One of the most common sports injuries is the cruciate ligament tear. No wonder, because most sports put a lot of stress on the knees. We asked Stuttgart orthopedist Dr. Christian Mauch about the causes and risks, as well as the consequences and options for treatment.
Why are cruciate ligament tears so common?
Dr. Mauch: Because of the growing popularity of extreme recreational sports and the continuously increasing demands on competitive athletes. The best example is skiers with carving skis that allow ever-increasing speeds.
The knee joint itself is particularly susceptible to injury because of its complicated ligament construction. An inner and an outer ligament, as well as an anterior and a posterior cruciate ligament, provide stability and mobility, but also make the joint vulnerable. Most often, the anterior cruciate ligament tears in a sports injury when the knee is hyperextended or twisted with the lower leg stationary.
What are the consequences of such an injury?
Dr. Mauch: Surgery and a ban on sports for a period of three to six months. This is because menisci and the cartilage in the knee joint are usually also damaged in a cruciate ligament injury. Proper treatment and regeneration are therefore particularly important.
How can I tell if the cruciate ligament is torn?
Dr. Mauch: The first signs of a serious knee injury are severe pain, swelling and bruising in the joint. However, it is almost impossible to make a definitive diagnosis of whether it is a tear on the spot. A 100 percent certainty is often only brought by the results of X-rays, magnetic resonance imaging and medical examination.
What are the first aid measures in the event of a cruciate ligament injury?
Dr. Mauch: First of all, immobilize the affected leg and take it easy. To combat swelling and relieve pain, the affected knee should be cooled with ice and stabilized with a pressure bandage. And then quickly to the doctor, because an effusion must be punctured.
If the cruciate ligament is torn, what can the doctor do?
Dr. Mauch: Cruciate ligament injuries can be treated both surgically and nonsurgically. However, I always recommend surgery for athletes and young people, as well as for people who have a physically demanding job.
Only in older patients who do not participate in sports or who already have significant cartilage damage do I advise against surgery. Without a cruciate ligament, cartilage damage (osteoarthritis) occurs sooner, and in athletic patients, the next accident can lead to further injury to the cartilage and meniscus.
Suppose you decide to have surgery. When is the right time to do it?
Opinions differ on this question. The literature describes that operating too early into the fresh injury can lead to scarring in the knee. Therefore, like many of my colleagues, I recommend immediate surgical intervention after the accident or after the initial swelling has subsided.
And how is the cruciate ligament tear then surgically repaired?
Dr. Mauch: The most common surgical method is cruciate ligamentoplasty (a new cruciate ligament). In this gentle and quick procedure, the damaged cruciate ligament is replaced with a piece of the patient’s own tendon, for example from the patellar tendon or the semitendinosus tendon. After about six weeks, the inserted piece of tendon is firmly fused to the bone.
Does the new tendon take over all the functions of the cruciate ligament?
Dr. Mauch: Yes, but only if intensive rehabilitation is followed after surgery. This is because the graft is still susceptible to new injuries during the first ten months. I therefore consider the follow-up treatment to be almost as important as the operation itself. I always urge my patients to do the same.
What is the advantage of this surgical method?
Dr. Mauch: It is very gentle for the patient. In fact, the entire procedure is performed arthroscopically, i.e., only through small incisions in the skin. The graft is removed through an incision about three to five centimeters long. The rest of the operation is performed without opening the joint. Through two small skin incisions, the joint is looked at from one side and worked on from the other side. The new ligament is inserted into the joint through drilled areas created in this way.
