Cruciate ligament tear: symptoms and treatment

Kreuzbandriss: Ursachen, Symptome und Behandlung

A torn cruciate ligament is one of the most common sports injuries. And its symptoms are relatively clear to diagnose. However, the choice of treatment – with or without surgery – depends on various factors.

Symptoms of a cruciate ligament tear

It feels and sounds like a soft crack of a whip. This is why patients often clearly recognise the moment a cruciate liga­ment tears. In most cases, the diagnosis is clear, as the patient immediately feels strong pain. In some cases, however, a cruciate ligament tear only becomes noticeable later.

If you have any of these symptoms, see a doctor immediately:

  • Strong acute pain
  • Instability in the knee (buckling outwards, unsteadiness when walking)
  • In some cases, a tearing or shifting sensation

The doctor will test the stability of the knee. An X-ray or MRI will also be conducted. These tests will provide a relatively quick indication of whether one or more ligaments are partially or even completely torn.

Diagnosing a cruciate ligament tear. Is surgery necessary?

Luckily no. Whereas 30 years ago about 80% of cruciate ligaments were ope­ra­ted on, today around 50% of patients can initially do without surgery. In some cases, a cruciate ligament tear is treated completely conservatively, i.e. without any surgery at all. In other cases, surgery is not performed until later.

Whether cruciate ligament surgery is advisable depends on whether there are any concomitant injuries (e.g. a collateral ligament tear) Also important is how active and how old the patient is.

What do the cruciate ligaments do?

Together with the muscles, the cruciate ligaments form the connection between the upper and lower leg. Effectively, they hold the knee together and limit its range of motion.

The anterior cruciate ligament

The anterior cruciate ligament ensures that the shin doesn't slide forward when we bend our knee. The cruciate ligament comes under strain when the lower leg is fixed, but the upper leg rotates. These are precisely the situations that, in the worst case, can cause the anterior cruciate ligament to tear. This happens most often in ball sports, winter sports and martial arts, which is why it is a common sports injury. The anterior cruciate ligament doesn't usually tear alone. Often menisci or collateral ligaments are also injured.

The posterior cruciate ligament

Of the two, the posterior cruciate ligament tears much less frequently than the anterior. In most cases, this occurs when force is exerted on the front of the leg, i.e. on the shin. If «only» the posterior cruciate ligament is torn, an operation is often not necessary. The posterior cruciate ligament has a much better blood supply than the anterior and therefore better chances of healing.

Causes of a cruciate ligament tear

Human ligaments and tendons can withstand the load of tremendous forces and masses. Nevertheless, there are situations where these forces are so extreme that, if the knee twists at the same time, the cruciate ligament tears.

A cruciate ligament tear is more likely in the case of:

  • Lack of or inadequate awareness of the actions of one’s body, technically known as proprioception: the ability of a person to sense their body’s posture and movements.
  • Lack of control when muscles and nerves interact during dynamic movements.
  • Dynamic misalignment of the knee: the knee buckles inward when loaded or the knee and hip bend too little after landing from a jump.
  • Previous injuries.
  • Muscular imbalance: when the anterior thigh muscle is too strong in relation to other leg muscles, for example.
Other risk factors

But there are other factors over which we have no influence, such as cold and bad weather, that can contribute to a cruciate ligament tear. Other risk factors are the female gender and age, i.e. under 20 years.

How to avoid a cruciate ligament tear

It is not only important to have strong muscles to avoid knee pain and a torn cruciate ligament. Research shows that a cruciate ligament tear occurs less often when athletes take preventive action:

  • Warm-up training
  • Torso stability training
  • Proprioceptive training
  • Jump training
  • Strengthening all the leg muscles

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