Cruciate ligament rupture
Together with the meniscus, the medial collateral ligament and the lateral collateral ligament, the cruciate ligaments are the most important stabilisers of the knee joint without which the knee joint can not properly function. The most important stabilisation task is performed by the anterior cruciate ligament. Ruptures of the cruciate ligaments (ruptures of the anterior cruciate ligaments occur much more frequently than ruptures of the posterior cruciate ligament) most often occur following a twisting trauma of the knee joint and need to be clearly diagnosed. In most cases a magnetic resonance tomography is performed. Patients with ruptured cruciate ligaments often report a “sliding away of the knee” during day-to-day movements. From this it follows that the knee is increasingly damaged: Firstly, in general, on the meniscus (the wear of which further increases the instability) and then also on the joint surfaces, which results in an increasing arthrosis.Presently, in order to prevent a premature arthrosis of the knee joint in particular patients that are ambitious in terms of sports are recommended a quick stabilisation by means of a replacement for the cruciate ligament.
In case of recent injuries of the cruciate ligament staggered surgery tactics prevail: Firstly, following the cruciate ligament rupture an intensive physiotherapy is performed for approx. 6 weeks in order to stabilise the knee and to let the primary damage resulting from the injury subside. After the completion of the physiotherapy the anterior cruciate ligament is then replaced by a tendon produced naturally in the body.
Treatment
All surgeries, also those on the anterior cruciate ligament, are performed by arthroscopy via two small entry channels in the knee joint. As it is not possible to suture the anterior ligament it is necessary to extract an autologous tendon (regularly the semitendinosus tendon). Therefore, via a small cut on the inside of the thigh a tendon of a length of approx. 20 cm is extracted which, fourfold folded, later replaces the former cruciate ligament. Even athletes do not suffer from strength deficiencies in the area of the inside of the thigh (adductors). The extracted tendon is then placed via drilling channels specifically created for this purpose to replace the former anterior cruciate ligament. The cruciate ligament is then fixated by means of absorbable screws. The introduced suture and fixation material does not need to be removed at a later stage.When reconstructing the cruciate ligament, the exact positioning of the transplant and of the drilling channels is vital. If badly placed, significant restrictions of mobility or an increasing instability can occur. The healing time of the transplant amounts to approx. 12 months which is why following a replacement of the cruciate ligament the knee joint can be exposed to full stress only approx. 1 year later.
Surgery
The operation is generally performed as an ambulant treatment. After the surgery the knee should be consistently relieved with the help of underarm crutches. Subsequently, a physiotherapeutic treatment is performed in order to achieve a consistant recovery. During the first 3 to 5 days the knee should be consistently cooled and put up. Further, lymph drainage should be applied in cooperation with the physiotherapist. Prior to the surgery, you will be provided with a special after-treatment program. The incapacity to work amounts to approx. 2 weeks in case of sitting activities while patients active in physical professions can normally return to work approx. 4 to 6 weeks after the operation.Resumption of sports after surgery
After 6 to 8 weeks, patients are normally able to resume light physical activities such as swimming, cycling and walking (with orthoses). Stop-and-go-sports should not be played for approx. 6 months. Due to the protracted transplant healing, contact sports should not be resumed earlier than approx. 12 months after the surgery.Complications
In the framework of the more complex operation of the anterior cruciate ligament complications can occur as well.Prior to the operation we will provide you with all information regarding the risk and possibility of complications.
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