With the increasing interest in sports in our country, the better understanding of the importance of sports for health and easier access to sports areas, there is a satisfactory increase in the number of people doing sports. However, this positive development also brings with it an increase in sports injuries. Anterior cruciate ligament injuries are also frequently encountered, especially in our country where football and basketball are popular.
The anterior cruciate ligament is a ligament located between the femur (thigh) and tibia (shin) bones in the human knee, which actually prevents the knee from slipping forward and is a It is a structure that prevents it from rotating around itself or stretching sideways. This ligament, which is thicker and harder in men, is thinner and more flexible in women.
Like other ligaments in our body, the anterior cruciate ligament can be injured and ruptured due to trauma that causes strain on its endurance capacity. Although there are many factors affecting anterior cruciate ligament injuries, the main cause is indirect trauma. Injury generally occurs in sports activities, during dance, with sudden turns, slowdowns, unbalanced landings on one leg after a single jump, or rarely, with direct blows to the knee.
Structural differences in women, general ligament flexibility is greater. Due to age and hormonal effects, anterior cruciate ligament injuries are more common in men than in men. Another factor that greatly increases the risk of injury is fatigue. As muscle fatigue increases during activity or frequently repeated sports sessions, the support provided by the thigh muscles to the knee gradually decreases and the loads on the anterior cruciate ligament increase as the knee rotates. The imbalance between the forces of the knee, calf, thigh and hip muscles is also an important risk factor for ligament injury. If the friction force between the shoes used during sports and the ground is high, the risk of injury to the ACL increases. However, shoes with special insoles can also be used to increase performance, especially in athletic branches. Wearing low-top shoes will reduce the risk. In football shoes, the screws on the edges are long and the screws in the middle are short, which can increase torsional pressure. Although initial studies have shown a positive contribution to injury prevention. Although they reported that they were safe, further research has shown that knee braces or braces have no scientific contribution to preventing ACL injuries.
ACL injuries are more common on bad ground. Although the increase in shoe-surface friction force on artificial surfaces contributes positively to performance, it leads to an increase in ACL injuries. It is reported that more ACL injuries occur in competitions held in outdoor sports under extremely rainy and humid weather conditions. However, along with the ground, the shoes worn are also important. Therefore, lightly watered dry surfaces are thought to carry the least risk.
ACL injuries are encountered more frequently during competitions than during training.
The type of sport performed is also a risk factor for the risk of ACL injury. Football, basketball, volleyball, handball, American football, gymnastics and skiing are sports that pose a higher risk of ACL injury for athletes. In general, it is possible to say that ACL injuries occur due to abnormal loading of the knee. These injuries most commonly occur when landing on the ground after jumping, sudden changes in direction, and sudden deceleration. It has been shown that excessive load is placed on the knee in the anterior-posterior and internal-external directions after sudden, unexpected decelerations and turns. It has also been suggested that poor trunk control and lateral movement of the trunk are effective on the mechanism of ACL injury.
The most effective and important step in preventing ACL injuries is to perform correct and adequate warm-up and stretching exercises before sports activity. In this way, the flexibility of the ligament increases and the risk of rupture under sudden loads is reduced. For professional athletes, there are special training programs to prevent ligament injuries, to increase agility, the strength of certain muscle groups and whole body control, and to teach "correct falling". The knee of a patient who suffers an injury swells within minutes and the patient has difficulty stepping on that knee. Unable to continue activity. The most appropriate intervention after the injury is to apply cold to the knee and It is best to consult an orthopedic specialist as soon as possible.
ACL injury can be easily detected through physical examination and appropriate tests. An MRI of the knee that suspects an ACL injury during physical examination reveals the ACL injury and any accompanying injuries such as meniscus tear, internal-external collateral ligament injuries, posterior cruciate ligament injury and/or cartilage damage.
According to the injuries detected, the patient By recommending a suitable knee brace, the strength of the knee is temporarily supported and ice application is continued. If the anterior cruciate ligament tear is left alone, the probability of healing is very low. A dysfunctional ACL means a patient whose knee constantly rotates, who cannot jump or run, whose knee joint calcifies rapidly over time, who experiences frequent knee pain, and who can never rely on his knee. For this reason, the treatment of ACL injury in patients who do active sports, are young, and have an active working life is surgery.
Although there are many methods defined for anterior cruciate ligament tear surgery, all of the methods somehow lead to the creation of a "new anterior cruciate ligament" for the patient. is based on. In creating the new ligament, muscle tendons (tendons) taken from the patient's own knee can be used, as well as ready-made implants. It is placed so that it adheres to the bone. During the same surgery, other injuries within the knee (meniscus tear, lateral ligament damage, cartilage injury, etc.) can also be detected and necessary interventions can be made. Post-operatively, certain exercises are started immediately and the patient is discharged after being monitored in the hospital for another 1-2 days. . After discharge, the patient can walk using a pair of crutches and bearing weight on the operated side, unless his doctor warns him otherwise. After the surgery, the physiotherapy process begins in order to bring the knee to its previous level of function. The content and duration of physiotherapy and the timing of return to active sports are determined by the Physical Medicine and Rehabilitation specialist doctor and the Orthopedic Specialist who performed the surgery. Sports of active young patients who do sports at amateur level Although it takes up to a year for professional athletes to return to normal training, it is possible for professional athletes to start regular training after 6-8 months. By strengthening the muscles around the knee with appropriate physiotherapy, taking into account occupational and sports performance needs, you can have a knee that is reliable and does not rotate constantly in low physical performance. However, if the patient is young, wants to do active sports or works physically for his profession, at the first serious strain, the partial tear will turn into a full tear and the patient will need surgery. For this reason, surgery will be the appropriate treatment option in cases of partial ACL rupture in young, physically active patients who do/want to do sports in order to prevent loss of time measured in months and years.
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