Cruciate ligament rupture – causes, symptoms and modern treatment in Vienna
Acute care & follow-up treatment
Anterior cruciate ligament rupture (cruciate ligament tear) is one of the most common sports injuries. While around 80% of the general population return to sporting activities after an injury, only around 55% of competitive athletes reach their original level. Persistent instability of the knee joint – especially during sporting activities – can damage the cartilage and meniscus and lead to premature joint wear. For many of those affected, cruciate ligament surgery is therefore the most effective way to regain stability and be able to participate in sports without restriction.
If you have suffered a cruciate ligament rupture, please feel free to make an appointment at my practice in Vienna – I will advise you personally on the best treatment options.
OVERVIEW
Does a torn cruciate ligament require surgery?
Whether cruciate ligament surgery is necessary depends largely on your personal goals and requirements. If you are young, active and want to maintain your current sporting activities without restrictions, you will generally benefit significantly from an operation.
A stable knee is essential to avoid consequential damage to the meniscus and cartilage, especially in sports with a lot of rotational and weight-bearing movements – such as soccer, skiing or martial arts. Studies show that even without noticeable instability, damage can occur at an early stage if the cruciate ligament is missing. In such cases, surgical treatment is usually the safest way to restore stability in the long term and prevent joint wear and tear.
Whether the cruciate ligament is sutured (refixed) or reconstructed with a tendon replacement depends on several factors – including the type of tear, your age and your sporting ambitions.
If you have a sedentary job and are less active in sports, surgery can be avoided under certain circumstances. In such cases, targeted physiotherapy and muscle building can provide very good results. However, if the feeling of instability or “giving-way attacks” occur, where the knee suddenly buckles, surgery must be considered again to avoid long-term damage.
What is a cruciate ligament rupture?
A cruciate ligament rupture is an injury to the knee joint in which one of the two cruciate ligaments – in most cases the anterior cruciate ligament – tears partially or completely. The cruciate ligaments run inside the knee joint and are crucial for its stability, as they control the movements of the thigh in relation to the lower leg.
Cruciate ligament ruptures are particularly common in sports involving abrupt changes of direction, jumps or sudden stops, such as soccer, handball, tennis or skiing. Typical symptoms include a sudden cracking sound, rapid swelling, pain and a feeling of instability in the knee.
If the injury remains untreated, this can lead to meniscus damage, cartilage wear and premature joint wear (osteoarthritis) in the long term.
Cause of a torn cruciate ligament in the knee
A torn cruciate ligament often occurs in sports with many changes of direction, i.e. typical stop and go sports with sudden turning movements, such as soccer, handball or basketball. In most cases, the body’s center of gravity is further back, the knee joint is slightly bent, the foot is fixed to the ground and the knee is forced valgus (=X-leg) and outwards.
- Landing on one leg after a jump
- Sudden stop
- Sudden rotational movements
In skiing, the knee is usually bent more, the center of gravity is further back, while the knee is rotated inwards. This is known as the phantom foot mechanism or dynamic snowplow. However, classic “threading” through a valgus (=X-leg) and external rotation can also lead to a rupture of the anterior cruciate ligament.
What accident mechanisms apply to ball sports?
A cruciate ligament rupture often occurs in ball sports due to sudden, uncontrolled movements. Typical accident mechanisms are
- Abrupt changes of direction (cutting moves), e.g. when dodging in soccer or handball
- Stopping after a sprint, often combined with a twisting movement of the body
- Landing after a jump on an extended or twisted leg
- Direct physical contact or duel that pushes the knee outwards or inwards
Situations in which rotational movement and strain occur simultaneously are particularly risky. The anterior cruciate ligament cannot withstand the strain and tears.
Studies show that around two thirds of cruciate ligament ruptures occur without direct contact with the opponent – i.e. purely due to unfavorable movement sequences. Well-trained muscles and coordination training are therefore particularly important in ball sports in order to reduce the risk of injury.
What accident mechanisms apply to skiing?
Torn cruciate ligaments are also one of the most common injuries to the knee joint when skiing. Typical accident mechanisms are
- Twisting of the knee in the event of a fall - especially if the ski gets stuck in the snow and the upper body continues to rotate
- Falling backwards (phantom foot mechanism): The body weight shifts backwards while the ski remains fixed; this results in a strong rotational and shear load on the anterior cruciate ligament
- Fall in the plow with knee twisted inwards
- Landing after a jump on an extended or unstable leg
- Collision with other drivers or obstacles
Situations in which the ski remains fixed while the body continues to move are particularly critical. This creates enormous forces on the knee, which can tear the anterior cruciate ligament.
Good skiing technique, targeted muscle training, correctly adjusted bindings and a realistic assessment of your own skiing ability help prevent this.
Diagnosis of a cruciate ligament rupture
he history and accident mechanism are enough to raise suspicion of a cruciate ligament rupture. However, the clinical examination by a specialist remains crucial. Tests such as the Lachman test, the pivot shift test or the anterior drawer can be used to reliably check the stability of the cruciate ligament.
Imaging procedures such as magnetic resonance imaging (MRI) are required to confirm the diagnosis. It not only shows the cruciate ligament tear itself, but also possible concomitant injuries (e.g. meniscus or cartilage damage).
Patient groups for cruciate ligament rupture
- The COPER: Conservative therapy alone can restore previous sporting activity.
- The NON COPER: Complain of knee joint instability and cannot return to their usual sport. Sometimes the feeling of instability (giving way attacks) is a problem even in everyday life. Surgery should be recommended for this group to prevent chronic wear and tear of the cartilage and meniscus.
- The ADAPTORs: Adapt their sporting activities so that no instability occurs. This group can also be treated primarily conservatively.
important to know
The difference between COPER and NON-COPER cannot be reliably determined by tests in advance. If instability attacks occur during conservative treatment, surgical cruciate ligament treatment should generally be switched to in order to ensure the long-term function and stability of the knee joint.
How do I recognize a cruciate ligament rupture?
Many athletes feel a snap in the event of an accident, which is accompanied by an immediate effusion of the knee joint. A hemarthrosis (= bloodyeffusion of the joint) indicates a torn anterior cruciate ligament until proven otherwise. The loss of the stabilizing function of the ligament can result in “giving way attacks”. These are rotational movements between the thigh and lower leg which, if left untreated, lead to the destruction of the meniscus and cartilage tissue.
Symptoms of a cruciate ligament rupture
Various symptoms can occur in the event of a cruciate ligament rupture, including
- Sudden and severe pain in the knee
- Swelling
- Instability of the joint
- a feeling of joint dislocation or “buckling”
- Limited mobility
- and a cracking sound during the injury
Bruising may also occur in the knee area. It is important that a torn cruciate ligament is diagnosed and treated by a medical professional, as appropriate rehabilitation and possibly surgery may be required to restore stability and function to the knee joint.
First aid for cruciate ligament ruptures - the POLICE rule
If a cruciate ligament rupture occurs during sport or on a skiing vacation, simple immediate measures can help to reduce pain and swelling.
In the past, the PECH rule (rest, ice, compression, elevation) was often recommended for sports injuries. Today, however, the modernized POLICE rule applies:
P = Protection
The injured joint is protected from further strain, e.g. with a splint or bandage.
OL = Optimal Loading
Instead of complete rest, it is important to take appropriate early exercise to promote healing and regeneration.
I = Ice (cooling)
Cooling helps to relieve pain and swelling.
C = Compression
An elastic bandage reduces swelling.
E = Elevation (elevation)
Elevate the injured leg to improve circulation and reduce swelling.
Important: The POLICE rule does not replace a medical examination. If a cruciate ligament rupture is suspected, the knee should be examined quickly by an orthopaedist or trauma surgeon.
Treatment of a cruciate ligament rupture
Depending on the patient’s age, sporting ambitions, profession and additional concomitant injuries, the decision on therapy is discussed individually with the patient. Existing cartilage damage or already existing knee pain also play an important role in the treatment decision.
There are 2 therapeutic options:
- Conservative therapy
- Cruciate ligament surgery
How do I know if my cruciate ligament injury requires surgery?
Whether a cruciate ligament injury should be operated on or can be treated conservatively depends on several factors. The extent of the injury (partial or complete tear), the age and sporting activity of the patient and their personal sense of stability are decisive. In young, athletically active people or if the knee is clearly unstable, cruciate ligament surgery (cruciate ligament plastic surgery) is usually recommended in order to restore full resilience and prevent consequential damage such as meniscus tears or cartilage damage. In older patients, less active people or partial tears, conservative therapy with physiotherapy, muscle strengthening and stabilization training can also be successful. The final decision should always be made after a detailed clinical examination and imaging (MRI) in consultation with a specialist orthopaedic surgeon.
A precise assessment by a specialist is crucial in order to find out which treatment method – surgery or conservative therapy – is best for your individual case. Simply make an appointment at my surgery in Vienna. I will take the time to thoroughly analyze your situation and work with you to create the optimal treatment plan.
Rehabilitation after a cruciate ligament rupture - what happens afterwards?
After a cruciate ligament rupture – whether treated surgically or conservatively – rehabilitation plays a central role in the complete restoration of knee joint function. Immediately after the injury or operation, the initial focus is on pain relief, reducing swelling and careful mobilization. This is followed by several rehabilitation phases: First, the mobility of the knee is gradually regained, followed by targeted muscle building of the thigh and trunk muscles to ensure stability. In a further step, coordination and balance exercises are integrated before finally beginning sport-specific training. The entire process takes several months, and patience and consistent training are crucial. Only when the knee is stable, strong and pain-free again should the patient return to sport – usually after 6 to 12 months.
Your cruciate ligament specialist
Find out more about cruciate ligament surgery & treatment for a torn cruciate ligament in this video!
Frequently asked questions - FAQ Cruciate ligament rupture
What is the function of cruciate ligaments in the knee?
The cruciate ligaments – the anterior and posterior cruciate ligaments – run inside the knee joint and are the stabilizers of the joint during movement. The cruciate ligaments connect the thigh bone (femur) to the shin bone and ensure that the two bones do not shift against each other in an uncontrolled manner during movement. The anterior cruciate ligament prevents the tibia from moving forward, while the posterior cruciate ligament prevents it from sliding back too far. Together, they ensure controlled movement, stability and safety when walking, running, jumping or changing direction quickly in sport.
Does every cruciate ligament rupture require surgery?
No, not every cruciate ligament rupture needs to be operated on immediately. Whether an operation is necessary depends on age, sporting activity, the extent of the injury and the feeling of stability in the knee. Surgery is often recommended for young and athletically active people in order to make the knee permanently stable and avoid consequential damage. For less active patients or partial tears, conservative therapy with physiotherapy and muscle strengthening may be sufficient.
Can a cruciate ligament heal without surgery?
A completely torn cruciate ligament will not grow back together on its own. Conservative treatment is possible for partial tears or if the knee remains stable even without the cruciate ligament. Physiotherapy, muscle strengthening and stabilization training are important here. However, surgery is usually advisable in cases of persistent instability or high sporting exertion.
Is complete healing possible after a cruciate ligament rupture?
Complete healing in the sense of the torn cruciate ligament “growing back together” is not possible, as the fibers of the ligament in the joint do not regenerate by themselves. However, full stability and resilience of the knee can be restored with an operation (cruciate ligament surgery), in which the ligament is replaced by the body’s own tendon, or with consistent conservative therapy (in the case of a partial tear or low level of activity). As a result, many patients are able to return to their usual level of sport and activity – provided that rehabilitation is carried out consistently.
How can I tell if my cruciate ligament is torn?
Typical signs are
- a sudden cracking or tearing sound in the knee during an accident
- Severe pain and rapid swelling
- the feeling that the knee "gives way" or is unstable
- Limited mobility
An exact diagnosis can only be made by an orthopaedic specialist with a clinical examination and an MRI.
What happens if a cruciate ligament rupture is not treated?
An untreated cruciate ligament rupture can lead to permanent instability in the knee. This significantly increases the risk of meniscus and cartilage damage. In the long term, premature osteoarthritis can even develop. Individual assessment and the right treatment are therefore crucial.
Which sports are possible again after a cruciate ligament rupture - and when?
- Everyday life & light training: after 2-3 months (conservative) or 6-8 weeks (after surgery)
- Cycling & swimming: usually possible after 3-4 months
- Jogging & light fitness training: after 4-6 months
- Contact sports & skiing: after 9-12 months at the earliest
The return always depends on the healing process, the muscles and the stability of the knee. A sports clearance test by an orthopaedist or physiotherapist is advisable before returning to full activity.
How long will I be unable to work after cruciate ligament surgery?
This depends on the type of activity:
- Office work / sedentary activity: usually possible again after 2-3 weeks
- Physically demanding work: often only after several months
The duration is individual and should always be determined in consultation with the attending physician.
What can I do in everyday life after a cruciate ligament rupture - and what should I avoid?
- Allowed: walking with supports, careful weight-bearing (according to doctor's instructions), physiotherapy, everyday movements in pain-free areas.
- Avoid: Twisting movements, abrupt stops, sports involving jumping or contact loads in the early healing phase.
Everyday life should be resumed slowly – always according to medical advice.
What role does physiotherapy play in the treatment of a cruciate ligament rupture?
Physiotherapy is crucial – both for conservative therapy and after an operation. It helps to restore mobility, strengthen the muscles and build up stability in the knee. Consistent physiotherapy reduces the risk of consequential damage and speeds up the return to sport and everyday life.
What concomitant injuries often occur with a cruciate ligament rupture?
A cruciate ligament rupture often does not occur alone. Frequently affected are
A thorough diagnosis by MRI is important in order to assess the entire injury.
Are there late effects of a cruciate ligament rupture?
Yes – a cruciate ligament rupture can have long-term consequences, especially if it is not treated or rehabilitated properly. Typical long-term problems are
- Meniscus damage - additional tears occur more frequently due to instability
- Instability of the knee - the feeling that the joint "gives way"
- Cartilage damage - permanent overloading leads to wear and tear
- Premature osteoarthritis - increased risk of premature joint wear and tear
- Recurrent injuries - repeated cruciate ligament ruptures or injuries to other structures
With individual therapy (conservative or surgical) and consistent physiotherapy, these late effects can be prevented or at least delayed in many cases.
How long does it take to heal after a cruciate ligament rupture?
The healing time after a cruciate ligament rupture depends heavily on the type of injury and the chosen therapy:
Conservative treatment (e.g. for partial tears):
With physiotherapy, muscle building and stabilization training, the knee can be able to bear weight again after about 3-6 months.
After cruciate ligament surgery (cruciate ligament plastic surgery):
- Suitability for everyday use: after approx. 6-8 weeks
- Light sporting activities: after about 4-6 months
- Return to high-impact sports (e.g. soccer, skiing): usually after 9-12 months
Important: The healing time varies from person to person. Consistent physiotherapy, targeted muscle development and adherence to the rehabilitation plan are crucial for a full recovery.
Can a cruciate ligament rupture be prevented?
A rupture of a cruciate ligament cannot be completely prevented, but the risk can be significantly reduced by:
- Targeted muscle and stabilization training
- Coordination and balance exercises
- Good technical training in sport
- Correctly adjusted ski bindings and suitable footwear
Important: The healing time varies from person to person. Consistent physiotherapy, targeted muscle development and adherence to the rehabilitation plan are crucial for a full recovery.