Torn ACL

Cruciate ligament tear: Description

In a cruciate ligament rupture usually the anterior cruciate ligament in the knee joint is injured, more rarely the posterior cruciate ligament. The affected cruciate ligament may tear completely or only partially.

Both cruciate ligaments have the task to stabilize the knee, to limit his movements and to protect against contortions. They run crosswise in the interior of the joint from the femur (femur) to the tibia (tibia). In addition to the two cross straps, the inner and outer straps also stabilize the complicated knee joint.

Anterior cruciate ligament

The four-centimeter-long and ten-millimeter-wide anterior cruciate ligament twists particularly in the knee flexion, thus preventing an advance of the tibia compared to the thighbone. It consists of two shares. The anterior portion attaches to the middle of the tibia at the front, while the posterior portion is located at the outer portion of the posterior articular surface of the tibia. Both parts unite for common anchoring in the posterior, inner area of ​​the outer articular process of the femur.

Anterior cruciate ligament injury (such as a cruciate ligament tear) is the most common ligament injury to the knee joint, followed by isolated injury to the inner ligament. Those affected are usually between 20 and 30 years old, physically active and male in more than two thirds of the cases. Only in rare cases (ten percent) does an anterior cruciate ligament tear occur in isolation. In about half of the cases, the meniscus is additionally damaged.

In about a quarter of cases, the anterior cruciate ligament is torn and not completely interrupted.

Posterior cruciate ligament

The posterior cruciate ligament is considered the most stable of the four knee ligaments. It consists of two strands: one anchored to the anterior, outer femoral articular surface, while the second strand attaches to the middle of the thighbone at the back. Together, both strands pull to the back of the tibia. The posterior cruciate ligament prevents thrusting of the tibia backwards.

A posterior cruciate ligament tear is less common than an anterior cruciate ligament rupture and often happens during exercise. Then it is often an isolated injury (no accompanying injuries). If, on the other hand, a traffic accident is the cause of a posterior cruciate ligament tear, further fractions of the knee are usually injured.

Cruciate Ligament Tear: Symptoms

Everything important to the typical signs of a cruciate ligament tear read in the article cruciate ligament tear: Symptoms.

Cruciate Ligament Tear: Causes and Risk Factors

Sports and car accidents are the most common reasons for one anterior cruciate ligament tear, In sports, the injury often happens when putting on the ground with sudden braking with the knee in knee extension as in a jump. By such a fall, the knee is involuntarily braked, bent and turned outwards. An anterior cruciate ligament tear thus classically occurs as a result of an abrupt braking movement with simultaneous rotation in the knee. The risk is mainly for football and skiing.

Complex injuries often occur in an anterior cruciate ligament tear: The rupture is accompanied by an injury to the inner meniscus and / or the inner ligament. In violation of all three structures one speaks of an “unhappy triad”, the “unfortunate threesome”.

One posterior cruciate ligament tear is usually the result of external violence as in sports or car accidents. By forcibly countering with a bent knee, the posterior cruciate ligament is overstretched and torn. Even with strong rotational movements and a lateral Aufklappdruck on the knee joint, the rear cruciate ligament can tear. Most of the time, other parts of the knee are also damaged.

Cruciate ligament tear: examinations and diagnosis

The specialists for a cruciate ligament rupture are orthopedists, accident surgeons and sports physicians. First, the doctor will ask questions such as:

• How did you hurt yourself?
• When did the accident happen?
• Did you hear a noise during the accident?
• Could you still go after that?
• In which movements do you have particular pain?
• Have you ever injured your knee before?

From the description of the accident, the doctor may be suspected of a cruciate ligament tear, especially if the knee joint is swollen. If the anterior cruciate ligament is torn, sufferers report a pop noise during the accident. Afterwards they could not go anymore. Rupture of the posterior cruciate ligament, on the other hand, is less frequently accompanied by a noise.

Physical examination and tests

Then the doctor examines the injured knee and performs stability tests, gait and balance tests. Important tests to detect ACL injury (such as ACL tear) are the drawer test, the Lachman test, and the pivot shift test. So the patient lies on the back with the injured leg in the drawer test at 45 degrees hip flexion and 90 degrees knee flexion. If the doctor can now push the lower leg in the knee joint forward like a drawer over the thigh (front drawer test), there is an injury to the anterior cruciate ligament (such as an anterior cruciate ligament tear). If an excessive displaceability of the lower leg relative to the thigh to the rear is possible (rear drawer test), this indicates damage to the posterior cruciate ligament.

In addition, the doctor checks blood circulation, motor skills and sensitivity in the affected area (DMS test) and the range of motion of the injured knee compared to the healthy opposite side. For example, knee flexion is reduced by up to 20 degrees in the knee due to altered biomechanics. However, shortly after the accident, the flexion can not always be tested because the knee is usually hurts and swollen as a result of the bruise. Then you have to wait a few days.

imaging

With the help of the X-ray examination, it can be clarified whether there is additionally a bony injury in the knee area or a bony band tear. The cruciate ligament tear itself can not be recognized on the X-ray image. This requires a different imaging technique, such as magnetic resonance imaging (MRI). It shows whether the affected cruciate ligament is completely torn or only torn.

Cruciate ligament tear: treatment

First aid measures in case of suspected cruciate ligament rupture should follow the PECH rule (rest, ice, compression, supine). Stop exercising, put your leg up, cool your knee (ice, cryospray, etc.) and apply a pressure bandage. Common painkillers help against severe pain.

The doctor can treat a cruciate ligament surgery conservatively or surgically. This depends, for example, on the type and severity of the injury (cruciate ligament tear or complete tear, isolated injury or with accompanying injuries, etc.). Individual factors are also taken into account in therapy planning, for example the age of the patient, his sports ambitions and the extent of knee-loading activities (for example at work). For example, a cruciate ligament rupture is more likely to be operated in younger patients who are very active in sports than in older patients who are less active and are hardly exposed to greater knee loads.

Cruciate Ligament Tear: Conservative Treatment

Immobilization and stabilization of the knee in a splint is the first step in conservative treatment for a cruciate ligament tear. Duration of immobilization is several weeks. This is followed by intensive physiotherapy. It is important to strengthen the thigh muscles in order to stabilize the knee joint. The patient should gradually move and strain the injured knee gradually. The quality of physiotherapy is crucial for the stability and function of the knee joint after a cruciate ligament tear. Knee instability due to poor treatment may otherwise be the result.

ACL-Op

Everything important about the operative treatment can be found in the article Kreuzband-Op.

Cruciate Ligament Tear: Disease Course and Prognosis

After a cruciate ligament rupture, there are rarely complications such as bleeding, joint infections, thrombosis, nerve and vascular injuries. The long-term results after a cruciate ligament tear are good in most cases – both in surgical and conservative treatment. Consistent physiotherapy is very important in both cases, so that the joint does not wear too soon (osteoarthritis). The risk of osteoarthritis is also increased if the full range of motion in the knee joint can not be achieved by the therapy. For a good late result, it is important to regularly train the muscles regularly (especially the thigh muscles).

To prevent torn ACL, you should warm up your muscles well before exercising. Those who improve their coordination skills through jump training and running training also reduce the risk of injury.

If necessary, after a successfully treated cruciate ligament tear also knee-straining sports such as football or skiing are possible again. However, it should be remembered that the knee is after a Torn ACL not as stable as before.