterior cruciate ligament starts in the anterior aspect of the tibia in the joint space and goes up to the back of the joint space on the femur. The ACL ligament crisscrosses the PCL ligaments that starts in the posterior aspect of the tibia joint space and ends in the anterior aspect of the femur. The anterior cruciate ligament prevents the tibia from sliding forward along the femur, while the PCL prevents the tibia from sliding backward on the femur.
Both anterior cruciate ligament and posterior cruciate ligaments can be torn or sprained. These ligaments generally get injured due to rigorous sports activity but it can also be injured in accidents. Almost half of all the injuries to ACL happen at the same time with the damage to the articular cartilage. Injuries to the ligaments in the knee can be differentiated according to their severity:-
Posterior cruciate ligament tears involve the exact grades as above with ACL ligamentous injuries. One of the biggest difference between an anterior cruciate ligament and Posterior Cruciate Ligaments tears is that most Posterior Cruciate Ligaments tears are only partial tears whereas the anterior cruciate ligament tears are usually tears completely.
The doctor evaluates the injury by checking for knee instability and comparing it with the uninjured knee. In PCL injuries, the knee generally sags backward when they are bent. The injured knee can also slide further back when the knee is bent greater than a 90-degree angle. X-rays do not show the actual ligament but it shows the ligament that has a torn off piece of the bone at the time of the injury. Doctors perform MRI to analyze the exact condition. MRI is usually the best way to assess the ligamentous injury in the knee joint. MRI uses radio waves and a strong magnet to visualize bones and soft tissue.
Anterior Cruciate Ligament Injury
The best treatment for anterior cruciate ligament tear varies from patient to patient. The treatment of ACL injuries can be nonsurgical or surgical. The torn anterior cruciate ligament does not heal on its own and needs surgery. People with a low activity level or are elderly people can tolerate having their anterior cruciate ligament torn if they don’t want to be active and if their joint is basically stable. The orthopedic surgeons may recommend wearing a knee brace to enhance the stability of the knee. Crutches or walker can also be recommended to limit the amount of weight bearing on the affected leg.
Surgery is the most common treatment for cruciate ligament injuries. Anterior cruciate ligament can’t simply be stitched together. Usually, the surgeon uses a tissue graft on the ligament that acts as a scaffold for the new ligament so that they grow back on it. The grafts used in the surgery can be taken from the patellar tendon, hamstring tendon or from donor tissue. The entire surgical procedure is done arthroscopically. The arthroscopic approach is a less invasive procedure which involves less loss of blood, less disturbance to other tissues and faster recovery.
Posterior Cruciate Ligament Injury
Many posterior cruciate ligament injuries heal without surgery. The injury can be treated with ice, compression, rest and elevation. Orthopedic surgeons may recommend a knee immobilizer to prevent the movement of the knee. Patients are also advised to use Crutches or a walker to prevent putting too much weight on the affected knee.
Surgery is recommended in case of multiple injuries inside the knee. The surgery is performed with an arthroscopic approach which involves less incision, less loss of blood and faster recovery. Orthopedic surgeon makes small incisions around the knees and uses sterile saline solution to pump in the knee to see the structures more clearly. Surgical drills are inserted through the small incisions to drill small holes into the upper and lower leg bones where the bones come closer at the knee joint. The holes are further used for grafting procedures. Patellar tendon autograft, hamstring autograft, and allografts are the types of grafts used in the surgery. The type of graft used depends on the patient’s condition.
Treatment for cruciate ligament injuries can be very expensive in western countries whereas this treatment is available in India at much more affordable costs. India has a large pool of highly skilled and qualified orthopedic surgeons. Patients from different countries come to India to undergo orthopedic surgeries due to the huge success rate of orthopedic surgeries that are performed in India. Availability of world-class medical treatments at affordable costs has given rise to many medical tourism companies in India. There is medical tourism company in India but Travcure has one of the largest networks of associated orthopedic surgeons and top healthcare facilities in India.