A cruciate ligament tear is also referred to in medicine as cruciate ligament rupture. It is a crack caused by external violence. A cruciate ligament tear often occurs as a sports accident in football players or skiing. Typical signs of a cruciate ligament tear are knee pain, as well as visible bruising and swelling.

What is a cruciate ligament tear?

Schematic representation of healthy cruciate ligaments and the various forms of cruciate ligament tear. Click to enlarge.

A cruciate ligament rupture usually affects both cruciate ligaments, as they work in the knee almost like Siamese twins: the cruciate ligaments lie in the interior of the knee between the joint bones, crossed over one another. On the one hand, they stabilize the knee against the dreaded cruciate ligament rupture, while on the other, they provide lateral, three-dimensional mobility, which is important for sitting, walking and standing. Apart from the cruciate ligaments, the outer and inner ligaments on the knee are just as important, because without this fixation, the knee would fall out of its forward-facing plane, especially if the cruciate ligament ruptured, and the affected person would not be able to move.

The cruciate ligaments themselves consist of collagenous muscle fibers and are cushioned by a mucosal sac, the synovial sac, to the joint bone. They may be reinforced by other ligaments, such as the meniscofemoral ligament and the humphry ligament, but not every human being has the same characteristics. The cruciate ligaments are 18.5 to 33.5 mm long and usually formed of three fiber bundles, the front, the rear and the middle bridge.

They form the bridge between thigh and lower leg with the knee ligaments outside and inside and the connection to the front meniscal band. The combination of the ligaments on the knee prevents the overstretching of the tibia forward, as well as the overstretching to the rear. With a healthy structure, the cruciate ligaments optimally regulate the movement of the knee on all axes and the symmetrical alignment of thigh and lower leg.

causes

A cruciate ligament rupture is unfortunately relatively common, although the cruciate ligaments are protected by the crossed position particularly against heavy use. A torn ligament usually arises only by an extreme overstretching of the ligaments in one direction. The cruciate ligaments can hardly tear under normal physical stress, unless someone moves his knee in a dangling motion with considerable violence. This usually happens only in accidents and during sports.

The cruciate ligament rupture is a typical athlete injury, as it occurs most often by the high load on the knee during football and skiing. If the soccer ball starts from the side with force, so that a rotation in the forward movement arises, this can lead to overstretching of the cruciate ligaments, which leads under load or with additional slipping of the other foot on the lawn for cruciate ligament tear. In a cruciate ligament tear on the anterior cruciate ligament of the rolling sliding mechanism of the femoral head is disturbed sensitive. This causes damage to the meniscus and wear on the cartilage in the knee joint. In the flexion position of the knee, the lateral knee ligaments are relaxed and this is where most ACL tear accidents occur, as the full force of the movement is transferred unimpeded to the inner ligaments.

Slalom skiing while skiing, start in bent position as when sledding or even ice hockey can be triggers. If the knee is moved too far forward, the anterior cruciate ligament may tear, while a blow to the tibial bone may endanger the posterior cruciate ligament. Tearing both cruciate ligaments, which occurs in most cases with strong force from the movement, so the rotation of the lower leg is not limited to the rear inside. The stability of the cruciate ligaments is a prerequisite for the health of the knee joint.

Destroyed cruciate ligaments also endanger the meniscus in its healthy function. When strained, they can absorb the force of an unexpected stroke, as in football, and pass it on to the muscles. When slackening the risk of accidents is much greater, because by jerky stretching increases the risk of small fiber tears or complete tearing of the tapes.

Symptoms, complaints & signs

A cruciate ligament tear is clearly noticeable. The moment the tape breaks, a snapping or crackling noise can be heard. After that, the affected knee swells and pain sets in. The pain is described by those affected as dull to stinging, with recurrent pain peaks, during which the stinging greatly increases.

In addition to the pain, bruise develops in the joint. The hematoma usually escalates rapidly and can spread throughout the course of the joint. The bruise can occur immediately after the cruciate ligament rupture, but sometimes it is delayed or not at all. The ligament injury causes instability in the knee, which in some cases results in further symptoms and discomfort.

Typical is the feeling that thigh and lower leg wedge each other. In addition, there is a pronounced gait insecurity, often associated with a spontaneous kinking in the joint. After a few days, there is a loss of power and a distension and inhibition or pseudoblock in the knee joint. Depending on which cruciate ligament is affected, the type and severity of the symptoms can vary widely. In some cases, a cruciate ligament rupture occurs without further injury.

complications

Again and again, patients with cruciate ligament tears may experience complications and disorders after surgery. If the treatment of a cruciate ligament rupture is completely absent, instability is to be expected, since an ideal cruciate ligament would ensure a good fixation of the thigh and lower leg in the knee joint. The instability leads to an increased mobility of the knee.

As a result, possible damage to the knee, possible wear damage or further consequential damage can subsequently appear in the body. Since there is no spontaneous healing in a cruciate ligament rupture, in any case, a professional treatment in the form of surgery is recommended. If the result after an operation is unsatisfactory, it often comes to a repetition of the procedure.

The specialists divide the possible disorders after surgery into early and late complications. The early complications that occur immediately after the operation include wound healing disorders, a bacterial infection of the knee joint or a thrombosis in the leg. The likelihood of early complications is rather low compared to late complications.

Late complications include remaining residual instability of the knee joint or remaining restriction of movement. Limiting the movement often results in a lack of full extensibility and flexion of the knee joint. Also a reaction to intolerance with bone extensions is possible.

When should you go to the doctor?

Anyone who has suffered a cruciate ligament rupture should go to the doctor quickly. A rupture of the cruciate ligaments is an injury that definitely requires medical and medical treatment. Otherwise, a full recovery can not be guaranteed. The cruciate ligaments provide stability and flexibility inside the knee, so that a tear in the cruciate ligaments severely restricts and impedes the entire movement process. Affected individuals will be in great pain even when they are resting, so going to the doctor is essential. Those who completely refrain from medical treatment must expect considerable complications.

Even irreparable secondary damage can occur, as a healthy cruciate ligament ensures the overall stability of the knee. A full extension and bending ability of the knee can also no longer be guaranteed if the visit to the doctor fails. Thus, a cruciate ligament rupture should always be medically, medically and surgically supplied, otherwise serious consequences can occur, which can no longer be cured.

Treatment & Therapy

A cruciate ligament tear, ie the injury or severance of one or both cruciate ligaments on the knee joint, is diagnosed by the doctor by carefully examining the movement of the knee. The knee can be swollen to twice. The doctor, preferably a sports doctor or orthopedist, must proceed with caution. In cruciate ligament rupture by violent falls during sports with twisting of the knee joint, often more ligaments are affected.

The patient has extremely severe pain from the bruising normally associated with the tear. If the physician shows blood and light fluid during the puncture of the knee, this indicates a tear of the cruciate ligaments. If it is also found in the medical history that lower leg and thigh can be moved against each other like a drawer, this is a sure sign of cruciate ligament rupture. The extent of knee ligament injuries, however, can only be specified by a knee reflex. At endoscopy, the doctor will not only detect the injury, but also apply a cruciate suture to reunite the severed fibers.

If the cruciate ligaments are so fissured and unevenly demolished that they can not be repaired with a suture, the surgeon replaces them with a strip of fibrous tissue taken from the thigh muscles. In older people, the doctor likes to forego surgery and restores the knee with a knee brace to heal the fibers by themselves.

Outlook & Forecast

The cure for a cruciate ligament tear is in most cases very good. The different healing times of the conservative as well as the operative treatment should be considered. In terms of conservative therapy, the treated person must immediately put his knee back in the form of a detailed muscle-building program after a short period of immobilization. On the other hand, if a cruciate ligament tear has been surgically corrected, the patient may not fully recover his knee until about three to four months have elapsed.

There should be no serious complications such as bleeding of the nerves and vessels, joint infections or thrombosis. If a physiotherapeutic therapy is started early, the risk of osteoarthritis decreases significantly. Thus, a joint wear is counteracted. In order to increase the chances of recovery, it is important during therapy to train the joint to a sufficient extent and above all regularly. Thereafter, the full agility and strength is expected again.

If the affected person wishes to return to the highest sporting level after the healing process, he should give this project at least six months to counteract a renewed cruciate ligament rupture. In all cases it is recommended to treat a cruciate ligament tear as soon as possible. If no treatment measures are initiated, the person concerned is expected to experience reduced performance and knee joint wear.

prevention

The same exercises that the orthopedist recommends for strengthening the knee and muscles to strengthen the ligaments are also used after healing a cruciate ligament rupture to reactivate the knee. Knee exercises to strengthen all ligaments are also the best prevention for active athletes who exercise sports with stress on the knee joints. Since a cruciate ligament rupture almost never occurs in ballet dancers, whose ligaments and joints are exposed to extreme strain and strain, some exercises of training on the pole there can be copied for the knee strengthening.

All up and down movements, knee flexion and stair climbing should be performed symmetrically out of the joints and slowly so that the muscles can accompany the positions of the ligaments. Alexander technique and a complementary medical manual treatment method (eg Rolfing) are body therapies that can generally serve to strengthen ligament weakness. Anyone who fully utilizes his pelvic floor muscles as an athlete and uses the spine in optimum alignment with gravity will be less prone to accidents and unanatomical movements.

aftercare

A cruciate ligament tear is a serious injury that can cause extensive damage. To reduce the risk of osteoarthritis and other complaints, careful follow-up is necessary. Patients with cruciate ligament rupture are first required to perform all offered medical check-ups during the first weeks and months.

In addition, those affected seek the doctor in addition to when new complaints are added or the healing process is delayed. An essential component of the aftercare for a cruciate ligament tear is the physical protection. In particular, the knee must not be exposed to unnecessary stress, neither in sports nor at work.

Nevertheless, muscles and ligaments around the knee have to be trained, so that individually coordinated exercise programs with the physiotherapist are necessary. Even if the symptoms of cruciate ligament rupture have subsided after a few months after conservative or surgical therapy, caution is advised.

In principle, patients with ACL cracks throughout their lives should perform regular examinations, in which the condition of the ligaments and especially the knee joint is checked. Because a cruciate ligament tear promotes the development of osteoarthritis, which often shows only decades after the accident. The doctor may therefore prescribe special sports, health shoes and insoles that prevent osteoarthritis and minimize the long-term effects of the cruciate ligament tear as much as possible.

You can do that yourself

In case of a cruciate ligament rupture, it is important to first protect the injury and keep it at rest. Against the swelling and pain relief, the affected leg is best cooled immediately with ice packs or cooling batteries and stabilized with a compress. Subsequently, a doctor should be consulted immediately.

Immediately after surgery, the injured ACL should continue to be cooled and spared - at least a week. Also important is the stretching. Here, the joint is moved passively and - if possible - completely stretched. Then you can start training again slowly. In cooperation with the physiotherapist you can start with physiotherapy and gentle sports like swimming. In the first few weeks, the focus should be on slowly improving the load capacity of the crossbelt through individual exercises. Lightweight squats and exercise equipment such as the leg press or a bicycle ergometer are ideal for this. Accompanying these physiotherapeutic measures, the injury must be monitored regularly.

Ideally, the cruciate ligament rupture is completely cured after six to eight weeks, and it may be changed back to the original training. In severe cases - such as when the cruciate ligament had to be replaced - the strength and coordination exercises should be permanently maintained.

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