One of the most common sports injuries is the cruciate ligament tear. No wonder, because in most sports, the knees are heavily loaded. We have the Stuttgart orthopedist dr. Christian Mauch interviewed about causes and risks as well as consequences and possibilities of treatment.
Why are cruciate ligament tears so common?
Dr. Mauch: Due to the growing popularity of extreme recreational sports and the continuously increasing demands on competitive athletes. The best example are the skiers with the carving skis, which enable ever higher speeds.
The knee joint itself is particularly susceptible to injury because of its complicated ligament construction. Although an inner and an outer band as well as an anterior and a posterior cruciate ligament provide stability and mobility, but also make the joint sensitive. In most sports injuries, the anterior cruciate ligament tears when the knee is overstretched or twisted when the lower leg is stationary.
What are the consequences of such an injury?
Dr. Mauch: Operation and sports ban for a period of three to six months. Mostly, in a cruciate ligament injury menisci and cartilage in the knee joint are damaged. Proper treatment and regeneration is therefore particularly important.
How can I tell if the cruciate ligament is torn?
Dr. Mauch: First signs of a serious knee injury are severe pain, swelling and bruising in the joint. A clear diagnosis, whether it is a crack, is hardly possible on site. A 100% certainty often brings only the results of X-rays, magnetic resonance imaging and medical examination.
What first aid measures are there in case of a cruciate ligament injury?
Dr. Mauch: For the time being, immobilize and protect the affected leg. Against the swelling and to relieve the pain, the affected knee should be cooled with ice and stabilized with a pressure bandage. And then quickly to the doctor, because an outpouring must be punctured.
If the cruciate ligament is torn, what can the doctor do?
Dr. Mauch: Cruciate ligament injuries can be treated both surgically and non-surgically. However, I always recommend an operation to athletes and young people, as well as people who do a physically demanding job.
Only in older patients who do not exercise or already have a significant cartilage damage, I advise against surgery. Without cruciate ligament there is a cartilage damage (osteoarthritis) and in sports patients the next accident can lead to further injuries of cartilage and meniscus.
Suppose you decide to have surgery. When is the right time?
Opinions differ on this question. It has been described in the literature that too early in surgery into the fresh injury can lead to scarring in the knee. Therefore, like many of my colleagues, I recommend immediate surgery after the accident or after the first swelling has gone down.
And how is the cruciate ligament tear surgically repaired?
Dr. Mauch: The most common surgical procedure is the cruciate ligament surgery (a new cruciate ligament). In the gentle and rapid procedure, the damaged cruciate ligament is replaced by a piece of the body's own tendon, for example from the patellar tendon or the semitendinosus tendon. After six weeks, for example, the inserted tendon piece is firmly attached to the bone.
Does the new tendon take on all functions of the cruciate ligament?
Dr. Mauch: Yes, but only if you look after the operation for intensive rehabilitation. Because the graft is still vulnerable to new injuries in the first ten months. The after-treatment, therefore, I consider almost as important as the operation itself. I attach this always to my patients to the heart.
What is the advantage of this operation method?
Dr. Mauch: It is very gentle for the patient. The whole procedure takes place arthroscopically, ie only over small skin incisions. About three to five centimeters long cut the graft is removed. The rest of the surgery is done without opening the joint. About two small skin incisions, the joint is viewed from one side and processed from the other side. The new band is drawn into the joint through drilling areas created in this way.