The 2022 World Cup in Qatar is in full swing, in the first round of Group D group matches in the early hours of November 24, defending champion France 4-1 victory over Australia, but unfortunately, only 11 minutes after the start of the game, France’s main defender Lucas Hernandez withdrew from the game due to injuries, and was confirmed to be a “rupture of the cruciate ligament of the right knee after the game! “and had to withdraw from this World Cup journey.
Lucas Hernandez on the ground with an injury
The cruciate ligament, also known as the cruciate knee ligament, is located in the center of the knee joint and is very tough, lined by synovial membrane, and can be divided into the anterior and posterior two ligaments, the two ligaments synergistically can limit the excessive movement of the knee joint, of which the anterior cruciate ligament is abbreviated as ACL.
Soccer and basketball are the most demanding sports for the ACL, and also the most likely to cause ACL injury. Many soccer stars in the world have suffered the pain of ACL rupture during the game, such as foreign Ronaldo (Brazil), Piero (Italy), James. Owen (England), Dessler (Germany), Diego Costa (Spain), Falcao (Colombia) and domestic Sun Jihai, Wang Yongper, Yu Hai, Shao Jiayi and so on.
The role of the anterior cruciate ligament
Role of the anterior cruciate ligament
In the early days of ACL ruptures, the treatment was direct repair, but the failure rate was high. Nowadays, the surgical treatment is no longer “repair” but “reconstruction”. Clinically, early reconstruction of the anterior cruciate ligament (ACL) is advocated to restore the stability of the knee joint, and the most commonly used graft materials include autologous tendons, allograft tendons, and artificial ligaments. In recent years, the recent excellent results of the LARS artificial ligament have been emphasized by the field of arthroscopy and orthopedic sports medicine, and many ball players have used the LARS artificial ligament to reconstruct the ACL.
C-Arm in ACL Reconstruction with LARS Artificial Ligament
While the arthroscope is a key piece of equipment in ACL reconstruction, hence the term “arthroscopic ACL reconstruction”, the C-arm X-ray machine can also be used to assist in the LARS ACL reconstruction.
In this procedure, the femoral and tibial stops of the ACL are found and the tibial and femoral channels are created. In order to prevent the extrusion screw from dislodging, intraoperative care should be taken not to extrude the screw too deeply, which can be done by fluoroscopy under the c-arm machine while extruding to ensure that its caudal end is in the lateral cortex of the bone, so as to effectively avoid extruding the screw too deeply. Once the caudal end is found to enter the medullary cavity, patients should be informed that they cannot exercise in the early stage and start forging 3 weeks after the operation to avoid leading to ligament laxity after reconstruction, poor surgical effect, and screw backwardness leading to laxity of the nail channel and fixation failure.
The paper “Observation on the efficacy of arthroscopy combined with treatment of anterior cruciate ligament rupture of the knee with LARS artificial ligament under c-arm machine” published in Shandong Medicine in 2013 concluded through the postoperative observation of 46 patients with complete rupture of the ACL that “arthroscopy combined with reconstruction of the ACL with LARS artificial ligament under c-arm machine can effectively restore the knee joint’s stability, accurately determines the reconstructed position, and autogenous ligament growth along the LARS artificial ligament was seen at 12-month postoperative MRI follow-up.”
Shown above is the first flat-panel 3D C-arm PLX7500A in China, which is developed and manufactured by Perlove Medical. The C-arm is equipped with a large-size 30cm*30cm dynamic flat-panel detector with 154μm pixel size, which makes the image delicate and clear, and the highest 16-bit gray scale degree also allows the implant contour to show a high dynamic range display.
