Anterior cruciate ligament tear

A tear of a cruciate ligament, frequently the anterior cruciate ligament, is among the most common injuries in sport and calls for highly specialised, individual treatment. Such tears usually arise through a twisting injury, frequently in the context of sporting activity, and the mechanism often involves no direct contact with an opponent. At the moment of the twisting injury, which typically occurs as valgus (knock-knee) stress with simultaneous inward rotation, enormous forces act on the anterior cruciate ligament.

If the ligament tears, the lower leg shifts forwards against the thigh. During this incomplete dislocation (subluxation), patients frequently sustain accompanying damage to the meniscus or the cartilage, as well as injuries to one of the two collateral ligaments. A precise analysis of the injury and a tailored treatment plan are essential, and are guided by the specific accompanying injuries, by sex and by the sporting activity level of the person affected.

The team at Sportklinik Freiburg carries out around 400 cruciate ligament procedures every year, which brings marked expertise, particularly in treating competitive and professional athletes

Athletes in particular are mostly unable to compensate for the instability, because of their high activity level, and generally do not return to their previous level of performance without a surgical reconstruction of the cruciate ligament. Alongside the question of the sporting activity level, the accompanying injuries are also of great importance in the decision to operate. Where there are meniscal or cartilage injuries immediately alongside the cruciate ligament rupture, or where the collateral ligaments are also unstable, surgery should be carried out. With non-surgical treatment, however, an increased risk of further injuries remains. The risk of a meniscal or cartilage injury rises by 1 % with every month without an anterior cruciate ligament. Where episodes of instability recur, this risk is considerably higher still. If such further injuries occur, the risk of early osteoarthritis rises significantly. The decision for or against an operation is therefore based on the sports played, the activity level, how pronounced the instability is and the accompanying injuries. Where patients have suffered no accompanying injuries, feel no instability and play no stop-and-go sports such as football, handball or basketball, non-surgical treatment can be a sensible option. If the aim is to return to these so-called level I sports such as football or handball, however, this is generally not possible without cruciate ligament surgery.

Surgical treatment with a cruciate ligament graft leads in most cases to a successful return to level I sports and lowers the risk of further injuries. The aim of the operation is to restore the original anatomy of the knee joint as well as possible. Today the semitendinosus or the quadriceps tendon are mainly available, and in rare cases the patellar tendon. In the arthroscopic technique, bone tunnels are made where the cruciate ligament formerly attached to the thigh and the lower leg. The tendon that has been taken is prepared so that it matches the natural cruciate ligament as closely as possible in length, diameter and strength. The graft is then introduced arthroscopically into the tunnels and fixed with special implants, so that it grows into the bone over the following months. This technique restores the original anatomy and function of the knee joint. Where there are meniscal injuries at the same time, these can generally be treated together with the cruciate ligament operation without difficulty and heal without consequence during rehabilitation (see meniscal injuries). The same applies to cartilage damage, although further factors have to be taken into account there (see "cartilage damage"). Accompanying injuries of the medial or lateral collateral ligaments are also treated at the same time where there is instability (see "collateral ligaments"). In competitive and professional athletes in particular, it has been shown that the risk of a further cruciate ligament rupture can be significantly reduced by an additional anterolateral stabilisation. In this procedure a strip of the iliotibial band is passed beneath the lateral collateral ligament and fixed to the thigh or the lower leg. After the operation, rehabilitation begins according to an individually tailored aftercare plan, developed in close cooperation with the physiotherapists. A plan adapted to the phase of healing, with regular testing, has proved its worth here. A return to sporting load is generally possible after about 9 months.