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Diagnoses and symptoms

Cruciate ligament tear

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FirstSpiritExport,OBISCM-1557-B2B,media,orthetik,50k30
FirstSpiritExport,OBISCM-1557-B2B,media,orthetik,50k30
Summary

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

A mother holds one child while holding hands with another as they stroll outside through a field. The mother is wearing the Ottobock's C-Brace.
What is?

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.

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¿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).

Ruptur des vorderen Kreuzbandes
Ruptur des hinteren Kreuzbandes
Ruptur des Seitenbandes

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.

Ruptur des vorderen Kreuzbandes
Causes

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.

Ruptur des hinteren Kreuzbandes
Symptoms

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.

Ruptur des Seitenbandes
Terapia

¿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.

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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.

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Training

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.

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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.

Folleto

Exercises you can do at home – Genu Move

This brochure has muscle-strengthening exercises to do at home after an anterior cruciate ligament tear.
Preguntas frecuentes

Preguntas frecuentes en caso de rotura de los ligamentos cruzados

Volver a la vida cotidiana: en 3 pasos hasta la órtesis de Ottobock

  1. Aquí encontrará un resumen de las órtesis y correajes que pueden ser adecuados para usted. Lleve consigo esta lista la próxima vez que acuda al médico.
  2. Consulte a su médico cuál de las órtesis es la más adecuada para su cuadro clínico. Seguidamente, su médico le extenderá una receta para la órtesis correspondiente.
  3. Acuda con la receta a una ortopedia. Allí recibirá su nueva órtesis después de haberse adaptado con precisión a sus medidas corporales.
Historias

Pacientes hablan de sus dolencias y experiencias

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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.

Solutions

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.