Submitted by: Larry J. Reaves

Children under 15 years constitute a special group with regard to ACL injuries. Previously it was expected that they would not be operated on until they were grown. Now it has been more commonplace to have a quick surgery to avoid early osteoarthritis developments.

Surgery for ACL injury in most places is performed ambulant. This means that the patient goes without food in the morning and can eat later on the same day. One must go without food either under general anesthesia or a spinal anesthetic. In connection with the operation the doctor will do an arthroscopic examination of the knee to see if there were other injuries that may be repaired at the same time. The doctor will then select one or more of the leg’s own tendons and use them to create a new ACL ligament with. Which tendons will be used can be different from place to place. The tendons are then put into the knee joint by drilling channels so that the end result will resemble the original wrappers.

Depending on the tendons that are chosen, they can be fixed solid in different ways. It’s not possible to say that one type of surgery is better than the other. The patient can start up walking again on the day after surgery, but it relieves the leg to use crutches the first time. In the first week the patient should not go about too much, to reduce swelling of the knee. Then the patient must train for at least three months. Cycling and swimming (front crawl), can usually be resumed after six weeks. Races can often be started after about three months if the knee does not give out. Other lighter sports may only be resumed after about six months. More stressful sports like handball or football may only be resumed after 9 to 12 months. But it cannot be expected that the knee will have quite the same strength or stability as before.

Cartilage damage in the knee can be caused by wear, or due to a sudden overload of cartilage. We will here only look at the sudden damage. Cartilage injuries can occur concurrently with other injuries in the knee, such as meniscal or ligament damage. The injury usually occurs with a higher load on the knee in one or another degree of bent knees. It can also occur, for example, from jumping onto the (over-) stretched knees. One can thus damage the cartilage and possibly also the underlying bone. In some situations, a small area of cartilage is pressed down, but sits in place. At other times, a piece of cartilage is turned aside completely, together with a small piece of the underlying bone. If you hit a piece of cartilage or bone loose, this can “swim” in the knee and is sometimes called a “mouse”.

Some people with age get some small extensions of cartilage or bone on the edge of the joint. One such piece can break off and become a mouse. A mouse can also occur without having had an actual injury. It can form some small debris that is loose in the knee.

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