Even just a minor but abrupt change in direction while moving can lead to a cruciate ligament tear – it can happen more quickly than most people think. A typically dangerous situation in this regard can occur when a person playing basketball or handball has to make a quick evasive maneuver and change direction, for example. Cruciate ligament tears usually occur in a sports setting, but it’s also possible to tear the cruciate ligament during everyday activities. Symptoms include swelling, pain, and functional instability of the knee joint. Treatment options vary depending on which of the two cruciate ligaments is injured, and whether there are other injuries to the knee. In many cases, cruciate ligament tears can be treated with physiotherapy, supports or orthoses, targeted muscle-toning exercises, and pain medication. However, surgery is not uncommon either.
Causes of cruciate ligament tears
Each knee joint has two cruciate ligaments – the anterior and posterior cruciate ligament. These ligaments connect the thigh bone to the lower leg bone (tibia, or shin bone). A cruciate ligament tear (cruciate ligament rupture) occurs when one of these ligaments in the knee is either partially or completely torn. Falls and accidents can, of course, cause both ligaments to tear. Traffic accidents and sports injuries are the most common causes of cruciate ligament tears. For example, the anterior cruciate ligament often tears when a person in motion has to stop abruptly when their knees are bent and their legs are in a slightly knock-kneed position and are simultaneously rotating outwards (valgus stress). This type of injury frequently occurs when people ski or play football or other ball sports that require rapid changes in movement direction.
Posterior cruciate ligament tears are much less common than anterior cruciate ligament tears.
The posterior cruciate ligament, on the other hand, tends to tear as a result of external forces – for example when a bent knee impacts an object or hits something in a car (e.g. the dashboard) in an accident. The resulting movements cause the posterior cruciate ligament to overstretch, which can then lead to a tear. Other knee joint structures are usually damaged as well in such situations. Posterior cruciate ligament tears occur much less frequently than anterior cruciate ligament tears.
Symptoms of cruciate ligament tears
A clear cracking sound can be heard when a cruciate ligament tears. The knee then swells up quickly and becomes very painful. Although the pain dissipates somewhat after a short time, it usually intensifies again if stress is placed on the knee. The knee becomes unstable when a person attempts to walk, and it also bends to the side. A person with a torn cruciate ligament cannot stretch or bend their leg. It’s also possible that a bruise might form, and blood is sometimes released internally later on.
What to do if you suspect a torn cruciate ligament?
If you tore your cruciate ligament, the first aid measures include elevating the leg, applying a compressive bandage and cooling the painful area.
Despite the symptoms mentioned above, a torn cruciate ligament isn’t always noticed right away. Nevertheless, a wobbly and unstable gait becomes apparent at the latest when the knee joint starts giving out.
For some patients, known as “copers”, the knee joint actually remains functionally stable despite the presence of a torn cruciate ligament. They are able to offset the structural deficit using the surrounding well-trained muscles. The “non-copers” cannot compensate in this manner, and their torn cruciate ligament results in a functionally unstable knee joint.
Diagnosing a cruciate ligament tear
A diagnosis is made on the basis of the symptoms described and various physical examinations that are conducted. For example, physicians can carry out a so-called drawer test to determine whether the anterior or posterior cruciate ligament is affected: If the anterior cruciate ligament is torn, it will be possible to pull the tibia forward like a drawer to a certain extent when the knee joint is bent (anterior drawer sign). If the posterior cruciate ligament is torn, it will be possible to push the tibia back (posterior drawer sign).
X-ray and magnetic resonance imaging (MRI) examinations can then be conducted to confirm the diagnosis and ensure that no further damage has occurred to the knee joint (MRT). In rare cases, an arthroscopy(minimally invasive examination of the knee joint) may be used purely in order to make the diagnosis. In general, however, an arthroscopy is considered as a supportive measure during surgery – e.g. when a torn ligament is replaced.
Treatment for cruciate ligament tears
The goal of treating a torn cruciate ligament is to relieve pain, stabilize the knee joint and restore the patient’s functional performance.
The choice of treatment depends on the severity of the injury and the patient’s activity level.In the case of a torn posterior ligament in a patient with a low level of athletic activity, targeted strength training alone might be sufficient to stabilize the knee joint. During the treatment period, special knee braces (orthoses) can be worn to relieve the knee joint and aid stabilization.
Surgery is generally used as a treatment for anterior cruciate ligament tears, as well as in the case of individuals who are very athletically active. Cruciate ligament surgery is usually performed around four to six weeks after the injury. Suturing torn cruciate ligaments usually isn’t very effective, which is why the cruciate ligament between the kneecap and the tibia (patellar tendon) is replaced by part of the tendon from the hamstrings (semitendinosus muscle tendon), patellar tendon or an artificial implant. In approximately 60% of cruciate ligament tears, the meniscus is also damaged – this is typically sutured during surgical cruciate ligament reconstruction.
After surgery, targeted physiotherapy and therapeutic exercise are used to build up muscles in the thigh. Weight-bearing on the affected knee should be limited for around 6 to 12 weeks after surgery. A special knee orthosis can be used to provide additional support to the joint during this phase.
Stabilizing the knee joint after a cruciate ligament tear
The knee joint can be very functionally unstable right after surgery for a torn cruciate ligament. Aids such as orthoses can be used to stabilize the knee joint and thus contribute to the healing process in cases of persistent knee pain or during post-operative rehabilitation.
SecuTec Genu is a hard-frame orthosis that stabilizes the knee joint according to the 4-point principle. It can be adapted to the individual needs of the wearer and is made of a lightweight, yet stable material. Comfortable padding and an optimal fit ensure secure positioning on the leg. SecuTec Genu is easy to put on and painless: The knee orthosis is simply placed on the leg from the front, which means there is no need to sharply bend the knee when putting it on. SecuTec Genu offers optimal comfort and outstanding functionality that enables patients to securely restore mobility and get back to their daily lives.
In conservative treatment or for patients with high mobility requirements(e.g. those returning to athletic activity), the SofTec Genu knee orthosis combines the advantages of activating supports and stabilizing orthoses. “Intelligent” hinges on the sides are adapted to the knee’s individual axis of rotation and provide optimal guidance. Mechanical stress on the joint is minimized and pain is relieved. That is why this orthosis is much appreciated by competitive athletes as well, since it helps them to quickly recover from injuries and return to their athletic activity.
