The anterior cruciate ligament has the function of stabilizing the knee joint. It supports rotational movements and forward movement. If the anterior cruciate ligament is torn, the knee becomes unstable. Furthermore, secondary damage can occur to the cartilage and menisci.
What is an anterior cruciate ligament tear?
Impacts of force can tear the cruciate ligament. It may be torn or completely ruptured. A tear of the anterior cruciate ligament occurs separately or is part of a larger knee injury. As a result of the tear, the knee is painfully swollen and has limited mobility. A feeling of instability and unsteadiness develops. The damaged cruciate ligament can cause buckling away events. Typically, the thigh and lower leg then shift uncontrollably against each other. In some sufferers, the symptoms do not develop until later, with sustained loading. Typically, anterior cruciate ligament tears are often sports injuries. High-motion sports with many changes of direction can lead to a cruciate ligament rupture.
Causes
The most common cause of anterior cruciate ligament rupture is extreme twisting trauma to the knee joint. This rotation in the joint with the lower leg stationary can cause multiple injuries in the knee. In addition to the anterior cruciate ligament tear, there may be damage to the collateral ligaments and other associated injuries to the cartilage and menisci. An anterior cruciate ligament tear always results from an unusual overload and force applied to the knee joint. It has then been exceptionally stretched, bent or twisted. An anterior cruciate ligament tear does not need any external impact. It can already occur when the femur is violently overstretched. Since very strong forces are required, previous damage can often play a role. For example, the cruciate ligament may have been slightly torn for some time, or cartilage may only be present in a degenerated form. A blow from the front can also tear the anterior cruciate ligament. Soccer, skiing or martial arts are known to cause such injuries. The “unhappy triad,” an unfortunate combination of three forms of injury, also frequently occurs. Then, in addition to the anterior cruciate ligament, the medial collateral ligament and medial meniscus of the knee are also affected.
Symptoms, complaints and signs
An anterior cruciate ligament tear is usually associated with significant and prolonged pain that persists even at rest. In most cases, affected individuals can self-diagnose a cruciate ligament tear because normal movement is no longer possible. Even the smallest movements cause great pain, so a visit to the doctor should not be put on the back burner. Only with appropriate treatment and care can an existing cruciate ligament tear be restored. In many cases, even a surgical intervention is possible to ensure a complete and timely recovery. However, anyone who forgoes a visit to the doctor at this point must reckon with a significantly more difficult course of the disease. Under certain circumstances, even permanent consequential damage can occur, which cannot be subsequently remedied. In many cases, there is severe swelling in the area of the affected knee. These swellings can be perceived by the human eye without any problems. At the latest when such a swelling occurs, an appropriate physician should be consulted immediately. Thus, the following applies: An anterior cruciate ligament tear must always be treated by a doctor, with medication or even as an inpatient. Otherwise, there will be significant complications that can not be repaired quickly.
Diagnosis and course
Schematic representation of healthy cruciate ligaments and the different forms of cruciate ligament rupture. Click to enlarge. Very important for accurate diagnosis of anterior cruciate ligament tear is thorough clinical examination. An experienced physician should not only determine the tear. Furthermore, the extent of instability is also very important. Movement tests can be used to make an initial tentative diagnosis. However, since the knee joint often cannot be moved completely in the case of an anterior cruciate ligament tear, the examination is more difficult. The doctor depends on the patient to describe the accident to him as precisely as possible. To get a more detailed picture, the doctor can perform a puncture of the knee joint.To do this, he pricks the bent knee with a needle. The fluid drawn off is then examined in detail. It is determined whether there is evidence of a ligament injury. Magnetic resonance imaging (MRI) provides certainty as to whether it really is an anterior cruciate ligament tear. It makes the anterior cruciate ligament visible and also allows concomitant injuries to be identified. The progression of the condition is influenced by the patient’s age, activity level, and the timing of diagnosis or initiation of appropriate therapy. If the anterior cruciate ligament tear is consistently treated conservatively or surgically, there is a good chance of regaining full functionality. However, the leg muscles must be well exercised on a permanent basis.
Complications
If an anterior cruciate ligament tear is treated promptly, no major complications usually occur. However, with inadequate physical therapy and in older patients, a rupture can lead to premature joint wear. Chronic pain, limited range of motion, and other secondary symptoms result from osteoarthritis. Problems can also occur during cruciate ligament surgery. In some cases, for example, bleeding, joint infections, thrombosis, or injuries to the nerves, muscles, or vessels occur. Postoperative complications also cannot be ruled out. Occasionally, movement restrictions or loosening of the graft occur after cruciate ligament surgery. In isolated cases, meniscal damage or fracture of the patella occurs. Permanent instability remains only in exceptional cases. If the patient takes painkillers, this is always associated with certain risks and side effects. In addition to typical complaints such as headaches or skin irritations, an allergic reaction to the drug can rarely occur. If the drug is taken over a long period of time, the internal organs, especially the kidneys, liver and heart, are also increasingly stressed. Sometimes addictive behavior also develops or the patient experiences withdrawal symptoms after discontinuation.
When should you see a doctor?
If health irregularities occur after a twisting motion, accident, or force is applied to the knee, a physician should be consulted. If there is discomfort in the knee area after a severe overuse, it is also advisable to clarify the symptoms. A doctor is not required if relief from the symptoms is already apparent within a few minutes or within half an hour. In these cases, sufficient relief and rest should be provided. If freedom from symptoms is achieved after a short time, there is no need for further action. However, if the knee can no longer be loaded as usual despite sufficient rest, if swelling develops or if the joint movement can no longer be performed as usual, medical consultation is necessary. Irregularity of movement or inability to move must be investigated and treated. Pain, discoloration of the skin appearance as well as discomfort when performing only small movements indicate an existing disorder of the joint. A doctor must be consulted to clarify the extent. If the appearance of the foot is already associated with discomfort, the affected person needs medical care. The symptoms should be understood as warning signals of the organism. To avoid further complications, no further stress should be put on the body.
Treatment and therapy
The first therapeutic measure for anterior cruciate ligament rupture is to stabilize the joint. Immediately after the accident, the leg must be spared and elevated. Furthermore, cooling makes sense and the application of a pressure bandage. A doctor can prescribe various painkillers and anti-inflammatory drugs for the pain or inject them directly. Cold therapy and physiotherapy are used as conservative therapy methods. The exact form of therapy depends on the extent of clinical and subjectively experienced instability. If the patient has only a low level of stress and little instability, a non-surgical treatment method may be sufficient. Special strength and coordination training for the affected knee is recommended. For very sedentary patients, children and adolescents, an anterior cruciate ligament replacement, a surgical procedure, is recommended. This can prevent recurrent buckling events as well as secondary damage.Surgery can only be performed after a period of rest, when the knee has completely swollen up again. During surgery, the torn anterior cruciate ligament is replaced by the patient’s own tendon graft. The medial femoral flexor tendons are often used for this purpose. General surgical risks occur but are very rare with this method.
Prevention
To prevent anterior cruciate ligament rupture, a thorough warm-up of the muscles before any sporting activity makes sense. Coordination exercises are also recommended. Other preventive measures include well-trained leg muscles, prudent athletic behavior and appropriate sports equipment. If the anterior cruciate ligament is treated surgically, the inserted graft requires several months to grow firmly into the bone. Athletes must therefore wait about six months before they are allowed to put full weight on the affected knee again.
Aftercare
Aftercare for an operated cruciate ligament begins immediately after the operation. During this process, the patient rests and cools the knee to counteract swelling and pain. Stretching the knee is also important, which is why a motor splint is usually used. It moves and stretches the joint in a passive manner. Wearing a knee brace for up to six weeks is also recommended. It ensures that the knee cannot be bent more than 90 degrees during this period. In the first weeks of rehabilitation, the load and scope of the exercises are adapted to the current condition of the knee. First and foremost, the thigh muscles such as knee extensors and knee flexors, which are extremely important for the stability of the knee, are strengthened. At first, the patient may only tense and relax the muscles. As he progresses, he also performs knee bends. Use of a bicycle ergometer, a leg press or performing aqua jogging are considered useful training measures. The patient will learn from the physiotherapist which measures are best suited for him individually.
What you can do yourself
If there is a suspicion of an anterior cruciate ligament tear, the affected leg must first be immobilized and rested. Against the pain and any swelling help cold packs or ice spray. The affected leg must then be stabilized with a bandage. Accompanying this, a doctor’s appointment must be arranged. Immediately after the operation, cooling and rest apply. Passive stretching of the joint can be achieved by means of a motorized splint. The most important self-help measure is regular physiotherapy. A physiotherapist must accompany the entire follow-up treatment so that the intensity of the training can be adapted to the current condition of the knee. As soon as the anterior cruciate ligament tear has healed as far as possible, gentle exercise can be started, such as swimming or aqua jogging. Excessive strain should be avoided. To promote muscle coordination, coordination exercises are also recommended 15 to 25 days after the operation, which can be performed independently after an introduction by a doctor. Blood circulation in the affected joint is stimulated by cold-warm showers and loose movements. Lastly, uncontrolled movements must be avoided. At the same time, an inflammation-reducing diet must be followed. The diet includes fresh vegetables, fish and saturated fats, while wheat should be replaced with millet or oats.
