Diagnosis

The diagnosis in case of suspected anterior cruciate ligament rupture usually begins with a questioning by the doctor about the course of the accident. For children who are still too young, parents may have to answer the doctor’s questions. The anamnesis interview is followed by palpation of the joint by the examiner.

This procedure is quite uncomfortable for the young patients, as the knee is very sensitive to pressure due to the torn ligament. In order not to cause any pain to the children and to take away their fear of further examinations, extreme caution should be exercised during this procedure. It often helps if parents or familiar persons are present during the examination to calm the little ones down.

In addition to palpation of the injured area, there are movement tests which can quickly confirm the suspicion of a torn cruciate ligament. On the one hand, the drawer test is always performed.Here an attempt is made to move the lower leg forward against the thigh while the knee is bent. If the joint had not been injured or the ligaments intact, no displacement would be observed.

However, if a torn anterior cruciate ligament is present, the abnormal mobility causes a forward displacement, a so-called “front drawer” or a positive drawer test (also known as the Lachmann test). Similarly, the drawer test can also be performed for the posterior cruciate ligament. If the lower leg can be moved backwards, this is a sure sign of a defective rear cruciate ligament.

Another movement test is the “Pivot Shift Test”. For this test, the lower leg is turned inwards under pressure. If this results in a displacement of the tibia bone at the joint surface, this indicates a torn cruciate ligament.

The pivot shift test is positive. Once the patient’s medical history and movement tests have been completed, the diagnosis of a torn anterior cruciate ligament can be definitively verified using imaging techniques. X-rays are used primarily to examine whether bony structures are involved in the tear.

If this is the case, the X-ray image quickly shows that a piece of bone is missing that was torn out with the ligament. Isolated torn ligaments without damage to the boil can best be diagnosed using magnetic resonance imaging (MRI). An MRI image of the knee joint allows a radiologist to either directly determine the damage to the ligament or to determine the degree of injury based on the deviation of the femur backwards.

Magnetic resonance imaging is also most suitable for children because the young patients are not exposed to radiation (as is the case with X-rays), since the imaging is based on a magnetic field that is harmless to the body. The disadvantages of X-rays and magnetic resonance imaging are, however, that the children have to remain very quiet, but they find this quite difficult, especially in exceptional injury-related situations. Here too, it can be helpful if the parents are present at least before and after the examination.

During the actual examination, the parents can, with a few exceptions, not be present, as one should not expose oneself unnecessarily to X-rays. If X-rays and MRI cannot provide a clear diagnosis, the doctor will in rare cases resort to diagnostic arthroscopy. The main disadvantage of this procedure is the fact that it is performed under general anesthesia.

Although the operation is only minimally invasive, the risks are still higher than with magnetic resonance imaging or X-ray diagnostics. The advantage of arthroscopy, however, is that if the diagnosis of “anterior cruciate ligament rupture” is confirmed, the cruciate ligament can be restored under the same anesthesia immediately after arthroscopy. Therapeutic measures in the case of a cruciate ligament injury are usually based on the extent of the injury.

If there is a joint effusion, it may be necessary to puncture the joint. Joint puncture, i.e. piercing the swollen joint with a needle to drain off the blood that has flowed in, is particularly necessary if the effusion prevents healing or further treatment. After removal of the effusion, the subsequent therapy can be approached either conservatively or surgically.

Conservative: If the ligament is only overstretched or torn and no bones are affected, the injury can be treated conservatively, i.e. not surgically. Tears of the posterior cruciate ligament are also often treated conservatively. Immediately after the accident, it can be helpful to cool the knee and to apply as little weight as possible to prevent the symptoms from worsening.

During the rest period, the leg can be relieved with the help of forearm crutches. Medication with painkillers (analgesics) can be useful depending on the intensity of the pain, but should be taken after consultation with the doctor. If the injury has been in the past for a longer period of time, after the pain has subsided, lymph drainage is mainly used to remove the swelling and systematic muscle building in the thigh to stabilize the knee.

Physiotherapy and physiotherapy are also useful therapy options after the acute phase. Children are often difficult to treat conservatively, since depending on their age they may not even understand that they should not put any weight on the leg, for example. Furthermore, children should take as few medications as possible, so pain medication is also a critical point during conservative treatment.Surgical:If it is a complete tear, an operation of the joint should be considered, because the lack of stability in the joint can lead to the rubbing together of bones and the formation of arthrosis.

Nowadays, torn ligaments are no longer sutured but fitted with a graft. The transplant is either a piece of the hamstring tendon (patellar tendon) between the patella and the tibia or the semitendinosus tendon (tendon of a thigh muscle). The operation is performed minimally invasive under general anesthesia and takes about one hour.

The instruments and a camera are inserted into the joint through two very small incisions (approximately 5mm) in the knee. The transplant tendon is then fitted exactly into the knee joint and fixed in the bone with self-releasing (bioresorbable) screws. This minimally invasive procedure can reduce the duration of an inpatient hospital stay to a minimum.

After about 1-3 days, the patient can leave the clinic after a successful operation. For the treatment of children, the operation is the method of choice. After the anesthesia, the young patients do not notice anything of the treatment and in the period after the surgery they do not suffer from pain for a long time thanks to minimally invasive surgery.

After only two nights, the children can return home to their familiar surroundings. Follow-up treatment:Whether surgery or conservative therapy, a torn cruciate ligament splint should be worn to stabilize the leg and avoid secondary injuries caused by careless movements. Physiotherapy and physiotherapy are the most important points in the aftercare of a torn anterior cruciate ligament.

There are various physiotherapeutic exercises for children as well as for adults to strengthen the muscles and improve stability in the knee joint. Children can be introduced to many exercises, for example, exercises on a trampoline, in a playful way, which makes post-treatment extremely easy and can sometimes even be fun. Lymphatic drainage as a component of physiotherapy is useful, but can be difficult to carry out in children, as they must remain calm. Crutches for the relief of the leg are also difficult to use in children, because depending on their age, the little ones are either not yet able to use the crutches or are much too impatient to use them consistently. Parents should have a lot of patience with their children during this time to ease the difficult recovery phase.