Information on cruciate ligament surgery

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What is a cruciate ligament tear?

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

What are the cruciate ligaments?

The cruciate ligaments are two ligament structures located in the knee joint space. They connect the thigh to the shinbone, with the anterior cruciate ligament running from the front bottom to the back top. The posterior cruciate ligament extends from the front top to the back bottom and crosses the anterior cruciate ligament (hence the name).

Causes and symptoms of a cruciate ligament tear

The most common cause of a cruciate ligament operation is a tear (rupture) of the anterior cruciate ligament. A posterior cruciate ligament tear, on the other hand, is rare. The triggers of cruciate ligament rupture include sports that require a fixed foot (playing football with cleats, skiing). This results in sudden, abrupt twisting movements or accelerations that place extreme strain on the knee joint. Since the relatively flat knee joint is largely stabilized by muscles, menisci, lateral ligaments and cruciate ligaments, a cruciate ligament rupture is unfortunately a common knee injury in such sports. In addition to isolated injuries to the cruciate ligaments, cruciate ligament rupture is a component of combined injuries in the knee area caused by accidents or other knee trauma.

The symptoms of a cruciate ligament rupture include:

• Pain
• Joint effusion
• A certain instability of the knee joint, which can lead to increased mobility of the thigh relative to the lower leg.
• Cruciate ligament rupture surgery, yes or no?

In principle, cruciate ligament rupture can be treated without surgery. The initial pain usually goes away quickly. In addition, physiotherapy helps to strengthen the muscles and ligaments and thus helps to stabilize the knee joint sufficiently. Cruciate ligament surgery is useful for professional athletes or people who want to be very physically active. For people who are not very sporty, are older, have arthritis and are only slightly unstable in the knee joint, conservative treatment without cruciate ligament surgery is completely sufficient. Cruciate ligament surgery is necessary to achieve full stability and the ability to participate in competitive sport again.

How does cruciate ligament surgery work?

Before every cruciate ligament operation, the treating orthopedic or trauma surgeon conducts a detailed patient interview (anamnesis). After the medical history has been presented, the physical examination takes place. Various cruciate ligament tests are carried out to check the stability of the anterior and posterior cruciate ligaments (including the drawer test). Since every cruciate ligament tear is a traumatic event, a radiologist is consulted during the procedure to rule out possible bone injuries (due to the cruciate ligament tearing with parts of the bone) using an X-ray. A magnetic resonance image is necessary to show the soft tissues such as ligaments and cartilage structures.

If the diagnosis is confirmed, the cruciate ligament operation is carried out under general anesthesia or regional anesthesia (an anesthetic injection in the area of ​​the spine that selectively eliminates the sensation of pain in the lower limbs). A cruciate ligament tear cannot be treated by suturing or attaching the original cruciate ligament, since poor blood circulation means that no real wound healing and therefore no strain is possible. A suitable tendon is removed from the patient's own body as a replacement. For example, the middle part of the patellar tendon can be used.

At the beginning of the cruciate ligament operation, the knee surgeon removes the suitable tendon through a small incision. The insertion is carried out using an arthroscopy. First, three extremely small 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 remains of the destroyed cruciate ligament under visual control and can then attach the new tendon to the femur and shinbone. If an operation is carried out due to an accident with multiple ligament tears, the cruciate ligament operation can be carried out in the same session.

What are the risks and side effects of cruciate ligament surgery?

Every cruciate ligament tear, regardless of the treatment, carries an increased risk of premature cartilage wear in the knee joint (knee osteoarthritis). As with any other operation, possible side effects are to be expected with cruciate ligament surgery. Depending on the location of the tendon removal, slight atrophy of the thigh muscles may occur. Furthermore, the removal of the patellar tendon can lead to pain, as the removal site and the new insertion site are in the same wound area and can affect each other painfully. In addition, although rare but possible, the tendon implant may not grow or grow in poorly, or the knee joint may become inflamed. The rate of transplant failure is around 4%.

Follow-up treatment and rehabilitation after cruciate ligament surgery
If the patient cooperates adequately in the postoperative period, cruciate ligament surgery guarantees an excellent prognosis. However, in order to achieve a high level of performance after 4 weeks of partial weight bearing, around 4 months of physiotherapy is necessary, which relies heavily on cooperation.

If you have any questions about the possibility or usefulness of cruciate ligament surgery for your specific case, arrange an appointment with a knee specialist.
Doctors at the Bonn University Hospital are specialists in cruciate ligament surgery.
Anyone who has torn a cruciate ligament wants the best medical care for themselves. That is why patients ask themselves, where can I find the best clinic for cruciate ligament surgery or a cruciate ligament specialist?

As this question cannot be answered objectively and a reputable doctor would never claim to be the best doctor, one can only rely on a doctor's experience. The more cruciate ligament operations a doctor performs, the more experienced he becomes in his specialty.

Cruciate ligament specialists are therefore orthopedists who have specialized in conservative and surgical treatment of the knee joint. Due to their experience and many years of work as orthopedists with a focus on knee surgery, they are the right people to contact for cruciate ligament surgery.