SPORTS ORTHOPAEDICS
Cruciate ligament rupture: Diagnosis, treatment and rehabilitation strategies
It’s a moment that many competitive athletes know only too well: An unexpected change of direction or an awkward fall — and there it is, a sharp pain runs through the knee.The suspicion is that it could be a cruciate ligament rupture. The diagnosis quickly confirms what many fear: The anterior or posterior cruciate ligament is injured. Such injuries are particularly stressful for active athletes, as they severely restrict mobility and can mean a long break from training . This is where the expertise of your trusted sports orthopaedist in Berlin comes into play to provide you with effective support.
The most important facts in brief
- A cruciate ligament rupture often occurs due to sudden changes of direction and falls during sport.
- The diagnosis is made through clinical tests and is confirmed with an MRI.
- Conservative treatment includes physiotherapy, orthoses and pain therapy.
- Surgery is required if the knee remains unstable or if there are additional injuries.
- Rehabilitation takes place in several phases and usually lasts six to twelve months.
What is a cruciate ligament rupture?
A cruciate ligament tear, also known as a cruciate ligament rupture, is a complete or partial tear of the ligaments responsible for the stability of the knee joint. The anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL) cross in the middle of the knee and stabilize the joint during flexion and extension. An intact ACL is crucial for the control and stability of the knee, especially during rotational movements and abrupt stops, which often occur in sport.
Typical Symptoms of a cruciate ligament rupture include
- Audible popping sound at the moment of injury
- Rapid swelling within a few hours
- Noticeable instability or “wobbling” of the knee joint when standing or walking
- Pain in the knee that increases with movement or strain
- Limited range of motion, especially when fully extending or bending the knee
Diagnostics
The diagnosis of a cruciate ligament rupture is made in several steps and combines clinical examinations with imaging procedures.
Clinical examination
First, a sports physician checks the stability of the knee using specific tests:
- Lachman-Test: assessment of anterior cruciate ligament stability using a passive shift of the lower leg
- Pivot shift test: examination of the rotational stability of the knee
- Anterior and posterior drawer: test to check stability during forward and backward movements of the lower leg
Imaging procedures
Usually Magnetic resonance imaging (MRI) is performed to precisely assess the injury. This procedure provides detailed images and makes it possible to differentiate between partial and complete rupture of the cruciate ligament. It is also possible to determine whether other structures such as meniscus or collateral ligaments are affected.
If there is a pronounced joint effusion or hematoma, a puncture to relieve the pressure can be considered.
Treatment options
For a stable partial rupture of the cruciate ligament conservative treatment can be considered. This includes several initial measures:
- Traumeel infiltration and Kinesio tape to support healing
- Pain medication (NSAIDs, depending on tolerance) to relieve pain and inflammation
- Stabilizing orthosis to control movement
- PRP injections (for stable partial rupture to promote healing)
Additionally, Intensive physiotherapy (12 to 18 sessions) is also recommended:
- Manual therapy (MT) for mobilization
- Physiotherapy (KG) to restore function
- Physiotherapy on equipment (KGG) to strengthen the stabilizing muscles
It is also necessary to take a break from sport and adapt to the load, whereby jerky movements and jumping sports should be avoided for at least three months. Joint stability can be improved through targeted proprioceptive training.
A surgery is necessary, if the following criteria are met:
- Active sportsmen and sportswomen with high loads: In sports involving rapid changes of direction, jumping or heavy loads (e.g. soccer, basketball, skiing), surgery is often advisable. Without the anterior cruciate ligament, the knee can become unstable, which increases the risk of consequential damage such as meniscus tears or osteoarthritis.
- Feeling of instability in everyday life: If the knee remains unstable despite conservative treatment, surgery is usually necessary to restore stability.
- Combined injuries: If there is additional damage such as a torn meniscus or injuries to the collateral ligaments, surgery is often recommended.
If the anterior cruciate ligament is completely torn, an ACL plasty is performed using a tendon graft, usually using the semitendinosus/gracilis or quadriceps tendon. The operation is performed at Sankt Gertrauden Hospital by Dr. Pouria Taheri.
Rehabilitation strategy
An effective rehabilitation strategy is crucial to regaining full knee function and avoiding long-term damage. The healing process takes place in several stages, with each stage involving specific measures to gradually improve the stability and resilience of the knee:
- Phase 1 (0–6 weeks): Partial weight bearing with orthosis, lymph drainage, pain management and passive mobilization to reduce swelling and maintain mobility
- Phase 2 (6–12 weeks): Increased weight-bearing, controlled movement and targeted muscle development to stabilize the knee
- Phase 3 (3–6 months): Proprioceptive training, running training and functional training to improve joint stability under dynamic conditions
- Phase 4 (from 6 months): Sport-specific training with targeted movement sequences; depending on stability and stress tests, possible clearance for contact sports
The time frame for returning to sport varies and should be determined on an individual basis. This usually takes at least six to twelve months. During this time, it is ensured that the knee is sufficiently strengthened and functional stability has been restored. Close cooperation with therapists and trainers ensures that the re-entry is gentle and safe. Test runs and sport-specific movement sequences help to evaluate the knee’s readiness for use.
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