Cruciate ligament tears

Causes and treatment options

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.
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. Despite these symptoms, cruciate ligament tears aren’t always immediately noticed. Nevertheless, a wobbly and unstable gait becomes apparent at the latest when the knee joint begins to bend away. With some patients, however, the knee joint remains functionally stable despite the presence of a cruciate ligament tear. These “coping patients” can compensate for the structural deficit with their muscles. The “non-copers” cannot compensate in this manner and therefore have a functionally unstable knee joint.

A tear in the anterior cruciate ligament is known as a “torn ACL”; the same injury in the posterior cruciate ligament is known as a “torn PCL.”

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.

Treating cruciate ligament tears

The goal of treatment is to relieve pain, stabilize the knee joint, and restore the patient’s ability to move normally.

First aid measures in the event of a cruciate ligament tear:

  • Elevate the leg
  • Apply a pressure bandage
  • Cool down the affected area

The choice of treatment depends on the degree of the injury and the extent to which the patient is athletically active. In the case of a posterior tear in a patient with a low level of athletic activity, targeted muscle toning alone might be sufficient to stabilize the knee joint. During the treatment period, special knee braces (orthoses) can be worn in order to relieve and stabilize the knee joint.

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. Surgery is usually performed around four to six weeks after the tear. Suturing torn cruciate ligaments usually isn’t very effective, which is why the cruciate ligament is replaced between the kneecap and the tibia (patellar tendon) by part of the tendon from the patellar tendon or the hamstrings. After surgery, physiotherapy is used to build up muscles in the thigh. The affected knee should not be exposed to maximum mechanical stress for around six to 12 weeks after surgery, which means a special orthosis can be used to provide additional support to the knee joint during this time.

Stabilizing the knee joint after a cruciate ligament tear

The knee joint can be very functionally unstable after an operation. Medical orthoses can be used to stabilize the knee joint and thus contribute to the healing process for those individuals who experience persistent pain in their knee joint or have undergone knee surgery. SecuTec® Genu is a functional orthosis that stabilizes the knee joint from the outside. It can be adapted to the individual needs of the wearer and is made of a light and stable material. Breathable non-slip pads ensure a secure fit on the leg. SecuTec® Genu is easy to put on, and there’s no pain involved when doing so: The knee orthosis is simply placed on the leg from the front, which means there’s no need to sharply bend the knee when it’s put on.SecuTec® Genu offers optimal comfort and outstanding functionality that enables patients to get back to their daily lives and move normally again. It combines the benefits of a support and orthosis. The SofTec Genu knee orthosis is equipped with “intelligent” side hinges that adjust automatically to the user’s individual axis of rotation. Mechanical stress on the knee is minimized and pain is relieved. This orthosis is therefore much appreciated by competitive athletes as well, since it helps them recover from their injuries quickly.