Rupture (tear) of the anterior cruciate ligament (ACL)
The need for treatment must be determined on an individual basis, taking into account age, athletic exertion, symptomatology, other diseases, and many other factors. The results after conservative therapy are hardly worse than with surgical reconstruction, even in patients who participate in sports.
Surgical ACL reconstruction is considered the therapeutic gold standard for regaining stability and improving knee function. However, the results after conservative therapy are hardly worse than with surgical reconstruction even in patients who participate in sports.
It is likely that conservative (wait-and-see) treatment is an appropriate treatment option for patients without high athletic demands and concomitant injuries. However, surgical ACL reconstruction seems to be associated with a higher gain in function compared with conservative therapy.
Indications for surgical therapy see below.
The time between diagnosis and reconstruction of a ruptured anterior cruciate ligament determines the arthrosis rate: after an interval of six months, the arthrosis rate was 11.7%; after 18 months, 21.6%; and after 36 months, 45.3%.
Rupture of the posterior cruciate ligament (ACL)
Not every torn posterior cruciate ligament requires surgery. A posterior cruciate ligament (ACL) rupture that is recognized right away can be treated with a posterior tibial support (PTS) splint. The PTS splint is a splint for the lower leg with a calf cushion. It pushes the lower leg forward in relation to the upper leg and thus supports the fusion of the parts of the injured cruciate ligament. The splint must be worn for a total of 6 weeks, both during the day and at night. For surgical therapy, see below under PCL replacement surgery (PCL = posterior cruciate ligament).
1st order
- Intraligamentous suture/transosseous refixation (for bony avulsion with screw) for fresh cruciate ligament rupture.
- Cruciate ligamentoplasty (minimally invasive by arthroscopy/arterioscopy) for old cruciate ligament rupture, chronic joint instability Procedure: Replacement of the old, torn ligament with a new, autologous (endogenous) graft: posterior cruciate ligament (PCL) replacement surgery:
- Standard grafts (most commonly used):
- Tendon of the semitendinosus muscle (muscle of the back of the thigh) or
- Part of the patellar tendon (the connection between the kneecap and the tibia).
- In selected cases:
- Tendon of the gracilis muscle (muscle of the back of the thigh) or
- Part of the quadriceps tendon (a muscle group of the front thigh).
- In exceptional cases: Donor grafts
- Standard grafts (most commonly used):
This must be followed by immobilization of the knee joint, then increasing mobilization. After discharge from inpatient treatment about 2 weeks partial loading on forearm supports and for 6 weeks wear a movable knee brace. This stabilizes the knee during the healing phase and provides protection in everyday life.
Surgical therapy is mainly given in the following factors:
- Instability of the knee joint – anatomic differences such as tibial reclination (physiologic backward bending of the proximal end of the adult tibia/tibia) and femoral morphology (morphology of the femur) may affect knee stability after injury
- Complex ligamentous ruptures
- Bony involvement
One-third of sufferers achieve good results with muscle training. One-third must limit their activities. Complications occur in one third.
Start with sports: the general rule is to take a break for 6 to 9 months after the cruciate ligament rupture. If necessary, perform muscle function testing to determine appropriate timing.
