One of the most frequently asked questions among patients and non-patients alike is: can the anterior cruciate ligament (ACL) rupture again? Unfortunately, the answer is yes. This fear is especially well-founded in athletes, as this injury can disable them for more than six months in any of their competitions.
In some cases, rupture of the ACL is due to external trauma. However, in most cases, patients rupture it on their own, due to knee displacements following a jump or a sudden change of direction.
These gestures are common in sports practice, but when the stress exceeds the ligament’s resistance capacity, it ruptures.
The anterior cruciate ligament is essential for pivoting and pivoting movements, as it stabilises the knee in these movements. Therefore, when it ruptures, many patients experience a sensation of knee “failure”, i.e., they feel a marked instabilitywhen attempting to pivot.
When a patient suffers a rupture of the anterior cruciate ligament, it is necessary to replace or repair the structure, especially in those who play high-impact sports. In addition, this injury can lead to more serious problems, such as a meniscus tear, caused by abnormal displacement of the joint.
One of the main drawbacks of an ACL tear is that it cannot stitch or regenerate naturally. This means that the ligament does not heal on its own, so surgeons must replace it with a tendon.
For ACL reconstruction, we typically use tendons from the hamstring (back of the knee) or patellar tendon (front). There is also the option of using transplanted tendons in some specific cases.
This graft needs a minimum of six months to heal and reach a strength similar to that of the original ligament. However, some patients may take up to two years to return to “normal”.
It is essential for the patient to bear in mind that in all cases, this will be a replacement ligament, so it will never be identical to the original.
After surgery, surgeons must be very cautious and warn patients about the importance of respecting recovery times.
Attempting to shorten rehabilitation times or over-stressing the knee drastically increases the risk of re-rupture. “We can’t fight nature”, and if a reconstructed ligament ruptures again, the process becomes even more complicated.
If a reconstructed ligament re-ruptures before one year, it is considered a surgical complication. However, if the re-injury occurs after twelve months, it is a new sports or traumatic accident.
In both cases, surgeons must evaluate each factor and decide what type of graft to use in the new reconstruction. In addition, we must consider whether the procedure will be performed in a single operation or in multiple stages, which further prolongs the patient’s recovery.
ACL rupture is a serious problem, especially for athletes. Statistics indicate that 30% of patients who undergo surgery do not recover their previous sporting level. And if we are talking about a second rupture, this percentage increases significantly.
I am operating on more and more ligament replacements than original injuries. An ACL tear is a complex injury, and recovery requires patience, commitment and discipline.
However, as an orthopaedic surgeon with years of experience, improving the lives of ACL patients is a challenge that motivates me. And I am very much a challenger.
