Cruciate Ligament Rupture Surgery

What Is a Cruciate Ligament Rupture?

A cruciate ligament rupture is a knee injury in which the anterior or posterior cruciate ligament is completely or partially torn. Rupture of both cruciate ligaments is also possible. Cruciate ligament rupture is one of the most common sports injuries of the knee joint and occurs in most cases with other knee injuries. A cruciate ligament tear can be treated without surgery or by cruciate ligament surgery.

What Are Cruciate Ligaments?

The cruciate ligaments are two ligamentous structures located in the knee joint space. They connect the thigh to the tibia, with the anterior cruciate ligament extending from the bottom of the front to the top of the back. The posterior cruciate ligament extends from the top front to the bottom back, crossing the anterior cruciate ligament (hence the name).

Causes and Symptoms of Cruciate Ligament Rupture

The most common cause of cruciate ligament surgery is a tear (rupture) of the anterior cruciate ligament. In contrast, posterior cruciate ligament rupture is rare. The triggers of cruciate ligament rupture include, in particular, sports with a fixed foot (playing soccer with cleated shoes, skiing). These involve sudden, abrupt rotational movements or accelerations with extreme stress on the knee joint. Since the relatively flat knee joint is mostly stabilized by muscles, menisci, external ligaments, and cruciate ligaments, a cruciate ligament tear is, unfortunately, a common knee injury in such sports. In addition to isolated injury to the cruciate ligaments, cruciate ligament rupture is a component combined with knee injuries from accidents or other knee trauma.

Symptoms of Cruciate Ligament Rupture:

• Pain
• Joint effusion
• A certain instability of the knee joint may lead to the increased displacement of the thigh in relation to the lower leg.

Cruciate Ligament Surgery Yes or No?

In principle, cruciate ligament rupture treatment is possible without surgery. The initial pain usually passes soon. Besides, physiotherapy helps strengthen the muscles and ligaments, which helps stabilize the knee joint sufficiently. Cruciate ligament surgery makes sense for professional athletes or people who want to be very physically active. A conservative therapy without cruciate ligament surgery is entirely sufficient for people who are not very keen on sports, at an older age, suffering from osteoarthritis and a low instability of the knee joint. The cruciate ligament surgery is necessary for full stability and the possibility to actively perform competitive sports again.

What Is the Procedure of Cruciate Ligament Surgery?

Before every cruciate ligament surgery, the treating orthopedist or trauma surgeon carried out a detailed medical history (anamnesis). After the patient's medical history has been presented, a physical examination is performed. Various cruciate ligament tests, which check the anterior and posterior cruciate ligaments' stability, are passed (including the drawer phenomenon test). Since every cruciate ligament tear is a traumatic event, a radiologist is consulted during the examination to exclude possible bone injuries (due to avulsion of the cruciate ligament with bone parts) using an X-ray. MRI is required to visualize soft tissues such as ligaments and cartilage structures.

Once the diagnosis is confirmed, the cruciate ligament surgery is carried out under general or local anesthesia (anesthetic injection in the spinal area that selectively eliminates pain sensation in the lower limbs). A cruciate ligament rupture cannot be treated by suturing or fixing the original cruciate ligament since wound healing and weight-bearing are not possible due to poor blood circulation. As a replacement, a suitable tendon is taken from the patient's body. For example, the middle part of the patellar tendon can be used.

At the beginning of the cruciate ligament surgery, the knee surgeon removes the suitable tendon through a small incision. The placement takes place via arthroscopy. First, three tiny incisions are made in the area of the knee joint. The optics (mini-camera) and two instruments are inserted into the joint. The orthopedist removes the destroyed cruciate ligament's remains under visual monitoring and attaches the new tendon to the femur and tibia. If surgery is performed due to an accident with multiple ligament tears, the cruciate ligament surgery can be completed in the same setting.

What Are the Risks and Side Effects of Cruciate Ligament Surgery?

Every cruciate ligament rupture, regardless of the therapy, carries an increased risk of premature cartilage degeneration in the knee joint (knee osteoarthritis). With cruciate ligament surgery, as with any other surgery, possible side effects are to be expected. Depending on the location of the tendon removal, there may be slight atrophy of the thigh muscles. Furthermore, removing the patellar tendon can lead to pain since the removal site and the new location are in the same wound area and can affect each other painfully. Besides, rare but possible is also non-engraftment or poor engraftment of the knee joint's tendon implant or inflammation. The rate of graft failure is about 4%.

Aftercare and Rehabilitation After Cruciate Ligament Surgery

With good patient cooperation in the postoperative period, cruciate ligament surgery ensures an excellent prognosis. However, to achieve a high level of performance after 4 weeks of partial weight-bearing, physiotherapy is necessary for about 4 months, which depends on the patient's cooperation.

If you have any questions regarding the possibility or advisability of cruciate ligament surgery for your specific case, make an appointment with a knee specialist.

Which Doctors and Clinics are Specialized in Cruciate Ligament Surgery?

Every patient suffering from cruciate ligament rupture wants the best medical care. Therefore, the patient is wondering where to find the best clinic for cruciate ligament surgery or a cruciate ligament specialist.

As this question cannot be answered objectively and a reliable doctor would never claim to be the best one, we can only rely on the doctor’s experience. The more cruciate ligament surgeries are carried out; the more experienced the doctor becomes in his specialty.

Cruciate ligament specialists are orthopedists who specialize in the conservative and surgical treatment of the knee joint. Their experience and many years of practice as orthopedic surgeons specializing in knee surgery make them the right professional for carrying out cruciate ligament surgery.

Sources:

http://www.awmf.org/leitlinien/detail/ll/012-005.html

http://www.dgu-online.de/index.php?id=273

gelenk-klinik.de/orthopaedische-operation/knieoperation/kreuzbandplastik.html

Winker, Karl-Heinrich (2011): Facharzt Orthopädie Unfallchirurgie. Munich: Urban & Fischer.

Grifka, Joachim (2011): Orthopädie und Unfallchirurgie. Für Praxis, Klinik und Facharztprüfung ; mit 155 Tabellen. Berlin [u.a.]: Springer.