Cruciate Ligament and Cruciate Ligament Tear

Together with the medial and lateral ligaments, the cruciate ligaments are not only important for stabilizing the knee joint, but also limit the extension of the tibia and restrict the rotation of the knee joint. The video shows the knee joint and its structures:

The cruciate ligaments are divided into an anterior and a posterior cruciate ligament, with the anterior cruciate ligament having to support greater loads. For this reason, injuries to the anterior cruciate ligament occur more frequently during sports activities than injuries to the posterior cruciate ligament. Stable cruciate ligaments are of fundamental importance, particularly in competitive sports such as soccer, where the stress on the knees is especially high. Are you affected? Then find your specialist now. 

An overview of the cruciate ligament’s functions:

• Limiting the extension of the tibia
• Stabilization of the knee joints
• Limiting rotation

Cruciate ligament tear

Cruciate ligament tears are particularly feared among athletes. Even with optimal medical care, as is the case in professional sports, many athletes must refrain from competitive sports for several months following a cruciate ligament tear. This injury is often caused by an unnatural twisting of the knee joint. In such cases, the cruciate ligaments are no longer able to absorb the impact of the movement. It is primarily the anterior cruciate ligament that tears in these instances; the posterior cruciate ligament is affected much less frequently.

A cruciate ligament tear can be treated both conservatively and surgically. Conservative treatment options include physical therapy, pain management, and cold therapy.

If the cruciate ligament tear is treated surgically, this is done using a procedure known as cruciate ligament reconstruction. In this procedure, the torn cruciate ligament is replaced with a healthy tendon from the patient’s own body as a graft. The video shows the procedure for this arthroscopic surgery: 

Appropriate treatment is important for the patient, as an untreated cruciate ligament tear is not only associated with severe pain but can also cause long-term degenerative damage to the knee, which may necessitate the implantation of a knee prosthesis.

Additional Damage

A cruciate ligament tear can also result in bone avulsions, although this is relatively rare. It is much more common for a cruciate ligament tear to be accompanied by damage to the meniscus or the medial collateral ligament. The medial meniscus is fused to the medial collateral ligament, which is why it is also affected in some cases when the medial collateral ligament and the cruciate ligaments are injured.

In other cases, cartilage damage may occur at the same time.

If an injury occurs, with a bit of luck, the patient will suffer only a partial tear of the cruciate ligament. In this case, there is no complete rupture of the ligaments; instead, they tear only partially. However, even in this case, surgery may be necessary, depending on the extent of the tear.

A tear or a complete rupture of the cruciate ligament is the most serious injury these ligaments can sustain. Less severe, however, are cruciate ligament strains, which, while they also require medical or physical therapy treatment, heal much more quickly.

The most common cruciate ligament injuries:

• Cruciate ligament strain,
• Cruciate ligament tear,
• Cruciate ligament tear,
• Cruciate ligament tear with additional damage to the meniscus and medial collateral ligament.

Cruciate ligament injuries can generally be attributed to violent impacts or significant forces acting on the knee joint. This typically occurs during excessive twisting, extension, or flexion of the knee joint. In most cases, this happens during sports activities or in traffic accidents, which is why choosing the right trauma surgeon can be particularly important.

A tear of the anterior cruciate ligament is often classified as a sports injury. This can be caused by an abrupt change in direction while jumping or running, or as a result of a sudden twist of the leg. A tear of the anterior cruciate ligament can also occur as a result of a fall onto the knee, for example, in sports such as skiing or soccer.

A posterior cruciate ligament tear, on the other hand, is often the result of external force. This leads to hyperextension of the knee joint, as can occur, for example, during an impact injury in a traffic accident.

Overall, the cruciate ligament is a key ligament in the knee joint that, together with the other cruciate ligaments, ensures stability and controls movement between the femur and the tibia. A cruciate ligament tear often occurs when the anterior cruciate ligament tears or the posterior cruciate ligament is affected while the knee is bent, causing the knee joint to become unstable. In particular, a tear of the anterior cruciate ligament or a cruciate ligament rupture results in the ligament being torn, necessitating targeted treatment.

The cruciate ligaments are located in the knee joint between the femur and the tibia, with the anterior cruciate ligament (ACL) running anteriorly and the posterior cruciate ligament (PCL) running posteriorly. The two cruciate ligaments ensure that flexion, extension, and rotation within the joint are controlled, and the lateral portions of the cruciate ligaments, together with the collateral ligaments and menisci, provide additional stabilization. If a cruciate ligament injury or an injury to the anterior cruciate ligament occurs, conservative treatment with physical therapy may be sufficient, or surgery on the anterior cruciate ligament—involving cruciate ligament plasty or cruciate ligament reconstruction—may be necessary.

During surgery, a tendon from the patient’s own body is often used, while the patient and the orthopedic surgeon decide on a case-by-case basis whether to proceed with conservative or surgical treatment. Physical therapy usually begins the day after surgery to improve mobility in the knee joint and the entire joint. A torn anterior cruciate ligament or a torn cruciate ligament may also be accompanied by associated injuries such as meniscus tears, cartilage damage, or a bone avulsion or fracture at the tibial tuberosity.

The posterior cruciate ligament provides stability in the background, and injuries to the posterior cruciate ligament are less common but can also impair the function of the knee joint. In some cases, isolated injuries are possible, but the anterior and lateral structures are often affected as well, for example in the area of the lateral femoral condyle. Early, orthopedically tailored treatment is crucial to restore the stability of the cruciate ligaments and prevent long-term limitations.