Pic of torn acl. ACL Tear: Causes, Symptoms, and Treatment Options
What are the common causes of ACL tears. How can you recognize the symptoms of an ACL injury. What treatment options are available for ACL tears. How long does ACL recovery typically take. Can ACL tears be prevented through proper training and conditioning.
Understanding the Anterior Cruciate Ligament (ACL)
The anterior cruciate ligament (ACL) is a crucial component of the knee joint, playing a vital role in maintaining stability and proper function. Located in the center of the knee, the ACL connects the femur (thighbone) to the tibia (shinbone), preventing excessive forward movement of the tibia and providing rotational stability to the knee.
ACL injuries are common among athletes and active individuals, often resulting in significant pain, instability, and impaired knee function. Understanding the anatomy and function of the ACL is essential for recognizing potential injuries and seeking appropriate treatment.
ACL Anatomy and Function
- Location: Central portion of the knee joint
- Structure: Bundle of strong, fibrous tissue
- Primary functions:
- Prevent anterior tibial translation
- Provide rotational stability
- Limit hyperextension of the knee
Common Causes of ACL Tears
ACL tears can occur due to various mechanisms, often involving sudden changes in direction, abrupt stops, or direct impact to the knee. Understanding these causes can help individuals take preventive measures and reduce their risk of injury.
Are certain sports associated with a higher risk of ACL tears? Indeed, sports that involve rapid changes in direction, jumping, and pivoting movements are more likely to result in ACL injuries. Some high-risk sports include:
- Basketball
- Soccer
- Football
- Skiing
- Gymnastics
Common mechanisms of ACL injury include:
- Sudden deceleration combined with a change in direction (cutting maneuver)
- Landing from a jump with the knee in an extended position
- Pivoting with the foot planted firmly on the ground
- Direct contact or collision to the knee, especially from the side
- Hyperextension of the knee joint
Recognizing the Symptoms of an ACL Tear
Identifying the signs and symptoms of an ACL tear is crucial for seeking timely medical attention and preventing further damage to the knee joint. While symptoms may vary in severity, there are several common indicators that suggest an ACL injury has occurred.
Do ACL tears always cause immediate pain and swelling? In most cases, individuals experience a combination of the following symptoms immediately after the injury:
- A loud “pop” or “snap” sound at the time of injury
- Severe pain in the knee, often described as sharp or stabbing
- Rapid swelling of the knee joint within the first few hours
- Instability or a feeling of the knee “giving way”
- Limited range of motion and difficulty bearing weight on the affected leg
- Tenderness along the joint line
It’s important to note that some individuals may experience only mild discomfort initially, with symptoms worsening over time. Seeking medical evaluation promptly, even if symptoms seem minor, is essential for accurate diagnosis and appropriate treatment.
Diagnostic Procedures for ACL Injuries
Accurate diagnosis of ACL tears is crucial for determining the appropriate treatment plan and ensuring optimal recovery. Healthcare providers employ various diagnostic techniques to assess the extent of the injury and rule out other potential knee problems.
Can ACL tears be diagnosed through physical examination alone? While physical examination is an important component of the diagnostic process, it is often combined with imaging studies for a comprehensive evaluation. The diagnostic process typically involves:
- Physical examination:
- Lachman test: Assessing anterior tibial translation
- Pivot shift test: Evaluating rotational instability
- Anterior drawer test: Checking for excessive forward movement of the tibia
- Imaging studies:
- X-rays: To rule out fractures or other bone abnormalities
- Magnetic Resonance Imaging (MRI): Provides detailed images of soft tissues, including ligaments, tendons, and cartilage
- Ultrasound: May be used to assess ligament integrity and detect fluid accumulation
- Arthroscopy: In some cases, a minimally invasive surgical procedure may be performed to directly visualize the ACL and surrounding structures
Treatment Options for ACL Tears
The treatment of ACL tears depends on various factors, including the severity of the injury, the patient’s age, activity level, and overall health. While some individuals may benefit from non-surgical management, others may require surgical intervention to restore knee stability and function.
Is surgery always necessary for ACL tears? Not all ACL injuries require surgical intervention. The decision to pursue surgical or non-surgical treatment is based on individual factors and should be made in consultation with a healthcare provider. Treatment options include:
Non-surgical Management
- RICE protocol (Rest, Ice, Compression, Elevation)
- Physical therapy to improve strength, flexibility, and stability
- Bracing to provide support and limit potentially harmful movements
- Activity modification to avoid high-risk movements
- Pain management through medications or other modalities
Surgical Treatment
ACL reconstruction surgery is often recommended for athletes, young individuals, and those with significant knee instability. The procedure typically involves:
- Graft selection: Using either autografts (from the patient’s own tissue) or allografts (from a donor)
- Arthroscopic surgery: Minimally invasive technique to remove the damaged ACL and prepare the knee for graft placement
- Graft fixation: Securing the new ligament in place using various fixation methods
- Post-operative rehabilitation: Crucial for restoring strength, stability, and function
Rehabilitation and Recovery Process
Regardless of the chosen treatment approach, rehabilitation plays a critical role in the recovery from ACL injuries. A comprehensive rehabilitation program aims to restore knee function, improve strength and stability, and prevent future injuries.
How long does ACL recovery typically take? The recovery timeline can vary significantly depending on the treatment approach and individual factors. Generally, patients can expect:
- Non-surgical treatment: 3-6 months for return to normal activities
- Surgical reconstruction: 6-12 months for full recovery and return to sports
Key components of ACL rehabilitation include:
- Range of motion exercises
- Strengthening exercises for the quadriceps, hamstrings, and surrounding muscles
- Balance and proprioception training
- Functional exercises specific to the patient’s goals and activities
- Gradual return to sport-specific drills and activities
Adherence to the rehabilitation program and close follow-up with healthcare providers are essential for achieving optimal outcomes and minimizing the risk of re-injury.
Prevention Strategies for ACL Injuries
While not all ACL injuries can be prevented, implementing certain strategies can significantly reduce the risk of experiencing an ACL tear. Prevention programs focus on improving neuromuscular control, strengthening key muscle groups, and enhancing overall biomechanics.
Can ACL tears be prevented through proper training and conditioning? While complete prevention is not always possible, targeted training programs have shown promising results in reducing ACL injury rates, particularly among athletes. Effective prevention strategies include:
- Neuromuscular training:
- Plyometric exercises
- Balance and proprioception drills
- Agility training
- Strength training:
- Focus on quadriceps, hamstrings, and core muscles
- Emphasis on proper form and technique
- Flexibility and mobility exercises
- Proper warm-up routines before physical activity
- Education on proper landing and cutting techniques
- Use of appropriate footwear and playing surfaces
Implementing these prevention strategies as part of regular training routines can help reduce the risk of ACL injuries and promote overall knee health.
Long-term Implications of ACL Injuries
Understanding the potential long-term consequences of ACL injuries is crucial for patients and healthcare providers alike. While many individuals successfully return to their pre-injury level of activity following treatment and rehabilitation, ACL injuries can have lasting effects on knee function and overall quality of life.
Do ACL injuries increase the risk of developing osteoarthritis? Research has shown that individuals who have experienced ACL injuries are at an increased risk of developing osteoarthritis in the affected knee, even after successful treatment. This risk is influenced by various factors, including:
- Severity of the initial injury
- Presence of associated injuries (e.g., meniscus tears, cartilage damage)
- Quality of surgical repair and rehabilitation
- Individual factors such as age, genetics, and activity level
Long-term implications of ACL injuries may include:
- Increased risk of re-injury or injury to the contralateral knee
- Development of post-traumatic osteoarthritis
- Persistent knee instability or weakness
- Reduced participation in high-impact activities or sports
- Potential need for additional surgeries or interventions in the future
To mitigate these long-term risks, it’s essential for individuals who have experienced ACL injuries to:
- Maintain a regular exercise routine focusing on knee strength and stability
- Engage in low-impact activities to promote joint health
- Maintain a healthy body weight to reduce stress on the knee joint
- Attend regular follow-up appointments with healthcare providers
- Be vigilant for signs of osteoarthritis or other knee problems
By understanding and addressing the potential long-term implications of ACL injuries, patients can take proactive steps to maintain optimal knee health and function throughout their lives.
Advances in ACL Treatment and Research
The field of ACL treatment and research is continuously evolving, with ongoing efforts to improve surgical techniques, enhance rehabilitation protocols, and develop novel approaches to ligament healing and regeneration. These advancements aim to improve patient outcomes, reduce recovery times, and minimize the long-term consequences of ACL injuries.
What are some promising developments in ACL treatment? Several innovative approaches and technologies are currently being investigated or implemented in clinical practice:
- Improved surgical techniques:
- All-inside ACL reconstruction: Minimally invasive approach with potentially faster recovery
- Double-bundle ACL reconstruction: Aims to more closely replicate native ACL anatomy and function
- Individualized graft placement: Utilizes advanced imaging and computer-assisted navigation for optimal graft positioning
- Biological augmentation:
- Platelet-rich plasma (PRP) therapy: May enhance healing and reduce recovery time
- Stem cell therapies: Potential to promote tissue regeneration and improve graft integration
- Growth factor treatments: May accelerate healing and improve ligament strength
- Advanced rehabilitation protocols:
- Blood flow restriction training: May enhance muscle strength gains while minimizing joint stress
- Virtual reality-based rehabilitation: Improves engagement and provides real-time feedback
- Accelerated return-to-sport protocols: Carefully designed programs to expedite safe return to athletic activities
- Tissue engineering and regenerative medicine:
- Development of bioengineered ligament grafts
- Exploration of scaffolds and biomaterials to enhance ligament healing
- Investigation of gene therapy approaches to promote ligament regeneration
These advancements in ACL treatment and research hold promise for improving patient outcomes and potentially revolutionizing the management of ACL injuries in the future. As research progresses, it’s essential for healthcare providers and patients to stay informed about emerging treatment options and their potential benefits.
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Arthroskopische Ansicht eines kurzen Längsrisses des hinteren. ..
Arthroskopische Ansicht eines kurzen Längsrisses (Eimergriffriss) des hinteren Teils des medialen Meniskus des rechten Knies, der Schmerzen, Schwellungen und Verfängungen verursacht. Der Riss befindet sich im weiß-weißen Bereich des Meniskus ohne Blutgefäße. Somit heilt es nach einem Reparaturvorgang nicht ab und stattdessen wird eine Teilresektion mit einem Meniskus-Ovalkorbstempel durchgeführt, der (durch einen anteromedialen Port) in das Gelenk eingeführt wurde. Das Bild wurde mit einem 4mm 30 Grad Arthroskop aufgenommen.
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Lateral collateral tear 3d medical vector infographic isoliert. ..
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Mediale Knieverletzungen.
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arthroskopische ansicht des komplexen bruchs des diskidenseitigen meniskus – acl tear stock-fotos und bilder
Arthroskopische Ansicht des komplexen Bruchs des…
Arthroskopische Ansicht eines komplexen Risses des lateralen Meniskus des rechten Knies, der Schmerzen, Schwellungen und Fang verursacht. Die Form des Meniskus ist halbdiskoid, breiter als normal und nähert sich eher der Form einer Scheibe als der üblichen Halbmond- oder C-Form. Es wird als anatomische Variante erkannt und wird durch das Versagen der Entwicklung der Form von der Scheibe zur C-Form während der Kindheit verursacht. Die Variante wird in 3-5 % bei MRT-Untersuchungen (von Erwachsenen) beobachtet. Der Bruch befindet sich im zentralen “überflüssigen” Teil des (halbdiskoiden) Meniskus. So sieht der Meniskus nach einer Resektion der gerissenen Teile normaler aus. Das Bild wurde mit einem 30 Grad 4mm Arthroskop aufgenommen, das im interkondylären Raum durch die Patellasehne (schwedisches Portal) platziert wurde. Text (Etiketten) wurde dem Bild hinzugefügt, um die Verwendung durch einen Designer zu erleichtern, der möglicherweise kein Mediziner ist. Eine Kopie desselben Bildes ohne den Text wurde in derselben Serie aufgenommen.
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Arthroscopic Blick auf die Vertriebenen bucket Griff Träne der. ..
Arthroskopische Ansicht eines verschobenen Eimergriffrisses des medialen Meniskus, der eine Verriegelung des (rechten) Knies verursacht. Der Chirurg versucht, den verschobenen Teil des Meniskus – den Eimergriff – (durch Drücken) mit einer Hakensonde zu reduzieren. ACL, vorderes Kreuzband; PCL hinteres Kreuzband; MFC, medialer Femurkondylus.
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Infografik Behandlung Methode rheumatoide Arthritis
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Verletzter Fußballspieler drückt sich in der Umkleidekabine an…
Verletzter Fußballspieler drückt sich in der Umkleidekabine den Oberschenkel
vorderes und hinteres kreuzband – acl injury stock-fotos und bilder
Vorderes und Hinteres Kreuzband
knie antomy – acl injury stock-fotos und bilder
Knie antomy
Konzept der Knieschmerzen für Männer
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Junge Frau trägt ein Korsett während der Rehabilitation mit ihr…
kleines mädchen berührt kniechirurgie narbe ihres vaters /acl, pcl/ – acl injury stock-fotos und bilder
Kleines Mädchen berührt Kniechirurgie Narbe ihres Vaters /ACL,. ..
Kleines Mädchen hilft ihrem Vater, der nach einer Knieoperation im Bett liegt
isolierte frau berührt rechtes kniegelenk – acl injury stock-fotos und bilder
Isolierte Frau berührt rechtes Kniegelenk
knieschmerzen. vordere kreuzbandverletzung. meniskus. acl. – acl injury stock-fotos und bilder
Knieschmerzen. Vordere Kreuzbandverletzung. Meniskus. Acl.
Knieschmerzen. Verletzung des vorderen Kreuzbandes. Meniskus.
asiatische frau patientmit mit bandage kompression kniespange unterstützung verletzungen auf dem bett im pflegekrankenhaus. – acl injury stock-fotos und bilder
Asiatische Frau Patientmit mit Bandage Kompression Kniespange…
frau hält ihr verletztes knie – acl injury stock-fotos und bilder
Frau hält ihr verletztes Knie
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Knie Verletzung/ACL, PCL /
nahaufnahme von fußgelenkschmerzen – acl injury stock-fotos und bilder
Nahaufnahme von Fußgelenkschmerzen
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Magnetresonanztomographie oder MRT Knie sagittale PDW und TIW…
konzept der knie-schmerzkrankheit. hände auf bein als verletzung von arthritis, gicht oder infektionen. – acl injury stock-fotos und bilder
Konzept der Knie-Schmerzkrankheit. Hände auf Bein als Verletzung…
schwere muskelkrampf – acl injury stock-fotos und bilder
Schwere Muskelkrampf
Eine männliche Person mit einem schweren Muskelkrampf
hand von asiatischen frau patient sitzen auf dem bett im krankenhaus versuchen, kniespange unterstützung nach tun hinteren kreuzband-operation tragen. – acl injury stock-fotos und bilder
Hand von asiatischen Frau Patient sitzen auf dem Bett im…
magnetresonanztomographie oder mrt-knievergleich sagittal pdw und tiw ansicht zum nachweis von riss oder verstauchung des vorderen kreuzbandes (acl). – acl injury stock-fotos und bilder
Magnetresonanztomographie oder MRT-Knievergleich sagittal PDW. ..
3d isometrische flache vektor konzeptuelle illustration von knieproblemen – acl injury stock-grafiken, -clipart, -cartoons und -symbole
3D Isometrische flache Vektor Konzeptuelle Illustration von…
3D-isometrische flache Vektor-Konzeptdarstellung von Knieproblemen, entzündlicher Arthritis und Osteoporose, Gelenkentzündung
knieschmerzen schmerzen – acl injury stock-fotos und bilder
Knieschmerzen schmerzen
asiatische senior oder ältere alte frau patient liegen mit verband kompression kniespange unterstützung verletzung auf dem bett in derkrankenpflege krankenhaus. – acl injury stock-fotos und bilder
Asiatische Senior oder ältere alte Frau Patient liegen mit…
acl knieverletzungbehandlung, rehabilitation und physiotherapie – acl injury stock-fotos und bilder
ACL Knieverletzungbehandlung, Rehabilitation und Physiotherapie
Junger Mann, der sich während der Rehabilitation nach einer Knieverletzung einer ACL-Physiotherapie unterzieht
starke knieschmerzen – acl injury stock-fotos und bilder
Starke Knieschmerzen
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3D männliche Figur in laufender Pose auf dunkelblauem Hintergrund
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magnetresonanztomographie oder mrt-knievergleich sagittal pdw und tiw ansicht zum nachweis von riss oder verstauchung des vorderen kreuzbandes (acl). – acl injury stock-fotos und bilder
Magnetresonanztomographie oder MRT-Knievergleich sagittal PDW…
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Junges Mädchen nach Orthopädischer Betrieb
asiatische frau patientmit mit bandage kompression kniespange unterstützung verletzungen auf dem bett im pflegekrankenhaus. – acl injury stock-fotos und bilder
Asiatische Frau Patientmit mit Bandage Kompression Kniespange…
knie anatomie – acl injury stock-grafiken, -clipart, -cartoons und -symbole
Knie Anatomie
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Schmerzen im Knie eines Mannes. Verletzung des Knies im Athleten.
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Acl. Schmerzen im Knie eines Mannes. Verletzung des Knies im…
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Arthroskopische Ansicht des rechten Knies mit einem verschobenen…
knie anatomie – acl injury stock-fotos und bilder
Knie Anatomie
patient steht auf krücken in krankenhaus station ware kniespange unterstützung nach tun hinteren kreuzband operation, bandage auf knie der asiatischen frau auf krücken.healthcare und medizinisches konzept. – acl injury stock-fotos und bilder
Patient steht auf Krücken in Krankenhaus Station Ware Kniespange…
konzept der knie-schmerzkrankheit. womanâs hands auf dem bein als verletzung von arthritis, gicht oder infektionen. – acl injury stock-fotos und bilder
Konzept der Knie-Schmerzkrankheit. Womanâs Hands auf dem Bein…
linkes knie mit der zeichnung der patella – acl injury stock-fotos und bilder
Linkes Knie mit der Zeichnung der patella
lateral collateral tear 3d medical vector infographic isoliert auf weißem hintergrund – acl injury stock-grafiken, -clipart, -cartoons und -symbole
Lateral collateral tear 3d medical vector infographic isoliert…
meniskustränen – acl injury stock-grafiken, -clipart, -cartoons und -symbole
Meniskustränen
filmröntgen der normalen gelenke und bänder des menschlichen knies medizinisches bildkonzept. – acl injury stock-fotos und bilder
Filmröntgen der normalen Gelenke und Bänder des menschlichen…
chirurg wickelt elastische bandage um das knie des patienten nach der operation im operationssaal – acl injury stock-fotos und bilder
Chirurg wickelt elastische Bandage um das Knie des Patienten…
behandlungskonzept für menschliche kreuzbandverletzung. orthopäde zeigt kreuzband in einem knie-gelenk medizinische unterrichtsmodell, nahaufnahme – acl injury stock-fotos und bilder
Behandlungskonzept für menschliche kreuzbandverletzung. Orthopäde
acl knie-verletzungen – acl injury stock-fotos und bilder
ACL Knie-Verletzungen
op-team mitten in kniegelenkersatz-op – acl injury stock-fotos und bilder
OP-Team mitten in Kniegelenkersatz-OP
menschliches knie anatomie – acl injury stock-grafiken, -clipart, -cartoons und -symbole
Menschliches Knie Anatomie
Anatomie des menschlichen Kniegelenks. Vektor
Cruciate ligament rupture: surgery, rehabilitation, costs
- Causes and course of the disease
- When is cruciate ligament rupture surgery necessary?
- What happens before the operation?
- How is the operation carried out at the Gelenk-Klinik?
- Which doctor specializes in surgical treatment of cruciate ligament rupture?
- Probability of success after cruciate ligament rupture surgery
- What kind of anesthesia is used during the operation?
- Postoperative care, rehabilitation and aids after cruciate ligament rupture surgery
- Will I feel pain after the operation?
- Conditions of stay at the Gelenk Clinic
- What should I pay attention to after the surgical treatment of cruciate ligament rupture?
- Cost of knee surgery
- How to make an appointment and for the operation itself for a foreign patient?
Clearly centered image of the anterior and posterior cruciate ligaments in the knee joint. The cartilaginous surfaces and menisci on the side of the tibia are indicated in purple. Stretching or injury to the cruciate ligament can occur due to dislocation or impact. The complete destruction of this component of the knee is called a cruciate ligament tear. © Istockphoto.com/MedicalArtInc
In the center of the knee joint, two ligaments intersect and hold the femur (Femur) and tibia (Tibia) together and hold them in position. Due to the rupture of one or two cruciate ligaments, the knee joint becomes unstable. Rupture of the anterior cruciate ligament is observed in patients most often. The causes of injury are injuries sustained after sports training, such as a dislocation of the knee joint during skiing or a collision during sports with a ball.
When the cruciate ligament is torn, the knee is very swollen and the victim feels severe pain. In most cases, the disease is accompanied by a click or crackle, during which you feel a jerk in the knee joint. After that, the mobility of the patient’s knee is limited. In order to stabilize the knee again and prevent arthrosis of the knee joint, the orthopedist can either suture the cruciate ligament or replace it with a tendon graft.
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Causes and course of the disease
Rupture of the anterior cruciate ligament is usually obtained after playing sports. Often, the outward deviation of the lower leg puts a load on the anterior cruciate ligament , which makes it easier to tear. The following situations are typical for this injury:
- violent side impact with an opponent while playing football
- overextension of the knee joint
- sudden braking at full speed
- sudden change of direction at full speed
- bad landing after a jump or spin
A typical accident is when an opponent is hit on the knee while playing football. In addition, cruciate ligament rupture occurs when skiing, after a fall, followed by dislocation and overstretching of the lower leg.
As a rule, the patient already feels the tear during the fall. The injury is often accompanied by the characteristic click of a stretched and damaged cruciate ligament. The gap occurs only under a significant force impact. The cruciate ligament can usually withstand 2400 kg. loads. However, its strength can vary: in women, the diameter of the cruciate ligament is much smaller. Therefore, they suffer from this disease much more often. In children, the Segonda fracture is more common – an avulsion fracture of the condyle of the tibia.
A torn posterior cruciate ligament requires more force than an anterior cruciate ligament tear. Injuries of this magnitude are usually observed during traffic accidents, for example, when a knee joint hits a car interior. Therefore, injuries of the posterior cruciate ligament are much less common, namely, only in 7-10% of all cases.
When is cruciate ligament rupture surgery necessary?
The course of a healthy posterior cruciate ligament from the front side of the thigh to the posterior articular surface of the tibia. © Radiopedia.org
Same patient: The anterior cruciate ligament is not visible due to a tear.© Radiopedia.org
If conservative treatment fails or does not bring the desired result, and if the patient is young and active, surgical reconstruction is the best solution in order to maintain the patient’s quality of life and sports activity. In addition, the operation must be performed in case of a rupture of more than 75% of the cruciate ligament or in case of separation of the ligament with a bone fragment.
A cruciate ligament tear needs to be treated promptly. Otherwise, within a few years you will have other injuries in the knee joint. The articular surfaces and menisci will be subjected to excessive stress, which can lead to premature wear, damage to the articular cartilage, and after 10-15 years to arthrosis of the knee joint. Often, due to the existing instability of the cruciate ligament, the meniscus is also torn.
In 80% of cases, cruciate ligament rupture causes damage to other structures of the knee joint:
- Tearing of the internal meniscus (69% probability)
- Tearing of the outer meniscus (49% probability)
- Articular cartilage injuries (probability 20-50%)
- Secondary arthrosis of the knee joint due to limited functionality of the meniscus
- Injuries of internal ligaments (often)
- Injuries of external ligaments (less common)
- Rupture of the articular capsule of the knee joint
What happens before the operation?
Before the operation, the doctor performs a comprehensive clinical examination. First, all the circumstances of the injury and the degree of instability of the knee are clarified. Thus, the specialist receives information about the degree of rupture. Unfortunately, the diagnosis is often made several years after the injury, as patients do not attach much importance to this and consider this injury as a simple sprain.
In the presence of strong thigh muscles, the diagnosis is usually not made as part of a clinical examination and surgery is not considered. However, over time, the patient feels discomfort in the knee joint. The cause of arthrosis can be an injury, as a result of which the cartilage is damaged. Very often, problems of the knee joint appear only after a few years, and only then the patient notices some instability while climbing stairs or during rotational movements, after which he feels severe pain in the knee.
In addition to diagnosing the degree of instability of the knee, cruciate ligament rupture is determined using special techniques such as the anterior drawer test (PVT), the Lachman test, or the lateral slip test (McIntosh test).
The Lachman test helps to establish the stability of the cruciate ligaments. The test is carried out according to the principle of the anterior drawer (AT), but also involves 30 ° knee flexion. © joint-surgeon
In addition, the condition of the cruciate ligaments is determined by MRI. X-rays are required to rule out bone associated injuries of the knee joint. Also, a joint puncture helps to make a diagnosis – aspiration of synovial fluid from the joint capsule. The cruciate ligaments have a good blood supply. Therefore, their rupture causes hemorrhage into the joint. The presence of blood in the joint fluid indicates a rupture of the cruciate ligament.
After diagnosing and checking the patient’s state of health, the attending physician conducts an explanatory conversation with the patient, during which he talks in detail about the course of the surgical intervention, as well as possible complications. After that, you will be directed to an appointment with an anesthesiologist, who will once again check whether your state of health allows you to inject anesthetics. As a rule, cruciate ligament rupture surgery is performed the next day after talking with the surgeon and anesthetist.
How is the operation at the Gelenk-Klinik?
The lateral or medial ligaments of the knee joint may suddenly fuse. This self-healing process does not extend to the anterior and posterior cruciate ligaments. © ttsz, iStock
As a result of acute injuries, it is possible to operate only after the concomitant diseases have been cured and the wound has completely healed. For this reason, the reconstruction of cruciate ligaments is carried out approximately 2-3 months after the injury itself. During this period, the mobility of the knee joint is severely limited. Physiotherapy helps prepare the knee for surgery.
Cruciate ligaments differ in structure from other ligaments of the knee joint: in case of ruptures of the external and internal collateral ligaments, immobilization of the joint with a special orthosis can contribute to the sudden healing of the injury. The cruciate ligaments do not have a similar self-healing effect. As a rule, operations on the cruciate ligaments are performed in order to restore their functionality.
Surgery usually takes 1.5 – 2 hours. During the operation, surgeons perform tendon grafting or suture. Which of the methods is right for you, you need to discuss with your doctor.
Cruciate ligament replacement and tendon grafting
The most common surgical technique is cruciate ligament replacement surgery. During this intervention, the surgeon first completely removes the damaged ligament in order to prepare the patient for transplantation. To receive a transplant, the doctor takes parts of autogenous tendons from other parts of the knee joint. As a rule, the operating doctor uses the patella ligament, which is located between the patella and the tibia, for this.
The advantage of autologous tendon transplantation is certainly the absence of body rejection, since the transplant is obtained from the patient’s own body, namely from the patellar tendon and Achilles tendon. After completion of the process of transplantation in the femur and lower leg bone with the help of special bone screws, after some time, the tendon graft is well absorbed by the body and begins to be supplied with blood vessels.
The only disadvantage of this intervention is the feeling of pain in the leg, namely in the place where the graft was taken. The patient may feel discomfort for several months. Extraction of the tendon also slows down the development of physical strength. However, this fact is only important for athletes. After the operation, the patient expects long physiotherapy sessions and specialized training.
In addition, the operation does not contribute to the restoration of the innervation process, which is of great importance for the coordination of movements. In professional sports, this is considered a disadvantage, but for most patients this fact does not matter much.
Cruciate ligament suturing by refixation of damaged structures
The anterior cruciate ligament tears much more frequently than the posterior cruciate ligament. Only 7-10% of all injuries involve the posterior cruciate ligament. © janulla, iStock
Modern procedures make it possible to preserve endogenous cruciate ligaments even after their rupture. The aim of plastic surgery with method Ligamis , offered by our clinic since the beginning of 2014, is to restore the stability of the knee joint – in accordance with natural functions. Using this system, the surgeon replaces the torn ligament with an artificial implant, which during the recovery period is responsible for the mechanical stabilization of the damaged cruciate ligament in the very center of the knee joint. In this case, the torn parts grow together again and heal under the influence of the implant. If this technique is successful, the patient will not need cruciate ligament plasty with endogenous tendons.
The result after Ligamis surgery is much better than after autologous tendon transplantation, since after refixation all nerves are preserved and thus the process of controlling the movements of the knee joint remains normal. Athletes should pay attention to the choice of the method of operation.
Since refixation of the tendon graft does not require donor material, there is no need for material sampling, accompanied by pain and muscle weakness in the area of graft extraction. Already a few days after re-fixation, the patient can load the knee in full.
Before referring the patient for cruciate ligament refixation surgery, a three-dimensional MRI examination is required. After that, the decision should be made as soon as possible, since after more than 3 weeks after the injury, the self-healing ability of the cruciate ligament decreases. Thus, this surgical intervention is recommended during the exacerbation of the gap, namely within three weeks after the injury. Otherwise, only transplantation can help the patient.
The Ligamis implant is usually removed by our highly qualified specialists 6-9 months after the successful healing of the cruciate ligament. During the extraction of the implant, the healing process is also checked.
Which doctor specializes in surgical treatment of cruciate ligament rupture?
At the Orthopedic Medical Center Gelenk-Klinik in Germany, the relationship of trust between patient and medical staff is highly valued. Your orthopedic doctor will accompany you from the first meeting with him until the postoperative period. He also takes care of the patient. Thus, you will have a responsible person to whom you can contact at any time. Specialists for the treatment of diseases of the knee joint and cruciate ligament rupture at the Gelenk-Klinik are Dr. Baum, prof. Dr. Ostemeier Privatdozent Dr. med. Dr. Markvas.
Probability of success after cruciate ligament surgery
Cruciate ligament surgery is very successful and in 90% of all cases leads to a complete recovery of the knee joint. Almost all patients return to normal activities, and professional athletes can resume training. This intervention is performed in our clinic quite often. Therefore, our highly qualified surgeons have many years of experience in the surgical treatment of this injury.
What type of anesthesia is used during the operation?
Cruciate ligament surgeries are usually performed under general anesthesia. However, doctors sometimes consider spinal anesthesia to avoid the risk of general anesthesia. To do this, the anesthesiologist injects an anesthetic into the spinal canal of the lumbar spine. In this case, the patient is fully conscious. The anesthesiologists at Gelenk-Klinik have many years of experience in performing such surgeries. Which of the above methods corresponds to your indicators is decided during an explanatory conversation.
Postoperative care, rehabilitation and aids after cruciate ligament rupture
In the first days after cruciate ligament rupture, the knee is immobilized with a Mecron knee brace that stabilizes the limb in the 0° position. For further healing, we use a rigid 4-point sports-functional low-profile orthosis of increased strength, which allows you to control the process of flexion and extension of the knee. In order to avoid unnecessary stress on the knee, you are given special crutches supported by the elbow. During this process, thrombosis prophylaxis with heparin and enoxaparin is mandatory. In addition, until you fully recover, you must wear compression stockings. We will be happy to make sure that you receive all the necessary funds on time..
Will I feel pain after the operation?
Every surgical intervention can cause pain. No exception and the operation to treat a rupture of the cruciate ligament of the knee joint. Thanks to the high professionalism and long-term experience of our surgeons, we manage to reduce the patient’s pain to a minimum. Before the operation, the anesthesiologist makes a special injection that anesthetizes the knee joint for approx. for 30 hours. After that, the pain subsides and the patient’s treatment continues with conventional medications. The goal of the medical staff of the Gelenk-Klinik is to ensure a painless postoperative period for the patient
Stay at Gelenk-Klinik
Single room at the Gelenk-Klinik in Gundelfingen, Germany. © joint-surgeon
During your inpatient stay at the clinic, you are in a single room with a shower and toilet. Towels, bathrobe and slippers are provided in each room. In addition, you can use the safe, mini bar and watch TV. Please bring your own medication, comfortable clothing and nightwear. After surgery, your condition is monitored around the clock by medical staff and professional physiotherapists. As a rule, you stay in the clinic for no more than three days. Your relatives can stay in a hotel, which is located near the medical center. We will gladly take care of your hotel reservation.
What should I pay attention to after surgical treatment of cruciate ligament rupture?
Immediately after cruciate ligament tear surgery, the knee should be in an elevated position. In addition, a cooling compress should be applied to the knee. Approximately 10 days after the operation, the stitches are removed, after which you can take a shower.
To avoid possible complications, the knee should be at rest for approximately 6 weeks. At this time, you are issued a sick leave and elbow crutches are issued. Prevention of thrombosis during the impossibility of full loads on the knee is a necessary procedure. To prevent the loss of muscle mass and preserve the natural functions of the knee joint, a course of physiotherapy is carried out.
You can plan your return flight home no sooner than 10 days from now. However, we recommend that you leave the clinic after at least two weeks.
- Inpatient care: 3-4 days
- Recommended hospital stay: 10-14 days
- When to book a return ticket: 10 days after operation
- Recommended time to leave the clinic: after 2 weeks
- When you can take a shower: after 10 days
- How much sick leave is issued: 6–8 weeks (depending on professional activity)
- When stitches are removed: after 10 days
- Outpatient physiotherapy: 2 weeks
- When you are allowed to drive again: after 6 weeks
- Light sports activity: 3-6 months after surgery
- Habitual sports activities: after 9 months
Cost of knee surgery
In addition to the cost of surgery, cruciate ligament rupture, additional costs for diagnostics, medical appointments and aids (e. g. elbow crutches) must be taken into account, which amount to approximately 1,500 to 2,000 euros. If you plan to undergo physical therapy after the operation, we will prepare a cost estimate for you and send it to you by e-mail.
Information about the cost of staying at the hotel, as well as possible additional treatment, you can find on the website of the service provider.
How to make an appointment and for the operation itself for a foreign patient?
First, you will be asked to provide up-to-date MRI images as well as the results of an X-ray examination. Thus, the doctor will be able to assess the condition of the knee joint. After we receive all the necessary documents through our website, we will send you a preliminary treatment plan and cost estimate within 1-2 days.
Orthopedic Medical Center Gelenk-Klink provides foreign patients with the opportunity to make an appointment in a short time. We will be happy to assist you with obtaining a visa, after the advance payment indicated in the preliminary cost estimate is received on our account. In case of refusal to grant a visa, the advance payment will be returned in full.
For patients from abroad, we try to reduce the time between the preliminary examination and the operation itself. Thus, you will not need to come to the clinic several times. During both outpatient and inpatient treatment, you will be accompanied by qualified medical staff who speak several foreign languages (English, Russian, Spanish, Portuguese). We also provide assistance in finding an interpreter (for example, into Arabic), which is paid by the patient on a separate basis. We will be happy to assist you in arranging a transfer, finding a hotel and suggest how interesting it is to spend your free time in Germany for you and your family members.
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20 iconic torn crosses in NBA history – Blogg on the floor – Blogs
Another knee injury rocked the NBA world – Rajon Rondo tore his anterior cruciate ligament. He is not the first and, unfortunately, he is not the last to tear up the “crosses”. It is believed that at the present time there are more such injuries than before; but thanks to modern medicine, cruciate ligament rupture no longer means the end of a career, as it was in the 80s, and the athlete returns to the floor in 6-8 months. In fact, there have been various examples in history.
The history of problems with “crosses” can only be traced back to the early 80s, and we have very accurate data on injuries since the 1990s. In the old days, almost all injuries of the knee, and even more so of the ligaments of the knee, were considered in a single vein. “When I played, we never heard of such a thing. Meniscus tear – yes, but there was never any talk of cruciate ligaments, ”said Elgin Baylor, who broke his kneecap and ended his career due to an Achilles injury, but did not encounter injuries of the “crosses”. Perhaps in the past there were indeed fewer torn knee ligaments, and it is believed that not only increased loads, but also high-top sneakers that support the ankle, may be to blame for this. Kareem Abdul-Jabbar stated that he does not wear such sneakers for this very reason. “You usually recover from a sprained ankle. I would not want the load to be transferred to the knee.”
Below are 20 of the most famous examples of NBA players tearing crosses. Let’s start with those who managed to return.
Bob Lanier
Perhaps the first recorded case of torn crosses was an injury to Bob Lanier, which the center suffered in college, shortly before the 1970 draft. Despite this, Detroit selected him 1st overall. While signing with the Pistons, Lanier was still wearing a cast on his leg. Bob spent the first five seasons without injury, and although he then had to undergo 7 more different operations on his knee (don’t forget that these were the 70s), Lanier had a brilliant career, getting into the Basketball Hall of Fame as a result.
After the Crosses: 14 seasons (959 games), 7 All-Star Games.
Walter Davis
There’s another reason why Phoenix fans hate the Lakers: it was on LAL’s home court during a 1984 preseason game that Walter Davis tore his cruciate ligaments in his knee. The parquet of the legendary “Forum” was slippery that evening, and an unsuccessful fall put the driven swingman out of action for a long time: a complete rupture of the posterior cruciate ligament, a partial rupture of the anterior cruciate and internal lateral. However, Davis returned at the end of the 84/85 season, and at 1987, he designed his last, sixth appearance at the NBA All-Star Game. Davis did not even lose in scoring after the injury, and in 1986/87 he set a personal record for minutes played in a season.
After the Crosses: 7 seasons (504 games), 1 All-Star Game.
Bernard King
King became the first player in NBA history to go to an All-Star Game with an ACL replacement. Of course, the injury took a toll on his career: Bernard led the NBA in scoring when a horrific injury forced him to re-link. Now technology has reached a new level, and the ligament for such purposes is borrowed from other parts of the body, and then, at 1985, King had to open the joint and stretch the tendon to make a new ligament. Because of such a complex operation, Bernard missed two years. The Knicks weakened, Ewing came to them from the draft, and the history of the NBA in New York spun in the other direction. Injuries made themselves felt in the future, and one can only wonder how history would have turned for King and the NBA without that unfortunate story, but the fact remains that on a newly built on the technologies of the Stone Age, King scored 28.4 points on average when he was already 34 years old.
After the Crosses: 4.5 seasons (334 games), 1 All-Star Game.
Danny Manning
Like King, Manning was unable to reach his full potential due to health problems. But if Bernard became the first All-Star on one knee, Manning became the first star to have ligament replacements in both knees. “First, strength returns, and only then confidence,” Manning himself claimed immediately after his return. A couple of years after these statements, he was already playing in the All-Star Game.
Since the Crosses: 12.5 seasons (859 games), 2 All-Star Games.
Ron Harper
A year after Manning’s injury in 1989, his teammate Ron Harper tore the crosses. Just as King consoled Manning and promised that he could play at a high level, Danny helped Ron with advice: “I told him to be patient. It was impossible to understand exactly what he was going through, but I could guess. Surprisingly, it was thanks to the injury that Harper became what we remember him now – after all, he turned from a flying super-athlete-sniper into a team player focused on the game of passing. This is exactly what Phil Jackson needed from him to successfully three-pit and later return the cups to LA.
After the “crosses”: 10.5 seasons (753 games), 5 champion rings.
Mark Price
Mark Price spent the best part of his career on a “foreign” cruciate ligament. His recovery was so successful – he returned a month and a half ahead of schedule – that Price’s example is often simply forgotten when torn “crosses” are remembered. Mark’s health problems began much later and for completely different reasons: a broken hand in 1994, a loose left heel at 1995.
Post-crosses: 6.5 seasons (427 games), 3 All-Star Games, 3 All-Stars at the end of the year.
Tim Hardaway
Before the start of the 1993/94 season, Golden State could be considered a contender for the highest places, because the team, among other things, joined the first pick of the draft – Chris Webber. Unfortunately, three major players were injured before the start of the season – Mullin, Marciulionis and Hardaway. At the same time, the last two both broke the “crosses” and dropped out for a whole year. Hardaway, after rehabilitation, began the second half of his career – less fast, but more successful, marked by the retired number in Miami.
Post-crosses: 8.5 seasons (559 games), 2 All-Star Games, 3 caps at the end of the year.
Baron Davis
Baron suffered a ligament injury while still in his freshman year at university while playing in the NCAA playoffs, then recovered by the start of the next season, played it even better than the previous one and decided to enter the NBA draft, where he left with the 3rd number. And now, a few years later, he is already a full-fledged star-beard of the NBA, and there is no question of any loss of athleticism: the young body withstood a serious injury.
Post-crosses: 12.5 seasons (835 games), 2 All-Star Games, 1 cap at the end of the year.
Jamal Crawford
Jamal suffered an ACL tear in the most honorable way for a Bulls player (which he was then, in July 2001), while sparring against Michael Jordan. “After the operation, you start recovery, you become more and more confident over time. And now the last stage is psychological: will I be able to play again as before? The injured leg by that time is even stronger than the healthy one, but you don’t believe in it – you are scared, you doubt it.
After the “crosses”: 11.5 seasons (856+ games), the title of the best replacement in the NBA.
Kendrick Perkins
In recent years, a number of big men have suffered torn knee ligaments and successfully returned to the court: Nene, Al Jefferson, David West. The most famous injury was the case of Kendrick Perkins, because it happened at the most important moment – in the NBA Finals. Many Celtics fans still believe that Perk’s crosses in Game 6 of the Finals were the turning point of the series: Boston led 3-2 in meetings and lost the remaining games without their center. Perkins has since been traded to the Thunder, and while his stats have gone down and his performance has been criticized, it’s clearly not because of his injured leg. They have already learned how to sew up “crosses” in basketball.
After the “crosses”: 2.5 seasons (139+ games), participation in the final.
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Alas, history also knows the opposite examples, although now they are becoming less. The same Danny Manning (twice) and Baron Davis again tore their cruciate ligaments, and it ended not as happily as the first time. Here are a few unfortunate players whose careers have been ruined by cross injuries.
Billy Cunningham
The first player to officially retire from the sport because of crosses. Game against the Knicks on December 1975 years was his last. While trying to outrun Butch Baird on the fast break, Billy felt intense pain: “I thought my knee came off.” The spectators of that match still remember the scream that escaped Cunningham’s chest. Billy tried to come back, but that was still the era when torn crosses meant the end of a career: a few preseason games in which it became clear that the joint did not hold without a ligament, and the Hall of Famer went to coaching.
After the “crosses”: coaching career, championship 1983 years old.
Doug Collins
In the season that Cunningham suffered an unfortunate injury, current Sixers coach Doug Collins was on the same team with him. His playing career is one of the saddest in terms of injuries. The No. 1 pick in 1973 suffered a serious leg injury in his rookie season, then suffered a cracked leg in 1979, and recovered only to have his crosses fail a year later. Doug Collins was the first to understand what happened to Derrick Rose at the end of Game 3 of last year’s Bulls-Sixers series: the fall happened in front of the Philadelphia bench, and Collins himself perfectly remembers what a torn knee ligaments looks like.
Post-Cross: coaching career, early Bulls success for Jordan.
Terry Cummings
In the 1990s, they didn’t finish their career because of crosses, but they didn’t always recover to the end either. During streetball in the offseason, San Antonio forward Terry Cummings, a two-time All-Star with Milwaukee, suffered a torn ACL. As a result, in the 1992/93 regular season, Cummings played fewer meetings (8) than in the playoffs of the same year (10). And despite the fact that in the end Terry played to 1999 years old, his statistics immediately fell by half: from 17 + 8 two seasons before the injury to 8 + 5 after. About 22 + 9 times the Bucks is out of the question.
After the Crosses: 6.5 seasons (415 games).
Doc Rivers
The 1995 San Antonio team was nicknamed the “ACL team” (anterior cruciate ligament) because four players from that roster had anterior knee ligament surgery. In addition to Cummings, as well as Jack Haley and Sean Elliott, Doc Rivers also received an injury earlier. So in Boston, there is someone to tell Rondo what awaits him in terms of rehabilitation. The main thing is not to talk about playing success: Rivers played only 2 seasons of 15 minutes on average. Do not forget that by the time of the injury, Rivers was already 32 – Rondo, Rose, Rubio are noticeably younger.
After the Crosses: 2 seasons (141 games).
Sean Livingston
Sean Livingston’s injury and subsequent career are usually frightened every time someone breaks crosses on the basketball court. There is no need to be afraid of repeating that story – Livingston tore three of the four knee ligaments at that moment: both “crosses”, one lateral ligament, as well as a meniscus – in addition, he dislocated everything that could be dislocated in the knee. This is much more serious than a single anterior ligament tear. The fact that after that Livingston still finds some strength to return is already a miracle.
After crosses: 4. 5 seasons (209+ games).
Leon Pou
Another sad example from the recent past is Leon Pou. Together with Rondo, Perkins, and Tony Allen, these are already four people from the Celtics championship team who survived a cruciate ligament tear. Now Leon plays in Puerto Rico. In his case, injury proneness and slow recovery played a big role in Pou’s career never bouncing back.
After the “crosses”: 1.5 seasons (50 games).
Michael Redd
Redd’s case is special. By the age of 31, his ligaments were so loose that they simply could not stand it, and when they were sewn up, there was a second rupture. And even after this, the efforts of the Phoenix doctors, who once raised Danny Manning to his feet after the third (!) rupture of the ligaments, allowed Redd to finish last season as part of the NBA team. So far, he is a free agent and hopes for a new contract in the NBA, but the knee is already very bad.
After the “crosses”: 1. 5 seasons (61 games).
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In the last couple of seasons, stars of the first magnitude are out of action because of the “crosses”, and therefore a lot of attention is riveted to this problem. Three point guards, whose last names begin with “P”, were especially affected. Luke Ridnaur should think about knee brace.
Ricky Rubio
Last March, two things became clear: Kyrie Irving would win nearly 100% of the vote for Rookie of the Year and Spain would come second in the Olympics. Both of these events could have happened without Rubio’s injury, but with her, the likelihood of their occurrence became very high. After the operation, the Spanish point guard missed more than six months, but returned by the time that was predicted. While he is not 100% ready and admits that his knee still hurts, but with each new game he gradually returns to his form. The only worry is that he plays on a team that has had players out of action every week lately.
Derrick Rose
April 28 can be celebrated as “Broken Crucifix Day” because on this day in 2012, two players suffered such an injury at once – Derrick Rose and Eman Shumpert. And if Shumpert has already returned, then Rose is yet to come. Chicago, without Rose, went from being a contender to being eliminated in the first round of the playoffs. So far the news is about the end of February or later. Helps him to recover Baron Davis, who survived the break of the “crosses” in his youth, and also last year. He knows this better than any other NBA player, and since young Davis’ and Rose’s playing styles are similar, Baron must help Derrick adapt his game after injury. And then Rose will come back the same way Davis came back from his injury 15 years ago.
Rajon Rondo
Yesterday a regiment of “crosses” arrived. More precisely, even earlier: doctors discovered that Rajon Rondo was playing out the previous match with Atlanta (which, by the way, recently lost Lou Williams due to the same misfortune) already on a torn knee.