Cruciate ligament tear

A Cruciate ligament tear is also called in medicine Cruciate ligament rupture designated. It is a crack that came about through external violence. A cruciate ligament tear often occurs as a sports accident in soccer players or while skiing. Typical signs of a cruciate ligament tear are knee pain and visible bruising and swelling.

What is a cruciate ligament tear?

A Cruciate ligament tear mostly affects both cruciate ligaments, as they function almost like Siamese twins in the knee: the cruciate ligaments lie inside the knee between the joint bones, crossed one above the other. There, on the one hand, they stabilize the knee against the dreaded cruciate ligament tear, on the other hand, they ensure lateral three-dimensional mobility, which is important for sitting, walking and standing. In addition to the cruciate ligaments, the outer and inner ligaments of the knee are just as important, because without this fixation, the knee would fall out of its forward plane, especially in the case of a cruciate ligament tear, and the affected person would no longer be able to move.

The cruciate ligaments themselves consist of collagen muscle fibers and are cushioned by a mucous membrane sac, the synovial sac, towards the joint bone. They can be reinforced by other ligaments, such as the meniscofemoral ligament and the Humphry ligament, but not everyone has these to the same extent. The cruciate ligaments are 18.5 to 33.5 mm long and usually formed from three fiber bundles, the anterior, posterior and middle bridge.

Together with the knee ligaments outside and inside and the connection to the anterior meniscus ligament, they form the bridge between the thigh and lower leg. The combination of the ligaments on the knee prevents overstretching the shin forwards and overstretching it backwards. If the structure is healthy, the cruciate ligaments regulate the movement of the knee on all axes and the symmetrical alignment of the upper and lower legs.

causes

A Cruciate ligament tear unfortunately occurs relatively often, although the cruciate ligaments are particularly protected against heavy use due to the crossed position. A ligament tear usually only occurs when the ligaments are extremely stretched in one direction. The cruciate ligaments can hardly tear under normal physical exertion, unless someone moves their knee in a dangling motion with considerable force. This usually only happens in the event of an accident or while exercising.

The cruciate ligament rupture is a typical injury for athletes, as it occurs most frequently as a result of the high stress on the knees when playing football and skiing. If the football is kicked from the side with force, so that a rotation occurs in the forward movement, this can lead to an overstretching of the cruciate ligaments, which leads to cruciate ligament rupture under stress or if the other foot slips on the lawn. If the cruciate ligament ruptures on the anterior cruciate ligament, the sliding mechanism of the femoral head is severely disturbed. This causes damage to the meniscus and wear and tear on the cartilage in the knee joint. In the bent position of the knee, the lateral knee ligaments are relaxed and most accidents with cruciate ligament rupture occur in this position, as the full force of the movement is transferred unhindered to the inner ligaments.

Slalom driving in skiing, starting in a bent position like sledding or ice hockey can be triggers. If the knee is moved too far forward, the anterior cruciate ligament can tear, while a blow to the head of the tibia puts the posterior cruciate ligament at risk. If both cruciate ligaments tear, which occurs in most cases when the movement is very powerful, the rotation of the lower leg is no longer limited to the inside. The stability of the cruciate ligaments is a prerequisite for the health of the knee joint.

Destroyed cruciate ligaments also endanger the healthy functioning of the meniscus. If the ligaments are tense, they can absorb the force of an unexpected blow, as in football, and pass it on to the muscles. If you relax, the risk of accidents is much greater, because jerky stretching increases the risk of small fiber tears or complete tearing of the ligaments.

Symptoms, ailments & signs

A cruciate ligament tear can be clearly felt. At the moment the tape breaks, a snapping or cracking sound may be heard. Then the affected knee swells and pain sets in. The pain is described by those affected as dull to stabbing, with pain peaks occurring again and again, during which the stinging increases sharply.

In addition to the pain, bruise develops in the joint. The hematoma usually follows quickly and can spread to the entire joint. The bruise can appear 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.

A typical feeling is that the thigh and lower leg are wedged together. In addition, there is a pronounced unsteady gait, often combined with a spontaneous buckling in the joint. After a few days there is a loss of performance and an extension and flexion inhibition or pseudo-blockade in the knee joint. Depending on which cruciate ligament is affected, the type and severity of symptoms can vary widely. In individual cases, a cruciate ligament rupture occurs without further injuries.

Complications

Time and again, patients with cruciate ligament tears can experience complications and disorders after surgery. If a torn cruciate ligament is not treated at all, instability is to be expected, as an intact cruciate ligament would ensure good fixation of the thigh and lower leg in the knee joint. The instability leads to increased mobility of the knee.

This can result in possible damage to the knee, possible wear damage or further consequential damage in the body.Since there is no spontaneous healing in the case of a cruciate ligament rupture, professional treatment in the form of an operation is recommended in any case. If the result is not satisfactory after an operation, the procedure is often repeated.

The specialists divide the possible disorders after an operation 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 residual instability of the knee joint or residual restriction in movement. Restricted movement often results in a lack of full extension and flexion of the knee joint. A reaction to incompatibility with enlarged bones is also possible.

When should you go to the doctor?

Anyone who has suffered a cruciate ligament rupture should see a doctor quickly. A rupture of the cruciate ligaments is an injury that definitely requires medical attention and medication. Otherwise a full recovery cannot be guaranteed. The cruciate ligaments inside the knee ensure stability and mobility, so that a tear in the cruciate ligaments severely restricts and hinders the entire movement. Affected people will be in severe pain even when they are at rest, so a visit to the doctor will be essential. Anyone who completely refrains from medical treatment must expect considerable complications.

Even irreparable consequential damage can occur, as a healthy cruciate ligament ensures the overall stability of the knee. Full extension and flexion of the knee can also no longer be guaranteed if a visit to the doctor is not taken. Thus, the following applies: A cruciate ligament tear should always be treated medically, with medication and surgically, otherwise serious consequential damage can occur that can no longer be cured.

Treatment & Therapy

A Cruciate ligament teari.e. an injury or severing of one or both cruciate ligaments in the knee joint is diagnosed by a doctor by carefully examining the movement of the knee. The knee can be swollen up to twice as much. The doctor, ideally a sports doctor or orthopedic surgeon, must proceed with caution. If the cruciate ligament ruptures due to violent falls during sport with twisting of the knee joint, other ligaments are often also affected.

The patient is in extreme pain from the bruises normally associated with the tear. If the doctor punctures the knee and shows blood and light-colored liquid, this indicates a tear in the cruciate ligaments. If the anamnesis also shows that the lower leg and upper leg can be moved against each other like a drawer, this is a sure indication of a cruciate ligament tear. However, the extent of knee injuries with cruciate ligament rupture can only be determined more precisely through a knee examination. During the endoscopy, the doctor will not only determine the injury, but also create a cruciate ligament suture to reconnect the severed fibers.

If the cruciate ligaments are so fibrous and unevenly torn that they cannot be repaired with a suture, the surgeon replaces them from a strip of fiber taken from the thigh muscles. In older people, the doctor likes to avoid surgery and immobilize the knee with a knee brace to allow the fibers to heal by themselves.

Outlook & forecast

The chances of recovery from a cruciate ligament tear are very good in most cases. The different healing times for conservative and surgical treatment must be taken into account. In terms of conservative therapy, the person being treated must immediately put weight on his knee again after a short period of rest in the form of a detailed muscle building program. If, on the other hand, a cruciate ligament tear has been corrected surgically, the patient may only use his knee to its full extent after about three to four months.

Serious complications such as bleeding of the nerves and vessels, joint infections or thrombosis should not occur. If physiotherapeutic therapy is started at an early stage, the risk of osteoarthritis is significantly reduced. This counteracts joint wear. In order to increase the chances of recovery, it is important to exercise the joint to a sufficient degree and, above all, regularly during therapy. After that, full mobility and strength can be expected again.

If the person concerned wants to be active again at the highest level after the healing process, he should give this project at least six months to counteract a new cruciate ligament tear. In all cases it is advisable to treat a cruciate ligament tear as soon as possible. If no treatment measures are initiated, the affected person can expect reduced performance and wear and tear of the knee joint.

prevention

The same exercises that the orthopedist recommends for knee and muscle training to strengthen ligaments are performed after a healing Torn cruciate ligament also used to reactivate the knee. Knee exercises to strengthen all ligaments are also the best prevention for active athletes who practice sports that place stress on the knee joints. Since a cruciate ligament rupture hardly ever occurs in ballet dancers, whose ligaments and joints are exposed to extreme stretching and strain, some exercises of the training on the bar can be copied there for knee strengthening.

All up and down movements, knee flexion positions, and climbing stairs should be performed symmetrically out of the joints and slowly so that the muscles can follow the ligament positions. The Alexander technique and a complementary medical manual treatment method (e.g. Rolfing) are body therapies that can generally serve to strengthen the ligaments. Athletes who use their pelvic floor muscles to the full and use their spine in an optimal alignment to gravity will be less prone to accidents and non-anatomical movements.

Aftercare

A cruciate ligament rupture is a serious injury that can result in extensive consequential damage. Careful follow-up care is necessary to reduce the risk of osteoarthritis and other symptoms. Patients with a ruptured cruciate ligament are initially required to attend all medical check-ups offered during the first few weeks and months.

In addition, those affected also see the doctor if new complaints arise or the healing process is delayed. An essential part of aftercare for a cruciate ligament rupture is physical protection. In particular, the knee must not be exposed to unnecessary stress, neither during sport nor at work.

However, muscles and ligaments in the knee area must be trained, so that individually tailored exercise programs are required by the physiotherapist. Even if the symptoms of the cruciate ligament tear have subsided after a few months after conservative or surgical therapy, caution is advised.

In principle, patients with cruciate ligament ruptures should have regular examinations throughout their lives, in which the condition of the ligaments and especially the knee joint is checked. A rupture of the cruciate ligament promotes the development of osteoarthritis, which often only shows up decades after the accident. The doctor can therefore prescribe special sports, health shoes and insoles that prevent osteoarthritis and minimize the long-term consequences of the cruciate ligament rupture as much as possible.

You can do that yourself

In the event of a cruciate ligament tear, the first thing to do is to take care of the injury and to calm it down. To counteract the swelling and to relieve pain, the affected leg is best cooled immediately with ice packs or cooling batteries and stabilized with a compress. A doctor should then be consulted immediately.

Immediately after the operation, the injured cruciate ligament must continue to be cooled and protected - for at least a week. Stretching is also important. The joint is moved passively and - if possible - fully stretched. Then you can slowly start training again. In cooperation with the physiotherapist, physiotherapy and gentle sports such as swimming can be started. In the first few weeks, the focus should be on slowly improving the resistance of the cruciate ligament through individual exercises. Light squats and training equipment such as the leg press or a bicycle ergometer are ideal for this. In addition to these physiotherapeutic measures, the injury must be checked regularly.

Ideally, the cruciate ligament tear is completely healed after six to eight weeks and you can switch back to the original training. In severe cases - for example, when the cruciate ligament had to be replaced - the strength and coordination exercises should be permanently maintained.