One of the most common reasons to have an arthroscopy done is for exploratory reasons
One of the most common reasons to have an arthroscopy done is for exploratory reasons. Doctors will typically use the scope to view the inside of the knee when they suspect the is a tear in the ACL, the PCL or to do a Lateral release of the knee. One reason is for an anterior cruciate ligament (ACL) tear. The leg forms at from three bones the femur the tibia and the patella. The two main bones of the leg the femur and the tibia are connected by ligaments and the patella is formed over to provide protection. There are many ligaments that hold your leg bones in place however, there are four primary ones, there are two collateral and two cruciate ligaments. The medial collateral ligament is found on the inner part of the kneecap or patella and the lateral collateral ligament is found on the outside of the knee cap. Both of these ligaments together control any sideways motion and give support for unusual movement. The cruciate ligaments are found inside the knee joint and cross each other to form an X. The posterior cruciate ligament is found in the back of the knee joint and the anterior one is located in the front. The main purpose for the cruciate ligament is to control the back and forth movement of the knee. The anterior cruciate ligament runs diagonally from the front to the middle of the knee and prevents the tibia from sliding in front to the femur. Also, it provides stability to the entire knee. Some of the causes for a tear in the ACL include a sudden change in direction rapidly, stopping suddenly, slowing down while running, landing or jumping incorrectly on the knee, or a direct contact or collision. There are different severities for a tear of the anterior cruciate ligament
Grade 1 sprain has mild damage with minor pain and no swelling. The tendon has been stretched, however it is still able to stabilize the knee during movement.
Grade 2 sprain has stretched the ligament to the maximum ability and the ligament is now loose. This sprain is also referred to as a partial tear.
Grade 3 sprain which is the most common type of injury to the cruciate ligament. This sprain is known as a complete or total tear, which means the ligament is in two pieces and is no longer able to support or stabilize the knee.
As stated, “Several studies have shown that female athletes have a higher incidence of ACL injury than male athletes in certain sports. It has been proposed that this is due to differences in physical conditioning, muscular strength, and neuromuscular control.” Studies have shown that is it more common for girls to tear their ACL because the difference in muscular strength compared to guys, however girls are still participating in the same sports as guys and are exposed to the same wear on their body. Generally, when the ACL is torn the immediate sign is a “popping” sound after landing wrong or turning in the wrong direction. Most injuries have swelling that will subside on their own however, with an ACL tear the swelling will continue along with bruising and the knee will be slightly immobile and will feel unstable. Once the stability feels weak it is crucial to go to the doctor because if it goes ignored it will damage the surrounding cushioning cartilage called the meniscus. Loss of range of motion of the knee is also a sign the ACL is torn, walking or bending at the knee maybe difficult. Furthermore, tenderness along the joint line and pain while walking can be felt if the ligament is torn. Generally, to be able to view the damage done to the knee an x-ray will be performed. Commonly, an x-ray is performed to rule out any broken bones or to see if there is a broken bone associated with the tear. X-ray machine will not be able to detect the damage done to the ligament only the damage done to the surrounding bone. Along with the x-ray a magnetic resonance imaging scan (MRI) will be done to view the ligament. The MRI allows better images of soft tissues which is what the ACL is made from. However, an MRI is usually not required to make the diagnosis of a torn ACL. Although, it makes it easier for the doctor to get a clear view of the tear they are able to diagnose the tear with a physical exam. There are two different ways to treat an ACL tear there is nonsurgical and surgical intervention. Nonsurgical intervention is going to be for elderly patients or anyone with a low activity level and the stability of the knee still needs to be intact. If the stability of the knee is not intact then the nonsurgical intervention is not an option. Bracing is one option which the doctor would provide a brae for the knee along with crutches to relieve for the weight off the knee. Along with bracing is physical therapy which is a selection of various exercises to restore function in the knee and strengthen the surrounding muscles. This option is helpful in aiding with pain and the ability to regain stability in the knee, however this will not fully heal the tear. The next option the heal the tear would be the surgical intervention, this option is for younger athletes who want to be able to return to playing a sport quickly. The surgery is minimally invasive with very little pain. The ACL is a very soft delicate ligament, so it won’t be able to be stitched back together, so in order to restore the stability of the knee the ligament will need to be reconstructed. the torn ligament is be removed and replaced by a tissue graft. The graft will act like a temporary structure for the new ligament to regrow on. Commonly, the graft will be taken from the patellar tendon, which is the small tendon that runs between the kneecap and shinbone. If for some reason that graft doesn’t take, then the hamstring which is located on the back of the thigh is the next option. Another option would be an allograft which is harvested from a cadaver.
