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Cruciate ligament rupture

Cruciate ligament injuries: surgical or conservative treatment?

The cruciate ligament tear is also called cruciate ligament r upture and is one of the most common injuries in the knee joint. The cruciate ligaments are stabilizing tissue ligaments as collagen fibers that cross over in the center of the knee joint. The cruciate ligaments are divided into anterior and posterior cruciate ligaments. They limit the extension of the knee joint over the tibia, control joint movement and provide stable support. At the same time, they prevent twisting of the knee joint. If the joint is nevertheless twisted too far in an accident during sports or due to sudden movements with external force, the cruciate ligaments can tear in parts or completely – the cruciate l igament tear occurs.

The anterior cruciate ligament is usually affected by a rupture, whereas the posterior cruciate ligament is rarely affected. While the posterior cruciate ligament primarily prevents posterior displacement of the tibial plateau, the anterior cruciate ligament is involved in limiting extension of the knee joint while providing stability in the knee joint along with the lateral ligaments. Typical mechanisms of injury to the anterior cruciate ligament include twisting of the knee joint when skiing in the snow or getting caught with the cleat in the turf while playing soccer. A good prevention against a cruciate ligament rupture is offered especially to athletes by a regular and careful warm-up training before the actual sport.

Orthopädie Zentrum München Ost - Knie - Erkrankungen

Table of Contents:

Symptoms of cruciate ligament rupture

Tear in the anterior cruciate ligament
Tear in the posterior cruciate ligament

Diagnostics and therapy for a cruciate ligament tear

Treatment of cruciate ligament tears at the Orthopaedic Center Munich East (OZMO)

Symptoms of cruciate ligament rupture

Severe pain in the knee joint, unsteadiness of gait during exertion, swelling and hematomas (bruises) are the first signs of a cruciate ligament tear. The symptoms of a cruciate ligament tear usually occur directly following a traumatic load on the joint, for example during sports when the knee has been twisted in motion. Many patients report feeling the tearing in the joint in the acute situation. The pain, swelling and hematomas occur either on the front side of the knee joint or in the back of the knee – depending on which of the two cruciate ligaments is affected.

Tear in the anterior cruciate ligament

If the anterior cruciate ligament tears, some sufferers report a noticeable and audible noise in the knee, followed by severe pain. The pain does not last long in the resting position, but returns with exertion. The knee noticeably loses stability and the thigh appears to shift backward relative to the lower leg when taking steps in a downward direction (e.g., down stairs).

Tear in the posterior cruciate ligament

If the posterior cruciate ligament is affected by the tear, some patients also notice a cracking sensation in the joint during movements. In this case, swelling and pain as well as bruising appear primarily in the back of the knee, but also radiate to the anterior region during stress, especially when starting and stopping movement. The lower leg also seems to push backwards in relation to the upper leg and imprints a wobbly step feeling. Pain is sometimes less with a posterior cruciate ligament tear if a slightly bent knee position is used while walking.

Diagnostics and therapy for a cruciate ligament tear

In the event of a cruciate ligament tear, a physician will always begin a detailed inspection of the knee joint with palpation. In addition, knee function tests are important in order to subsequently discuss the injury situation using imaging techniques such as magnetic resonance imaging (MRI) and computed tomography (CT). If necessary, X-ray examinations are also supplemented to rule out concomitant injuries, especially bone fractures. Only very rarely does the cruciate ligament tear occur directly at the connecting piece to the bone.

Acute therapy is performed according to the PECH rule. This stands for “rest, ice (cooling), compression and elevation”. Conservative therapies are performed with orthoses that immobilize the joint. Bandages and physiotherapy are also used in addition to symptomatic treatment with painkillers and, if necessary, decongestant ointments. Physiotherapy must be carried out carefully and over a longer period of time in order to avoid consequential damage and reduce future risks of injury.

The healing process can be supported by blood plasma therapy. In blood plasma therapy, also called PRP therapy, plasma is extracted from the patient’s blood and injected into the injured area of the cruciate ligament tear. In the prepared blood plasma, platelets (thrombocytes) are present, which secrete hormone-like growth substances and attract stem cells that are important for tissue regeneration. This stimulates the natural healing power, as the body reacts to the injection of the body’s own substance with improved healing of the cruciate ligaments.

Even in the case of a complete tear and associated instability, the cruciate ligament does not necessarily need to be replaced. The decisive factor is that the mucosal membrane necessary for nutrition is still intact. To ensure stable scar healing in this case, the bone on the mucosal tube must be stimulated in a small outpatient within 3 weeks. The operation is performed as a keyhole surgery (arthroscopy).

In the case of a rupture in which the cruciate ligament is totally shredded, the options described above are out of the question and the ligament must be replaced with a tendon from another area of the knee joint. In this case, there is no time window to be observed with regard to surgical treatment and one can also try to get one’s joint mobile and stable again with physiotherapy as a first step.

The rule of thumb for a cruciate ligament rupture is that the younger the patient, the sooner surgical treatment and restabilization of the anterior cruciate ligament is advisable. The reason for surgical stabilization, in addition to possible instability in the knee joint, is microinstability, which stresses the internal structures of the knee. As a result, tissue parts such as the meniscus and the articular cartilage can increasingly wear out due to increased gravitational forces.

Treatment of cruciate ligament tears at the Orthopaedic Center Munich East (OZMO)

You have a cruciate ligament rupture and are looking for a specialist in orthopedics in Munich? Then we look forward to welcoming you to the Orthopedic Center Munich East with our orthopedists. Our practice team looks forward to hearing from you to prepare appointments for one-stop diagnostics, treatment and follow-up. If needed, our accomplished specialists are also available with extensive surgical experience and can provide you with an independent second opinion on your health situation after a cruciate ligament tear, if desired.

Examination of the knee joint after cruciate ligament surgery by Prof. Dr. Diehl

Prof. Dr. Diehl: Cruciate Ligament – Cause Cruciate Ligament Rupture & Minimally Invasive Treatment Options

Mo – Th:	08:00 – 18:00
Fr:	08:00 – 12:00