During a trick on the BMX bike, Pascal seriously injures his left knee. The diagnosis: an unhappy triad. But the professional BMX and mountain biker does not give up. After complex surgery, subsequent physiotherapy, and with the support of his orthosis, he is back on his bike today – preventing osteoarthritis.

It was meant to be a relatively easy trick for Pascal to warm up. But during this 180 double bar spin, Pascal lands in a damp spot on the arena floor with his rear tire. He tries to catch the bike but his right foot remains firmly on the ground – while his leg continues to follow the rotating movement. “I was totally focused on the fall. Nobody noticed that something had happened to me. But you could hear it: there was a loud cracking sound.”

At that stage, Pascal had been a successful athlete under contract, mainly riding his mountain bike in skate parks and on dirt jumps. He also took part in shows abroad and was successful during many renowned German competitions.

Broken bones and a torn cruciate ligament in his knee

Now, Pascal is lying on the floor of the indoor arena, injured. Shortly after, he is diagnosed: broken bones and an unhappy triad. The unhappy triad is a very rare and serious combination injury of the knee joint, which can occur when a rotational movement is forced while the knee joint is bent – as happened to Pascal. The results are a torn anterior cruciate ligament, medial collateral ligament and damage to the medial meniscus.

I had to learn to walk again.

A torn cruciate ligament: there’s no way around surgery

A straight cruciate ligament tear in the knee usually grows back together quite well. Pascal’s injury, however, is more complicated. During surgery, physicians take out a piece of tendon from his thigh and “implant” it into his cruciate ligament. Pascal is not allowed to put any load on his leg for eight weeks. “The physicians told me that it would take as much as twelve months before I could walk again. I knew then: this is going to be a long journey.”

The next treatment step: physiotherapy for muscle development

Sensible handling of the injury is hugely important for the healing process after a cruciate ligament tear: regaining trust in his own movements and being able to do them with confidence – those are the first steps.


Looking back, Pascal tells us that he owed his physiotherapist everything: “Without him, I wouldn’t be sitting here today, and, most of all, I wouldn’t be doing my sport.” The therapist shows Pascal that he can rebuild his muscular foundation using many targeted exercises. “During physio, I noticed all the things I couldn’t do any longer. I had to learn to walk again,” Pascal explains.


Pascal’s range of motion is still very limited. “What motivates me for the future are my little victories. It took me four months instead of twelve to walk again. I was even back on my bike. I knew then: this is your home. This is where you belong. Those are the small steps that spur me on and encourage me.”

You know you have the orthosis on your knee, and you dare do something again, you’re freer mentally.

Preventing osteoarthritis: an orthosis ensures stability after a cruciate ligament tear

However, Pascal also notices that his knee is not quite as secure as before the accident, and that’s something he has to work on. The orthosis helps him by securing and stabilizing his knee. After surgery, Pascal wears it constantly, later during physiotherapy and now during cycling. “It’s also important for your mind. You know you have the orthosis on your knee, and you dare do something again, you’re freer mentally.”

Regaining and maintaining stability and mobility is also vital in preventing additional complications and secondary conditions after an unhappy triad. For Pascal, the risk of developing osteoarthritis is very high, for example. Two factors play a part in this for him: the serious knee injury and his high-performance sport. Both can cause osteoarthritis to start developing at a young age.

During the onset of osteoarthritis, the knee shouldn’t be rested too much, even if it’s painful. The right physical activities help to prevent or delay osteoarthritis. Pascal is on the right track for this: thanks to cycling and physiotherapy, his knee joints remain mobile and they are strengthened. The orthosis ensures the required support and stability.

It’s important to stick with it and not to be discouraged – in particular after such a complicated injury as an unhappy triad. Pascal is still battling with restricted movement in his knee. The strain of walking or standing for longer periods of time causes pain. Nevertheless, his condition 18 months after the accident – in which he didn’t only tear his cruciate ligament – is a small miracle. That’s why he won’t be disheartened by rather reserved prognoses by the experts: “People see me sitting on the bike again and think everything is back to normal. But that is not the case. Nevertheless, riding does help: the movement is beneficial for my knee, pedaling takes the load off the legs and trains my joints and muscles.”

Self-test: Do I suffer from osteoarthritis of the knee? 

Are you also an active or former competitive athlete, or are you battling with a serious knee injury like Pascal?

Then it’s likely that you’re at an increased risk of developing osteoarthritis risk – especially if you’re already experiencing knee pain every now and then.

Find out in our self-test whether your pain is a possible sign of osteoarthritis and which other factors also play a part. Afterwards, ask your physician for a reliable diagnosis.