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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.

Table of con­tents

The most impor­tant facts in brief

What is a cru­ci­ate lig­a­ment rup­ture?

Diag­nos­tics

Treat­ment options

Reha­bil­i­ta­tion strat­e­gy

Con­clu­sion

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.

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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

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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.

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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:

  1. Man­u­al ther­a­py (MT) for mobi­liza­tion
  2. Phys­io­ther­a­py (KG) to restore func­tion
  3. 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.

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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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A cru­ci­ate lig­a­ment rup­ture can have a sig­nif­i­cant impact on an athlete’s life, but with the right diag­no­sis, treat­ment and reha­bil­i­ta­tion strate­gies, a suc­cess­ful recov­ery As sports med­i­cine spe­cial­ist in Berlin at sportsmed.berlin, we attach great impor­tance to offer­ing our patients the best pos­si­ble care. The goal is com­plete func­tion­al recov­ery with opti­mum sta­bil­i­ty for sport­ing and every­day activ­i­ties!

Con­clu­sion

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