Cruciate ligament surgery is necessary when conservative treatment for a cruciate ligament tear has not been sufficient.
Here you will find the most important information as well as qualified specialists in cruciate ligament surgery.
A torn cruciate ligament often leads to knee instability and requires cruciate ligament surgery if conservative treatment is not sufficient. During the procedure, the torn ligament is usually replaced with a tendon graft and anchored to the bone. Minimally invasive cruciate ligament reconstruction allows for faster healing and rehabilitation. With physical therapy and targeted muscle strengthening, the knee can usually regain its stability and mobility after 6–12 months.
On the inner and outer sides of the knee joint, collateral ligaments work together with the muscles and the joint capsule to support the knee. They prevent the knee from bending too far forward. Inside the joint cavity are two cruciate ligaments that stabilize the knee.
The anterior cruciate ligament prevents the lower leg from sliding too far forward. When the knee bends, the posterior cruciate ligament tightens so that the lower leg does not slide backward. Together, they stabilize the femur and the tibia.
The video shows the structure of the knee joint, including its bones, ligaments, and cartilage:
The cruciate ligaments are highly tear-resistant yet elastic.
A tear can result from:
In these situations, doctors refer to a cruciate ligament tear or a cruciate ligament rupture.
The affected ligament may tear partially or completely. Depending on which ligament is injured, the injury is either an anterior cruciate ligament tear or a posterior cruciate ligament tear. In most cases, however, the anterior cruciate ligament is affected.
In severe injuries, both cruciate ligaments may tear—often in combination with meniscus or knee damage. Such complex injuries typically occur during a dislocation of the knee joint following an accident or the application of significant force.
© Henrie / Fotolia
If the knee is painful and swollen, this may indicate a cruciate ligament tear. Since the cruciate ligaments stabilize the knee, the knee becomes unstable after a cruciate ligament rupture.
Symptoms include:
You may also feel as though you can no longer bend or straighten your knee.
Anyone experiencing one or more of these symptoms should consult an orthopedic surgeon. The orthopedic surgeon can diagnose a cruciate ligament tear based on the following criteria:
Various movement tests (drawer test, Lachmann test, rotation-slip test)
Magnetic resonance imaging (MRI) provides an absolutely definitive diagnosis, as it can visually confirm a cruciate ligament tear.
By Kreuzbandguru - Own work, CC-BY-SA 4.0, Link
Once a cruciate ligament tear has been diagnosed, the question arises as to whether a proven treatment is sufficient or whether surgery on the cruciate ligament is necessary. The goal is always to ensure the stabilization of the knee joint and to restore its ability to bear weight in daily life and during sports.
Proven treatment methods for stabilizing the knee include:
If the posterior cruciate ligament is torn, many patients report fewer limitations. In these cases, structured exercise alone can sometimes provide the necessary stability. In the case of a torn anterior cruciate ligament, however, cruciate ligament surgery using modern surgical techniques is the recommended treatment in most cases.
Knee specialists determine on a case-by-case basis whether surgery is necessary—depending on age, athletic activity, accompanying injuries, and desired level of physical activity. Important to know: A cruciate ligament tear does not heal on its own. Without treatment, instability may develop, which can lead to osteoarthritis of the knee in the long term.
The recovery process after ACL surgery requires patience: rest, physical therapy, and a tailored exercise program over several months are crucial for a pain-free and stable knee.
Factors to consider when deciding for or against ACL surgery include:
If the cruciate ligament tear is accompanied by other injuries to the knee joint, cruciate ligament surgery is unavoidable.
Other injuries may include:
Without surgery, the knee is likely to remain unstable. In addition, painful osteoarthritis of the knee may develop as a long-term complication.
If the anterior cruciate ligament is injured, younger and athletically active patients benefit from surgery.
Surgery for a cruciate ligament tear is recommended in the following cases:
If conventional open surgery is performed, a longer incision is made on the front of the knee. This allows the surgeon to expose the entire knee joint.
Alternatively, cruciate ligament surgery can be performed via knee arthroscopy. This requires only two or three small incisions. This procedure is significantly less invasive.
Depending on the severity of the injury, there are different methods for restoring the function of a torn cruciate ligament.
In the case of a bony cruciate ligament tear, where a piece of bone has been torn away, doctors reattach it to its original location, where it can heal back in place.
Such an osteolateral cruciate ligament tear can occur, for example, in the femur or the tibia. This reattachment is also called refixation.
If the cruciate ligament is not completely torn (less than half the ligament’s diameter), doctors can attach or suture it back in place (reconstruction).
If doctors need to replace the torn cruciate ligament, a transplant is performed.
A suitable graft is a tendon from the patient’s own body, which doctors thread through a drill hole in the thigh and shin bones.
There, they anchor it using, for example:
With the double-bundle technique, doctors secure the tendon in two drill channels. A “bone-tendon-bone graft” consists of a piece of bone, a section of tendon, and another piece of bone.
A synthetic ligament can replace the torn cruciate ligament only in exceptional cases. For example, after multiple failed surgeries or in older patients whose tendons are no longer elastic. Rather, the synthetic ligament is intended to stabilize the injured cruciate ligament until it has healed.
Open knee surgery - By Uwe Gille - Own work, CC BY-SA 3.0, Link
Complications during cruciate ligament repair surgery are rare. If the procedure is performed using minimally invasive techniques, fewer “aftereffects” and a shorter time to full recovery can be expected.
You can effectively manage postoperative pain with pain medication.
The prophylactic administration of blood-thinning medications in the first few days after the procedure helps prevent thrombosis. Certain surgical risks and complications cannot be completely ruled out, even with ACL surgery.
After ACL surgery, the patient must not put full weight on the knee immediately. Therefore, patients use crutches for the first two to three weeks to take the weight off the affected leg.
Wearing a knee brace is recommended for six to 12 weeks after surgery. To help the knee regain its ability to bear weight quickly and restore its full range of motion, patients should participate in physical therapy and rehabilitation exercises. Doctors tailor the treatment plan to the individual’s healing process.
© Picture-Factory / Fotolia
If rehabilitation proceeds optimally, the knee joint will be stable and mobile again after about 6–9 months. With the exception of competitive athletes, patients should avoid high-risk sports that place heavy strain on the knee during the first year after surgery.
The prognosis is favorable: Eight out of ten patients regain the same level of performance they had before their injury following a cruciate ligament tear.
Treatments involving the human musculoskeletal system are performed by specialists in trauma surgery and orthopedics. They often pursue further specialization, such as focusing exclusively on knee surgery or sports medicine.
Every physician listed in the Leading Medicine Guide has attained the highest level of training and certification within their respective medical specialty society. Furthermore, we contacted this physician based, among other factors, on their case volume (surgeries, treatments, and therapies), which we determined by cross-referencing various publicly available sources. Following discussions with the selected physicians and the directors of the medical facilities, as well as a subsequent internal review, they were admitted to the Leading Medicine Guide.
The quality assurance of the Leading Medicine Guide is further ensured by 8 admission criteria. Each member must meet at least 6 of them:
