Pain after an accident

A cruciate ligament rupture usually occurs in connection with an accident. The direct symptoms after an accident resulting in a torn cruciate ligament are mainly dominated by severe pain.The pain that develops after the accident can be explained by the processes in the knee following the tear of the posterior cruciate ligament. The accident causes a bloody effusion into the joint capsule and creates a certain pressure on the capsule.

The capsule is supplied with nerves which register the stretching and cause the pain. A reduction of the effusion after the accident can therefore help to reduce the pain. Which therapeutic measure is taken depends on various factors: If a young patient who is active in competitive sports and who is also exposed to a high level of physical stress in the course of his job is suffering from a posterior cruciate ligament rupture without any accompanying injuries, surgical therapy is most likely to be successful.

However, the individual injury must always be in harmony with the various therapeutic measures. Within the scope of the operative therapy measures, cruciate ligament plastic surgery is the first priority. Such an operation is usually not performed directly.

Too high is the risk of joint scarring due to the insertion of the body’s own tendon during the operation, which would possibly lead to movement restrictions. A body-own tendon is characterized by the fact that the lost hold of the joint can almost be restored with it. The “old” properties and its functions are intended to mimic the ideal condition almost as closely as possible to nature.

The body’s own tendons therefore offer the possibility of anatomical reconstruction in a special way. These “ideal properties are not fulfilled by every body-own tendon. Within the scope of cruciate ligament plastics, the patellar tendon (= patellar tendon), as well as the tendons of the Musclus semitendinosus and Musculus gracilis (= hamstring) have proven themselves.

The age of the patient
The activity of the patient, including especially sports activities
The burden within the framework of the profession
The possible presence of concomitant injuries (meniscus rupture)
If a young patient who is active in competitive sports and who is also exposed to a high level of physical stress in the course of his job is found to have a posterior cruciate ligament rupture without any accompanying injuries, surgical therapy is most likely to be the most appropriate treatment. However, the individual injury must always be in harmony with the various therapeutic measures. Within the scope of the operative therapy measures, cruciate ligament plastic surgery is the first priority.
Such an operation is usually not performed directly. Too high is the risk of joint scarring due to the insertion of the body’s own tendon during the operation, which would possibly lead to movement restrictions. A body-own tendon is characterized by the fact that the lost hold of the joint can almost be restored with it.

The “old” properties and its functions are intended to mimic the ideal condition almost as closely as possible to nature. The body’s own tendons therefore offer the possibility of anatomical reconstruction in a special way.
The patellar tendon:Many people are probably familiar with the patellar tendon reflex. This is the reflex that can be triggered by a light blow with a reflex hammer and can elicit a reflex response.
If you want to use the patellar tendon as cruciate ligament plastic, you do not remove the entire patellar tendon. For a cruciate ligament plastic, it is sufficient to remove a 1 cm wide piece of this tendon. However, it is important that a block of bone adheres to both ends.

These bone blocks are fixed in the drill channels by means of so-called interference screws, which consist of either titanium or sugar (= carbon compounds). The graft is inserted arthroscopically, in the form of a knee joint endoscopy. The bone blocks of the patellar tendon usually grow in within 4-6 weeks.
The semitendinosus or gracilis tendon This is a tendon of the thigh.
In order to use it as a cruciate ligament plastic, it is removed as close as possible to the knee joint through a small incision on the inner thigh (on the inner tibial plateau). After the removal, a quadruple graft, also called a quadruple hamstring graft, is made from it by double placement. The doubling is necessary to produce a corresponding tear resistance.

This graft can also be made from another femoral tendon, the gracilis tendon. In some cases, the gracilis tendon can be removed in addition to the semitendinosus tendon. In such cases the transplant will then be taken eight times.The advantages of semitendinosus and gracilis grafts are the lower rate of complications, less pain after the removal of the tendons and only a small, cosmetically favorable skin scar. A disadvantage is the slower healing of the tendons into the bone channels compared to the patellar tendon. In contrast to the patellar tendon with its bone blocks, the semitendinosus and gracilis tendon only grow into the bone channels after about 10-12 weeks.