Cruciate ligament surgery in Vienna
Cruciate ligament surgery

Today, cruciate ligament surgery is almost always performed minimally invasively (arthroscopically). This means smaller incisions, less pain and faster healing.

Step 1 – Preparation

After diagnosis by clinical tests and MRI, a decision is made as to which surgical technique is most suitable. The cruciate ligament is often replaced with the body’s own tendons (tendon graft).

Step 2 – Selecting the graft

Patellar tendon
Hamstring tendon
Quadriceps tendon
Allograft

Step 3 – Operation

The torn cruciate ligament is removed.
The tendon graft is placed in the exact position of the original cruciate ligament.
is fixed in place with special screws or implants.

The operation usually takes 60-90 minutes and is performed under general or spinal anesthesia.

Good long-term results can be observed with cruciate ligaments that have been torn directly from the bone. Tears in the middle of the ligament should rather be treated with a replacement plastic.

The timing is crucial! Only injuries that are reattached to the bone in the first 3 weeks are likely to be successful. It is also known that the probability of a cruciate ligament suture failing again is higher than a cruciate ligament plastic surgery tearing again. It is therefore advisable to refrain from cruciate ligament sutures in young athletes.

Patient age (>25)
Surgery within 3 weeks
Cruciate ligament torn off directly at the bone

A cruciate ligament that has been operated on must first heal back into the bone before it can provide good long-term stability. This takes several months.

Milestones in rehabilitation:

(1) Full load within the first 2 weeks

(2) The patient is usually fit for work after 6-8 weeks

(3) Cycling is permitted after approx. 6-8 weeks

(4) Running only after 3 months

(5) It is possible to return to your usual sport after 6 months

(6) Fit for competition after 9-12 months at the earliest

After a simple cruciate ligament replacement, you only need crutches for 2 weeks. If the meniscus has also been sutured, you usually have to use crutches for 6 weeks.

The operation should be performed eitherin the first 10 days or after the primary irritationhas subsided(approx. 6 weeks). If surgery is performed during the irritation phase, the likelihood of severe scarring of the entire joint (=arthrofibrosis) increases.

Cruciate ligament ruptures do not always have to be operated on immediately! If the joint is unstable after a cruciate ligament rupture , surgery should be performed. If you are young and active in sports, surgery should be favored in order to avoid permanent damage. If the requirements are low, the patient is older and has little sporting ambition, and there is no tangible instability, conservative treatment can be chosen without any problems.

The function of the cruciate ligament can sometimes be well compensated for by a strong muscle sheath. As the cruciate ligament lies in the middle of the joint and the joint is filled with synovial fluid, no haematoma can form, which is so important for healing. In individual cases, scarring can occur with the posterior cruciate ligament. However, functional healing of the anterior cruciate ligament after a complete tear is very unlikely.

You should expect to stay in hospital for 1-2 days after a cruciate ligament reconstruction.

This mainly depends on which leg was operated on. If the left knee was operated on and you drive a car with automatic transmission, you can often drive after 3-4 weeks. However, if the right knee has been operated on, it usually takes 6 weeks or longer, as the joint must be stable enough to be able to brake quickly and powerfully in an emergency. It is important that patients only drive again when they can react safely and without restriction. The treating doctor should always be consulted before resuming driving.

This depends very much on the type of activity:

Office work or sedentary activities: usually possible again after 2-3 weeks.
Physically demanding occupations (e.g. construction workers, care workers): often only realistic after 3-4 months.

It is crucial that the knee is sufficiently resilient and stable. The return to work is individually coordinated with the doctor.

Depending on the study, the risk of a new cruciate ligament rupture is around 5-10%. The first 2 years after the operation are particularly at risk, as the transplant still has to heal and adapt to the strain. The other, healthy cruciate ligament can also have an increased risk of injury if the knee is not sufficiently stabilized or the muscles are not trained well enough. This risk can be significantly reduced through consistent rehabilitation, targeted muscle training, proprioceptive training and a gradual return to sport.

Cruciate ligament surgery is performed either under general anesthesia or spinal anesthesia (anesthesia from the hip downwards). Which method is chosen depends on the individual requirements and wishes of the patient. Both methods are safe and enable pain-free surgery.

Physiotherapy is an indispensable part of follow-up treatment. It often begins just a few days after the operation and accompanies the patient for many months.

The goals are:

– Reduce swelling and restore mobility
– Muscle development of the thigh and core muscles
– Stabilization and coordination training to make the knee safe in all everyday situations
– Gradual load build-up through to sport-specific training

Without physiotherapy, there is a high risk that the knee will remain permanently unstable, the muscles will break down or movement will be restricted.

An untreated cruciate ligament rupture can lead to permanent instability. As a result, meniscus damage, cartilage injuries and premature osteoarthritis are common. Although some patients can compensate for the missing ligament for a while with a strong muscle sheath, there is a risk of serious consequential damage in the long term. This is why medical assessment and treatment planning are crucial.

Cruciate ligament surgery is a proven and safe procedure, but – as with any operation – there are certain risks. The general surgical risks include infections, wound healing disorders and thrombosis. Particularly after cruciate ligament surgery, arthrofibrosis (scarring in the joint), restricted movement or, in rare cases, loosening or re-tearing of the graft can also occur. However, these risks can be greatly reduced through modern, minimally invasive surgical techniques, sterile conditions, consistent physiotherapy and close follow-up care. It is important that the patient and doctor work together to ensure consistent aftercare.

A cruciate ligament rupture cannot be 100% prevented, but the risk can be significantly reduced. Important measures include

– Targeted strength training, especially of the thigh and core muscles
– Proprioceptive training (balance exercises, jumping and landing techniques)
– Sport-specific technique training (e.g. correct braking and landing in soccer or handball)
– When skiing: correctly adjusted bindings and good skiing technique

Most patients achieve lasting stability after cruciate ligament surgery and can return to everyday life and sport. Studies show success rates of over 90 % if the operation is combined with consistent rehabilitation. The surgeon’s experience, the correct surgical method and the patient’s active cooperation in the follow-up treatment are crucial.