Ruptura del ligamento cruzado de la rodilla: ¿cuándo se debe operar?

Ruptura ligamento cruzado en la rodilla

Una ruptura del ligamento cruzado a menudo ocurre cuando una persona desentrenada se esfuerza repentinamente las rodillas. Si es necesaria la fisioterapia, ¿qué pasa con la operación?. Porque si la cirugía puede reparar el daño, no siempre es necesaria

Primero, una pequeña lección de anatomía. “La función del ligamento cruzado es estabilizar la rodilla cuando se hace un cambio repentino de dirección”, dice el Dr. Elias Dagher. Aparte de este tipo de movimiento, no tiene sentido, y se puede vivir sin él muy bien. “Como resultado, la cirugía se discute caso por caso, de acuerdo a diferentes criterios, incluyendo la edad y lo que usted quiere hacer con su rodilla.

La edad y condición del paciente, dos criterios principales

“Cuanto más joven sea, más recomendable será la operación, ya que existe un alto riesgo de volver a dañar su rodilla”, dice el Dr. Jean-Étienne Perraudin. Y ahora la operación también se realiza en niños. Por otro lado, la cirugía no es necesariamente la solución para los pacientes mayores de 60 años.

“En cambio, se les ofrece rehabilitación y, en algunas situaciones (por ejemplo, caminatas en terrenos accidentados), el uso de una férula adecuada”, dice el Dr. Perraudin. Para los pacientes de mediana edad, “la actividad física y profesional es un criterio de decisión importante.

Si el paciente desea reanudar un deporte fundamental (esquí, fútbol, balonmano, tenis…), se recomienda la operación. También lo es si utiliza la rodilla en su actividad profesional o si la inestabilidad de la rodilla es una fuente de riesgo (personas que trabajan en altura, por ejemplo)”, dice el Dr. Dagher.

Una operación cada vez menos pesada

Un ligamento roto no puede ser reparado, debe ser reemplazado por un injerto tomado del propio paciente. Para ello, se recupera un trozo de tendón del muslo y se introduce en la rodilla a través de pequeñas incisiones.

Para arreglarlo, dos escuelas chocan. “La técnica convencional consiste en cavar dos túneles completos, uno en el fémur y otro en la tibia”, explica el Dr. Perraudin. El injerto se pasa a través de estos dos túneles y se fija en los extremos con tornillos. “Pero, dice la Dra. Dagher, “no tenemos que hacer un túnel completo. Podemos hacer un cubículo para atar el ligamento.

Esta técnica, que apareció hace unos ocho años, afecta actualmente al 10% de los pacientes. El Dr. Dagher considera que “reduce la duración de la operación, lo que limita la inflamación, el dolor y, por tanto, el tiempo de recuperación”.

Esto es discutido por el Dr. Perraudin, quien añade que “es más complejo de lograr, y por lo tanto una fuente de heterogeneidad de un paciente a otro”. Sin embargo, ambos coinciden en que la operación (que ahora se realiza de forma ambulatoria en la mayoría de los equipos) y sus consecuencias son menos graves que hace diez o quince años.

¿Pueden prevenirse estos accidentes?

“La ruptura del ligamento cruzado ocurre a menudo cuando una persona que no ha practicado deportes durante todo el año se esfuerza repentinamente las rodillas”, advierte el Dr. Perraudin. Por eso es necesario que prepares tus músculos, por ejemplo, andando en bicicleta o nadando. Y empezar sin problemas.

También se debe prestar especial atención a las fijaciones de esquís. Uno de cada dos esguinces es el resultado de un ajuste incorrecto. Su flexibilidad debe adaptarse al nivel y al peso del esquiador. Para mayor seguridad, es mejor utilizar profesionales.

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