Anterior Cruciate Ligament Injury. Treatment in Germany
Best hospitals and doctors for anterior cruciate ligament injury treatment in Germany
Leading hospitals
Cost for treatment
Anterior cruciate ligament (ACL) injury occurs mainly in young people who play sports. The second most common injury cause is the professional training of military personnel. Most often, anterior cruciate ligament injury occurs in men aged 19-25 years. You can undergo treatment for ACL injury in Germany. This country uses minimally invasive arthroscopic surgery. Doctors use modern options for surgical interventions that provide a complete restoration of the biomechanics of the knee, without residual instability, without stiffness, with a minimum rehabilitation period, and a low risk of recurrence of the injury or degenerative changes in the knee. German surgeons have a high reputation, so athletes from all over the world undergo treatment in Germany.
Content
- Terms of treatment
- Principles of surgical treatment
- Materials for ACL plastic repair
- Types of surgical interventions
- Rehabilitation
- Why is it worth undergoing treatment in Germany?
Terms of treatment
To prevent anterior cruciate ligament injury from becoming chronic, it is necessary to perform surgical treatment no later than 3-6 months after the tear. In this case, the damage to the menisci, hyaline cartilage, as well as the capsular and ligamentous apparatus of the knee will be minimal.
The functional viability of the anterior cruciate ligament is very important, because in case it is violated, the biomechanics of the knee joint worsens, and protection from stress effects on the knee decreases. The result is the early development of gonarthrosis: the cartilage in the knee is destroyed, and the person has to implant an artificial joint.
However, with timely treatment, knee function can be fully restored. A person can return to maximum sports loads in a few months. German surgeons provide low-traumatic and reliable treatment, so most patients will not need repeated (revision) ACL surgery in the future.
Principles of surgical treatment
There are two approaches to disease treatment, one of which dominates. The ligament can be repaired or the anterior cruciate ligament can be reconstructed with the autologous, donor, or synthetic materials. In recent years, repair has been extremely rare since only a few injuries are suitable for suturing the patient's ligament. Most patients undergo anterior cruciate ligament reconstruction.
In the case of ACL injury, reconstruction remains the major surgical intervention. Physicians must fully recreate the ACL, providing an anatomical reconstruction for full knee function. To perform it, the orthopedist needs to choose the right sites for the graft attachment and provide the necessary degree of tension in different positions of the joint. With this approach, a person will have no residual knee instability or stiffness after anterior cruciate ligament injury treatment.
In addition, some hospitals perform hybrid surgical interventions. They combine reconstruction with the repair. Such interventions are possible with partial tears. In this case, the doctor creates the new ACL but strengthens it with the fibers of the patient's ligament.
In developed countries, almost all operations for the anterior cruciate ligament injury are performed using a minimally invasive arthroscopic method. Such surgery is performed through short incisions in the knee area. The doctor does not completely open the joint and minimally injures the tissues, creating good conditions for early rehabilitation.
Materials for ACL plastic repair
More than 250 surgical treatment methods for anterior cruciate ligament injury have been described. Its reconstruction usually involves the replacement with various materials:
- autograft;
- allograft (donor preserved tendon);
- synthetic materials.
Patellar ligament, semitendinosus tendon, gracilis tendon, or quadriceps tendon are used as the patient's tissues for reconstruction. Each option has its advantages and disadvantages: obtaining material with less trauma, higher strength, better engraftment, lower risk of complications from the donor site, etc. Therefore, in each case, the material for reconstruction is selected individually, depending on the level of the patient's activity, the requirements for a functional, aesthetic result, and the recovery timing after the anterior cruciate ligament injury.
When using the patient's tissues, an additional surgical injury is applied: the doctor has to take a tendon or ligament from the knee or other parts of the lower extremity. Nonetheless, this disadvantage is offset by the fact that the patient receives the strongest, actually native ligament, which, if the operation is performed correctly, will ensure knee stability, the possibility of any loads, and protect against secondary injuries to the cartilage and menisci.
The use of donor grafts does not require an additional incision during surgery, and there is no risk of complications from the donor site, but such tendons are less strong. They are usually implanted in patients with a low level of physical activity: those who do not play sports or do hard physical labor. So the risk of repeated anterior cruciate ligament injury is minimal.
The reconstruction involves the usage of artificial ligaments made of lavsan, polyester, and other materials. They are quite strong, and in recent years new artificial ligaments, such as LARS, have been developed that do not cause reactive synovitis (inflammation of the synovial membrane of the knee due to the presence of foreign tissue in it). To ensure the most physiological result, doctors implant two synthetic tapes. They imitate the anteromedial, and posteromedial ACL bundles.
Types of surgical interventions
The first operations for the anterior cruciate ligament injury treatment were developed in the 20th century. They suggested either suturing the ACL or reconstructing it. The first plastic surgery was performed in 1903 by F. Lange. He used the tendon of the semitendinosus muscle as a material for transplantation, but could not obtain a good functional outcome.
By the middle of the 20th century, there were many options for the surgical treatment of the anterior cruciate ligament injury, and it became more successful. In the second half of the 20th century, they began to use operations that are still being used today.
In 1969, ACL plastic surgery was performed for the first time. It was carried out with the patient's patellar ligament together with a bone block. It provided a secure fixation. The ligament remained attached to the same bone as before, but the bone itself was moved to a different location and implanted with a press-fit fixation.
At the end of the 20th century, double-fascicle ACL plastic surgery appeared. This operation was first performed in 1999. It provided better results than the single-fascicle one and remains the standard of ACL injury treatment today. Physicians implant virtually two new ligaments through two bony tunnels, providing better knee biomechanics with no residual instability.
Today, most ACL reconstruction surgeries are carried out using arthroscopic methods. Doctors no longer open the joint cavity with a large incision. This intervention is traumatic and requires a long recovery. In addition, it has a high risk of complications.
The first arthroscope appeared in the 1970s. In 1976, arthroscopic ACL plastic surgery was performed for the first time. The results were considered good. Arthroscopy continued to evolve, and over several decades, it generally replaced open surgery for ACL injuries.
The main advantages of arthroscopy are as follows:
- preserved joint membranes;
- lack of impaired blood supply and innervation;
- easier postoperative period;
- patients recover faster and spend less time in the hospital.
In the 21st century, hybrid surgery has been developed for ACL injury. If some of the fibers are retained, they are left. With this approach, patients recover faster. Here are some of the benefits of hybrid interventions:
- they create good conditions for the rapid engraftment of the transplant, so rehabilitation can be started earlier and more intense training can be used;
- preservation of the vascular network;
preservation of the mechanoreceptors, that provides the sensitivity of the knee (proprioception).
Rehabilitation
Most people with anterior cruciate ligament injury are young and physically active people. Many go in for sports, including professionally. Therefore, recovering as quickly as possible is one of the treatment goals.
Ligaments grow together for a long time. The whole engraftment occurs within 6 months. Until this time, it is undesirable to maximally load the knee because of the threat of injury recurrence. However, gradually a person restores physical fitness due to limited loads. Already 8 weeks after the surgery, they begin intensive training.
Rehabilitation after the surgical treatment of the ACL injury takes place in four periods:
- early postoperative – about 1 week;
- late postoperative – from 2 to 4 weeks, during which time surgical wounds heal;
- functional period – from 5 to 8 weeks, during this time there is a restoration of range of motion in the knee;
- training and recovery period – patients gradually return to their previous physical form and bring load level to the maximum.
Although a professional athlete has to recover for up to 6 months. Despite that, a close-to outcome result can be achieved after 4 months. From now on, you can return to sports training, but so far without extreme loads. As early as 4 weeks after the surgery, you can fully rely on the operated leg when walking. From the 6th week, the person does not feel any restrictions on daily activities and considers himself completely healthy.
Doctors in Germany use the latest programs for the patients' rehabilitation after sports injuries. Rehabilitation centers are equipped with state-of-the-art fitness equipment. The optimal mode of training loads is determined individually, based on the results achieved. The patient is regularly examined by specialists to make sure that the loads are safe.
Why is it worth undergoing treatment in Germany?
The best treatment for sports knee injuries is in Germany. Here are a few reasons why you should travel to this country to undergo ACL injury treatment:
- experienced orthopedists with high reputability in the world of sports medicine;
- minimally invasive arthroscopic surgery through short incisions;
- full restoration of the ligament with the patient's tissues or synthetic materials: it will be as strong as before injury;
- the use of anatomical ACL reconstruction options to ensure optimal knee biomechanics;
- in patients with partial tears, hybrid operations are performed with the preservation of the fibers of the patient's ACL to speed up recovery;
- minimal risk of postoperative instability or stiffness;
- full rehabilitation, providing a quick return to maximum sports loads.
To undergo treatment for the anterior cruciate ligament injury in Germany, you are welcome to use the Booking Health service. On our website, you can get up-to-date and accurate information about the cost of treatment in Germany, compare prices in different German hospitals, and book a medical care program at a favorable price. The treatment will be easier and faster for you, and the cost of treatment in Germany will be lower.
Leave your request on the Booking Health website. Our employee will contact you, consult, and answer all questions. We will take care of the organization of your trip abroad. We will provide the following benefits to you:
- We will select the best German hospital whose doctors specialize in the treatment for ACL injury in Germany and achieve the best results.
- We will help overcome the language barrier and establish communication with the doctor from the German hospital.
- Your waiting time for treatment will be reduced, and you will receive medical care on the most suitable dates.
- We will reduce the price. The cost of treatment in Germany will be lower than usual due to the lack of overpricing and coefficients for foreign patients.
- Our specialists will take care of all organizational issues: paperwork, transfer from the airport to the German hospital, and back, hotel booking, and interpreting services.
- We will prepare your documents and translate them into English or German. You do not have to repeat the previously performed diagnostic procedures.
- We will keep in touch with the German hospital after the completion of treatment.
- We will arrange additional diagnostics and treatment if required.
- We will buy medicines in another country and forward them to your native country.
While the best specialists in the world are taking care of your health, the Booking Health staff will help reduce the cost of treatment in Germany and take care of all the travel arrangements.
Authors:
The article was edited by medical experts, board certified doctors Dr. Nadezhda Ivanisova and Dr. Vadim Zhiliuk. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!
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