The Joint Capsule Is the Primary Factor Responsible of the Joint Instability

The joint capsule is the primary factor responsible of the joint instability.

Carmen G. Sacristán. M.D. and Paloma Gutiérrez Sacristán M.D.

Centro Médico Leonor Sacristán. Julián Berrendero 12. San Agustín del Guadalix. 28750 Madrid. Spain. Phone/Fax 0034 918419627 email

BACKGROUND: Up to the moment the treatment of total injury of the anterior cruciate ligament (ACL) isn´t solved. . The decision to reconstruct or nonsurgery the ACL isn´t the only problem, in point of fact the problem is the aftermath. Many reports shows how osteoarthritis appears whether the patientis operatedor not, a ligament injury will initiate osteoarthritis, and current treatment options are unable to stop progression. Why is not considered the joint capsule? The connective tissue is the solution.

METHODS: Thirty patients: twenty-seven with total tear ACLand three with partial tear ACL; twenty with associated as tear meniscus, postero-lateral capsule tear and Segond fracture and ten patients without associated injuries.

The connective tissue treatment is carried out with the Aponeurologic Surgery, it is a non-invasive tecnique of connective tissue, itis a techniquewe use inour clinicfor fourteenyears. Patients are treated twice a week for the first two months and once a week during the following two months, treating the connective tissue of the capsule, the anatomic ACL insertion sites and the expansions of the aponeurotic joints, that are fixed in the joint capsule and the synovia.

At the beginning,the first patients used a knee brace that limited the flexion and extension from 30º to 80º, later we don´t use a knee brace. Four months after the injury a MRI is carried out in which the ACL is observed in all its length.

Patients areevaluatedby clinical examination,MRI andarthometer KT 2000

RESULTS: Five months after the injury the patients can continue normally with their sport activity. The ACL is restituted. The knee is stable again without the usual postsurgical consequences.

CONCLUSSIONS:Although it may be possible to restore stability to the knee in one plane using current reconstruction procedures, this is not the case when considering all planes of motion. The ACL doesn´t stabilize all planes.

The joint capsule distributes loads in allplanes . Connectivetissueshould be treated independentlywhetherwe opt for areconstructive surgerytreatmentas ifwe do forthe conservative.

We have proved that the tissue of the ACL has been restituted without reconstructive surgery, carrying out the connective tissue treatment .

The Aponeurologic Surgery technique opens a new perspective on the understanding and treatment of ACL injury. This treatment avoids surgery’s complications and the conventional nonsurgicalconsequences.