Cruciate ligament tear
A cruciate ligament tear is an extremely common sports injury. Learn more about the causes of cruciate ligament tears and how they can be treated.
Causes, symptoms and treatment
When it comes to movement – getting from A to B – the knee joints are the body’s lynchpin. Without knee joints, movement quite literally comes to a standstill. You need your knees not only to perform everyday activities but also for virtually all types of exercise and contact sports.
Muscles and ligaments play an important role in helping your joints do their job. In your knees, your cruciate ligaments play the lead role. If a cruciate ligament tears, it can no longer provide support – which can lead to a whole string of very unpleasant symptoms. Read on to find out more. We’ll also take a closer look at the causes of cruciate ligament tears and how they can be treated.
Ottobock supports and orthoses
What is a cruciate ligament?
Four ligaments connect your thigh bone (femur) to your lower leg bone (tibia). They include the two collateral ligaments that stabilise the inner and outer sides of your knee joint and the posterior and anterior cruciate ligaments located inside your knee. Your cruciate ligaments are crossed like the letter X and run diagonally through the cavity of the knee joint. Cruciate means cross-shaped, which is how they got their name.
¿Qué función desempeñan los ligamentos cruzados?
Los ligamentos cruzados actúan a modo de estabilizadores centrales. Centran las superficies articulares en la articulación de la rodilla y mantienen la rodilla en su posición tanto en estado de reposo como también bajo carga y fuerza. Los ligamentos cruzados refuerzan y guían la rodilla en la flexión, ya que están tensados en ese momento. Los ligamentos laterales desempeñan la misma función pero en la extensión, momento en el que están tensados. De este modo, los ligamentos dirigen el movimiento a la vez que limitan el rango de movimiento de forma fisiológica. Así protegen la rodilla contra dislocaciones y la estabilizan incluso cuando los músculos que la rodean no están contraídos. Esta "protección pasiva" natural es posible porque los ligamentos, en comparación con los músculos, son relativamente rígidos, lo que les permite ofrecer siempre una determinada estabilidad.
El ligamento cruzado anterior impide que el fémur se desplace hacia anterior más allá de la tibia (fenómeno conocido como cajón anterior). El ligamento cruzado posterior impide que la tibia se desplace hacia posterior por debajo del fémur (cajón posterior).
What is a cruciate ligament tear?
A cruciate ligament tear in the knee – also known as a cruciate ligament rupture – is a complete tear of one or both cruciate ligaments. If a ligament is not completely torn, this is called a partial tear or rupture to a cruciate ligament. The anterior cruciate ligament in the knee joint is affected in a majority of cases, because the ACL is typically subjected to a higher level of stress in many accident situations. The posterior cruciate ligament only ruptures in about ten per cent of all cases.
When the anterior cruciate ligament ruptures, it can no longer prevent the femur from slipping forwards over the tibia. A ruptured PCL can no longer prevent the tibia from slipping backwards under the femur. As long as the medial and lateral ligaments are intact, your knee joint will still have a measure of lateral stability.
Statistically speaking, a cruciate ligament rupture occurs every five to six minutes in Germany. That adds up to some 100,000 cases per year. Eighty percent of these injuries occur during sports.
How can you rupture a cruciate ligament?
As ligaments are not particularly elastic, they can easily be overstretched if placed under too much strain. A cruciate ligament will generally tear if it is strained beyond its maximum tearing strength. There are various situations where this can happen. Most tears are caused by traffic accidents or sustained in contact sports or sports with a lot of movement. Sports that involve sudden changes of direction or speed have a higher risk factor. A cruciate ligament can also tear if it is twisted, sprained or hyperextended. This can happen due to a fall, collision or impact. Classic scenarios include hitting your knee on the dashboard in a car accident, battling for a ball in sports or landing after a jump. It can also happen if you fall when skiing and your ski does not release automatically, in which case the leverage effect can twist your knee. And the list goes on.
However, cruciate ligament tears can also occur in numerous everyday situations. All it takes is one wrong step – twisting your knee, slipping on the stairs, or falling off a ladder or chair when you’re doing DIY or hanging a picture is often enough to overextend a cruciate ligament and cause it to tear partially or completely.
What are the symptoms of a cruciate ligament tear?
In most cases, the symptoms of a cruciate ligament tear are very clear. They include pain, swelling and haematoma around the knee joint. You will no longer be able to extend or flex your knee fully. Some people don’t realise immediately that they’ve torn their cruciate ligament. It’s not until they try walking or bearing weight on the leg that their knee feels unstable and “wobbly”. The slightest pressure on the joint will then suffice to make the knee buckle and give way.
Many people report hearing a clear snapping sound and/or a crackle or a pop in the moment when the accident occurs. This is followed by acute and intense pain inside the knee. Another of the first symptoms can be a feeling of something tearing or moving suddenly inside the knee joint. Over the next few hours, the knee swells up. This, in turn, can result in throbbing pain caused by steady expansion of the joint capsule.
In many cases, the acute pain will subside relatively quickly if you rest, but will return as soon as you use the leg again. Blood vessels around the joint are often damaged during the injury as well. A haematoma can then develop, restricting the joint’s range of motion even further.
¿Cómo puede tratarse una rotura de los ligamentos cruzados?
Un tratamiento adecuado es importante para estabilizar la rodilla y prevenir un desgaste incrementado de la articulación, esto es, una artrosis de rodilla. En esto coinciden los expertos. El aumento del rango de movimiento de la articulación de la rodilla tras una rotura de los ligamentos cruzados está directamente relacionado con una mayor degeneración. En lo que sí difieren las opiniones de los expertos es en cuál es la mejor forma de tratarlo.
Una parte de los médicos opina que una intervención quirúrgica es la mejor opción. Aquí, un ortopeda sutura un ligamento cruzado roto o lo reemplaza por un injerto de tendón del muslo del paciente, lo que se conoce como reconstrucción del ligamento cruzado.
Por el contrario, otros médicos consideran que no siempre es necesaria una intervención quirúrgica. En su opinión, una rotura del ligamento cruzado anterior se podría tratar en muchos casos de forma conservadora, siempre en función del tipo de rotura, y curarse mediante estabilización. Este es el caso, por ejemplo, cuando la membrana sinovial (una suerte de membrana en forma de tubo elástica por la que transcurren los ligamentos cruzados) no está completamente rasgada y continúa manteniendo unidos los extremos de los ligamentos rotos.
Además, en muchos casos, gracias a un entrenamiento muscular específico, es posible estabilizar la articulación de forma que resista las cargas correspondientes al practicar deporte, en el ámbito laboral y en la vida diaria. Si la articulación de la rodilla está expuesta a cargas excesivas, la estabilidad de la musculatura puede ser insuficiente para compensar por completo la falta de un ligamento cruzado. En general cabe decir que las personas jóvenes y deportistas se operan antes que los pacientes más mayores.
El tratamiento conservador incluye, normalmente, el uso de una órtesis de rodilla rígida que limita específicamente la movilidad de la rodilla durante cerca de seis semanas a fin de evitar cargas incorrectas y desalineaciones que ponen en riesgo el éxito del tratamiento. También después de una operación de ligamentos cruzados se recurre a una férula estabilizadora.
How long does it take to heal?
Cruciate ligament tears always take several months to heal. If surgery is performed, this normally takes place two to four weeks after the rupture occurs. Until then, a suitable orthosis is used to stabilise the knee. Orthoses are also used after surgery. Patients will also need around four months of rehabilitation for the graft to heal properly and provide long-term stability. During this time, the body transforms the grafted tendon into a ligament. With conservative treatment, on the other hand, rehabilitation begins as soon as the injury has subsided. This can also take several weeks. So at the end of the day, both forms of treatment take a similar length of time. Rehabilitation therapy will primarily start with physiotherapy that moves the knee passively and focuses on building up muscle and doing coordination exercises.
The right exercises make all the difference
Professor Wolf Petersen, senior consultant in the orthopaedic and trauma surgery clinic in Berlin’s Martin Luther Hospital, is very clear about one thing: surgery can succeed only in combination with aftercare. In order to return to normal life, physiotherapy is not the only important factor. You will also need to play an active role yourself in the recovery process. Doing the right exercises at home makes all the difference to the success of your treatment and helps improve your symptoms.
This is exactly where the Genu Move exercise programme comes in. Developed by doctors, this programme covers a wide range of exercises designed for patients who are recovering from an ACL tear. The exercises support aftercare and are ideal for building up muscle strength. This enables you to actively contribute to your rehabilitation at home and increase the load-bearing capacity, mobility, strength and coordination of the affected leg.
Genu Move – phase 1
Your knee will be sore immediately after surgery. There will be pain and swelling. The aim of the first phase of healing (weeks 1 and 2) is to alleviate and manage these symptoms. At this point, patients can already start exercises to extend their knee joint.
Genu Move – phase 2
The ability to extend the knee achieved in phase 1 should now be maintained. So you should continue performing the exercises from phase 1. The aims of phase 2 (weeks 3 to 6) are to further improve your mobility, build up more muscle strength and achieve a normal gait.
Genu Move – phase 3
In the third phase of healing (weeks 7 to 14), your mobility should increase to the same level as the healthy knee. The aims of this phase are to restore full mobility and improve your endurance, strength and coordination.
Exercises you can do at home – Genu Move
Preguntas frecuentes en caso de rotura de los ligamentos cruzados
Word of mouth is always a good and reliable way to find a good specialist for knee surgery. Ask your friends, family and acquaintances about their experiences. If they are unable to help, your only other option will be to do some detailed research. First of all, you should find out as much as you can about how knees work and the tasks they perform. Your goal at this stage is to feel comfortable with important medical terminology and to understand your own information that you find.
Once this foundation is laid, you can visit hospital websites and read the doctors’ profile pages. These will give you an idea of their level of experience, fields of research and the types of surgery they specialise in. Different hospitals may offer different surgical procedures. In your search for the appropriate knee specialist, you can also check to see whether a doctor has published books or articles or completed further education in specialist areas. You should also pay attention to information about the hospital’s quality and hygiene management. If you have a very specific knee problem, you could also narrow down your search by referring to the lists of specialists that are published annually. Online forums, social networks and patient reviews can also help you obtain the information you need. However, the quality of information can vary considerably.
Once you’ve found a knee specialist, you should arrange an initial consultation to form a first opinion. In many cases, it can be wise to get a second or even a third opinion before you settle on a knee specialist.
Directly after surgery, the first priority is to reduce swelling. This can be done by elevating and icing the leg and performing lymphatic drainage. Many people need analgesics (pain medication) because the pain blocks the muscles and makes movement virtually impossible. Many of the physiotherapy exercises used in rehabilitation can be done at home. For example, you can lie on the sofa, lift your leg and write letters in the air. But always consult your doctor first and ask how soon you should begin with such exercises. For two to four weeks, patients should also practise walking with crutches for thirty to sixty minutes every day. This is another aspect that you should discuss in detail with your doctor first.
Un trombo es una enfermedad vascular o un trastorno del sistema circulatorio en el que se forma un coágulo de sangre en un vaso sanguíneo. Con frecuencia, en la fase inicial, los trombos transcurren de forma prácticamente asintomática, pero en una fase posterior pueden provocar una embolia pulmonar mortal. En general, permanecer sentado y tumbado durante mucho tiempo favorece la aparición de trombos, por lo que se deberá evitar en la medida de lo posible. Caminando, guardando reposo y practicando deporte como, por ejemplo, ejercicios para los pies y las piernas que pueda realizar tras la intervención quirúrgica, puede combatir de forma activa los trombos. A menudo, su médico también puede prescribirle inyecciones contra los trombos durante las primeras semanas tras la operación. Las inyecciones de heparina, una sustancia natural, pueden prevenir la formación de coágulos. Quien deba permanecer mucho tiempo de pie, por ejemplo, por motivos profesionales, debería utilizar medias de compresión.
After surgery, you can ideally slow or even reduce the swelling by icing your knee repeatedly and evenly. The cold also provides pain relief. Gel ice packs are ideal because they shape themselves to your knee and distribute the cold evenly over the affected skin surface. However, you should never place the gel or ice pack directly on your skin; always wrap it in a towel or waterproof bag first. If the ice pack touches your knee directly, it can damage the skin or even cause frostbite.
Cooling should be applied for a maximum of five to ten minutes. Follow this with a break of at least two hours. If you ice your knee too intensively or for too long, your body will go into protection mode and send extra blood to warm the area in question. This, of course, would be counterproductive, because more blood would only make your knee swell more. Also, the enzymes that trigger repair mechanisms in your knee work best at certain temperatures – not too cold and not too hot. The inflammation in your knee is the direct result of these repairs, which takes the form of heat development. This means that if you ice your knee too intensively or for too long, you hinder rather than help the healing process.
Good sleep is immensely important for the body’s internal repair processes, so it plays an important role in healing and recovery after a cruciate ligament tear. A good quality orthosis helps by preventing you from making undesirable movements – not just during the day, but even more so at night, when we can’t consciously control all of our movements. Your doctor may prescribe you analgesics that you can take at night before you go to bed for pain-free sleep. Often, icing the affected area will also bring pain relief.
Directly after an ACL tear, you will definitely be given a sick note for at least two to three weeks. The stitches will be removed after around two weeks. Most people are ready and able to work after around four to six weeks. This may take longer for people in physically demanding jobs.
There’s no one-size-fits-all answer to this question. It depends on the surgical procedure used and on your individual case. Doctors will generally advise their patients regarding this. If you’ve had an arthroscopy, there will be only minimal superficial wounds that will also be stitched cleanly. Aseptic wounds close within around 24 hours, after which microorganisms can no longer enter. At this point, you will generally be able to take a shower or wash with clear tap water without any issues. This is beneficial not only in terms of hygiene, but also for your sense of wellbeing. Small incisions can be safely covered with a waterproof plaster. Many patients will be allowed to shower between 24 and 48 hours after surgery so long as they don’t feel dizzy and their immune system is not compromised.
Open surgery is a different matter altogether. In this case, patients will usually need to wait until the stitches have been removed or will need to cover the incision securely (with a special plaster or film) before showering. If your knee is put in a plaster cast or splint after surgery, it will need to be kept dry at all costs. For the first six weeks following cruciate ligament surgery, you should not take long baths or go swimming as a rule, because prolonged contact with water will prevent the tissue from healing properly.
The guidelines for riding a bike are the same as for driving a car and will depend on the progress of your recovery. You should not go out cycling until you are able to control your bike. Ask your doctor for advice. After six to eight weeks, many patients will be able to start practising on an indoor bicycle, provided they are able to bend their knee sufficiently and without pain or discomfort. Many people are able to cycle on flat roads after about two months. However, you’ll need to be careful not to put too much pressure or strain on the new ligament structure, and you shouldn’t attempt uphill slopes for at least three months after surgery. The above guidelines are not set in stone. You should always consult your doctor first to discuss your individual case.
Lamentablemente no es posible indicar un plazo de tiempo que sea aplicable de forma generalizada. Depende de cada caso concreto y de la evolución de la recuperación. El conductor debe ser capaz de controlar el vehículo de forma segura sin que las consecuencias de la rotura de los ligamentos cruzados limiten esta capacidad. A menudo, los médicos y los seguros aconsejan esperar al menos de cuatro a seis semanas tras una operación de ligamentos cruzados antes de volver a conducir un coche, siempre que el estado de la rodilla lo permita. Por lo tanto, las personas afectadas deberían consultar a su médico antes de volver a ponerse al volante y, dado el caso, preguntar a su seguro.
Nowadays, surgery methods are fairly standardised, meaning that even “normal” patients are likely to receive the same quality of surgery as elite athletes. Recovery times are also comparable, though many people underestimate just how long it takes. After surgery for a cruciate ligament tear, you’ll need to allow sufficient time for the rehabilitation phase in particular before your knee is at full strength again. Two months of mandatory rehabilitation is not sufficient for this.
After their knee is surgically repaired, most people will need to do their exercises diligently and regularly for at least eight months to restore the strength in the affected leg. Talk to your doctor about the various exercises, sports or isolated muscle training routines – either at home or in the gym – that will best help your affected leg through each phase of recovery. These could include walking up slopes and doing sessions on a stepper. Both activities will build up your gluteus muscles, which play a significant role in stabilising your knees. Doing squats on one leg is also very helpful, but make sure your knee does not bend more than 60–70° in the process. Standing on tiptoes helps to build up your calf muscles, which also become weaker after surgery. Once you’ve recovered sufficiently to ride a bike, cycling in any form will help you stay mobile and will build strength in your knee.
You can even track your performance directly by measuring the circumference of the thigh. Is your sound leg larger? Then you still need to build up more muscle. Another positive sign is when your knee no longer swells up after using it. There are various classic cases in which cruciate ligaments are likely to tear, but you can reduce the chance of it happening to you by systematically building up your hip and gluteus muscles and exercising your thigh muscles (front and back).
The best way to avoid it is by training the right muscles. The stronger your muscles, the better they can relieve strain on your ligaments and stabilise your joints. In the event of an accident, strong muscles can – to a certain degree – protect your cruciate ligaments from tearing. Obviously, the muscles need to be tensed at the crucial moment. Athletes should always include special running, jumping, balance and strength exercises in their warm-up routines to stabilise their muscles.
This will always depend on your individual case and your doctor’s recommendations. There is no universal recommendation. But the fact is that if you engage in sports again too soon, you could injure the ligament again or damage your cruciate ligament reconstruction. Even when the rehabilitation phase is over, your knee will still be very sensitive and prone to reinjury. So don’t start too soon, and don’t try to do too much too quickly.
Cada fase debe acordarse con el médico responsable del tratamiento: tras un tratamiento de éxito deben realizarse primero ejercicios de movilidad lentos, como utilizar con precaución una bicicleta estática. Después de dos meses aproximadamente, está permitido montar en bici por trayectos llanos. Hasta el tercer mes deben evitarse las pendientes para no sobrecargar la nueva estructura de los ligamentos. Tras cuatro meses se puede empezar a correr con cuidado. Los deportes de contacto no deberían retomarse hasta pasados al menos seis meses.
Pacientes hablan de sus dolencias y experiencias
Jessica’s Genu Arexa story
Jessica’s anterior cruciate ligament was partially torn during a sudden braking manoeuvre when skiing. A few weeks later, she made a movement without thinking about it while dancing and ruptured the ligament completely. Since undergoing surgery, she has begun wearing the Genu Arexa knee brace. This allows her to move her injured knee in a controlled manner again and offers the best support for her recovery in combination with the "Genu Move" exercise programme.
La historia de Anna con la Genu Arexa
Anna siempre está activa, en el trabajo y, en particular, con su hijo de cuatro años. El pequeño tiene mucha energía y quiere probarlo todo. Además, a Anna le apasiona bailar. Entonces llegó el accidente de esquí, y Anna sufrió una rotura del ligamento cruzado. Gracias a la órtesis de rodilla con chasis rígido Genu Arexa, le ha sido posible recuperar con rapidez su vida diaria. Y pronto podrá volver a bailar también.
Julia’s Xeleton story
Julia had an accident in a climbing centre and injured her cruciate ligament. After undergoing multiple operations, she initially wore an immobilising brace. But when she was able to progress to the Xeleton rigid-frame knee brace, she was able to move her leg much more freely, which made everyday life significantly easier. Today, Julia uses the brace only when she feels she needs an extra level of protection – on the climbing wall or when skiing, for example.
Ottobock orthoses and supports for a cruciate ligament tear
The illustrated products represent treatment examples. Many different factors determine whether a product is actually suitable for you and whether you are capable of taking full advantage of the functionality of the product. Key aspects include your physical condition, fitness and a detailed medical examination. Your doctor or O&P professional will also decide which treatment is best suited to you. We’re here to support you.