Torn cruciate ligaments often occur in athletes who exercise intensively. Both the anterior and posterior cruciate ligaments can tear, but a tear of the anterior cruciate ligament (ACL) is more common. The ACL is the most important stabilizer of the knee and if it tears it can have major consequences for the quality of life, the level of sports and the risk of wear and tear later in life.
Causes and Symptoms of ACL Injury
Most ACL injuries are caused by sudden twisting movements in which the foot is firmly on the ground. One often feels a 'snap' or 'knot' in the knee and it swells within a few hours. The ligament may tear partially or completely.
Cruciate ligament tears
Partial Tear: Can sometimes heal, but often leads to an overstretched ligament, making the knee unstable.
Complete Tear: Does not heal on its own and must be surgically reconstructed.
A torn ACL causes severe pain and instability with certain movements, especially twisting movements and sudden changes in direction. This can cause the knee to feel weak and cause uncertainty during movement. If there are no complaints of instability, it can be decided not to surgically reconstruct the cruciate ligament.
Secondary Injuries
An ACL injury often involves multiple structures. In addition to ACL injuries, there is sometimes also damage to the inner ligament or outer ligament of the knee. For example, if there are lock complaints, it may be that the meniscus is also damaged.
Diagnosis and initial treatment
After an acute ACL injury, it is important to reduce swelling and improve mobility as quickly as possible. Always consult a specialist (orthopedic surgeon). X-rays are needed to rule out a fracture and an MRI scan to confirm the injury.
Depending on the research results, the surgeon chooses the most suitable treatment for a responsible recovery, so that you can exercise again.
Treatment and Rehabilitation
Nonsurgical: For some people, especially those who are less active, physical therapy may be enough to improve knee muscle strength and stability.
Surgical: For active individuals or athletes, surgical reconstruction of the ACL may be necessary to restore full functionality and stability to the knee.
Anterior cruciate ligament reconstruction is recommended for young, active athletes and/or patients with instability complaints. Non-operative treatment can also be chosen.
The operation
There are several methods for ACL reconstruction. The most common are the hamstring tendon, patellar tendon and quadriceps tendon. In the Netherlands, the hamstring method is usually used.
Recovery after a surgical procedure
ACL surgery is a major procedure and requires a lot of attention in the first month. After surgery, it is important to contact a physiotherapist as soon as possible. The therapist will help you walk on crutches, improve your mobility, and set treatment goals. The recovery process takes about nine months and is divided into several phases:
Phase 1: Limited ADL phase (0 – 2 weeks)
Phase 2: Loaded ADL phase (3 – 6 weeks)
Phase 3: Limited sports phase (7 – 12 weeks)
Phase 4: Functional/sport-specific exercise phase (13 – 20 weeks)
Phase 5: Sport-specific training (21 weeks and beyond)
The anterior cruciate ligament is therefore an essential part of the knee, especially important for stability and movement during physical activities.
