Anterior cruciate ligament rupture

What is an Anterior Cruciate Ligament Rupture?

Anterior cruciate ligament rupture is one of the most common and serious knee injuries. The anterior cruciate ligament (ACL) is located in the center of the knee joint and connects the femur to the tibia, contributing decisively to the stability of the joint.

Its role is to prevent excessive anterior displacement of the tibia and control the rotational movements of the knee. When this ligament is ruptured, the stability of the knee is significantly disturbed, which affects daily mobility and the ability to exercise.

The injury can be partial or complete, and often coexists with other knee injuries such as meniscus tear, medial collateral ligament rupture and articular cartilage damage.

How is the rupture of the anterior cruciate ligament caused?

A rupture of the anterior cruciate ligament is usually caused by sudden rotational movements that exert a lot of force on the knee. It is not necessary that this condition will be caused by a sports injury, a sudden or incorrect movement is enough.

The most common mechanisms that can cause anterior cruciate ligament rupture are:

• Sports with sudden changes of direction, such as tennis, basketball or skiing
• Sudden deceleration during movement
• Turning the body with the foot fixed on the ground
• Hyperextension of the knee
• Direct blow to the knee area, such as in football collisions or car accidents

While predisposing factors for rupture are:

• Muscle fatigue and insufficient muscle strength
• Incomplete or incorrect warm-up before exercise

Understanding the mechanisms and factors that lead to rupture is useful both for prevention and for choosing the appropriate therapeutic approach.

Rupture of the anterior cruciate ligament: symptoms

The symptoms of an anterior cruciate ligament rupture usually appear immediately after the injury and can vary in intensity, depending on the severity of the injury, the history of the injury and the individual patient.

More common signs and symptoms include:

• characteristic sound or sensation at the time of injury

• severe pain

• appearance of swelling (hemorrhage) within a short time (bleeding in the joint)

• difficulty walking or supporting the weight of the body with the knee

• feeling of instability in the knee, especially during rotational movements

Even if the pain decreases in a short period of time, knee instability is an important warning sign.

The Process of Diagnosis

The diagnosis of anterior cruciate ligament rupture is based on a combination of clinical examination and imaging methods.

As a first stage , the doctor takes a detailed history, focusing on the manner of injury and the symptoms that followed.

In the second stage, during clinical examination, tests are applied that evaluate the stability of the knee and the integrity of the ligament.

In some cases, confirmation of the diagnosis may be required. MRI is the method of choice, as it accurately visualizes both the soft tissues of the joint, such as the anterior cruciate ligament, and possible cartilage damage or bone edema.

In addition, a simple X-ray is always useful, mainly to rule out concomitant bone injuries. Early and correct diagnosis is crucial for designing the appropriate treatment approach.

Treatment options

The choice of the appropriate therapeutic approach for anterior cruciate ligament rupture is done individually and depends on a number of parameters, such as:

• Age
• the person’s daily activities
• The athletic requirements of the patient
• The degree of knee instability

Conservative treatment can be a solution for people with low functional requirements or for patients who do not experience severe instability. More specifically, it includes an organized physiotherapy program aimed at strengthening the muscles that stabilize the knee.

In contrast, surgical repair is most often recommended for younger or athletically active patients, as well as in cases where instability significantly affects everyday life.

The goal of surgical treatment is to restore the stability of the knee and prevent secondary damage, such as meniscus tears and premature wear and tear of articular cartilage.

Postoperative rehabilitation and restoration of functionality

Surgical repair of the anterior cruciate ligament rupture is performed with an arthroscopic technique and involves the reconstruction of the ligament using a graft. Although technically sound surgery is crucial, the overall success of treatment depends to a large extent on postoperative rehabilitation.

The rehabilitation program is structured, gradual and adapted to the needs of each patient, with the initial goal of:

• Control of pain and swelling
• The restoration of the range of motion
• Safe knee loading

Rehabilitation then focuses on progressively strengthening the muscles of the thigh and gastrocnemia, improving balance and proprioception, and controlling movement.

Consistency in the rehabilitation program and close cooperation with the attending physician and the physiotherapist are key factors for reducing the risk of re-injury and the safe return to everyday life and sports after the appropriate period of time.

If you are experiencing a ruptured anterior cruciate ligament or symptoms of knee instability, it is important to consult a medical professional with expertise and years of experience in knee surgery.

Orthopedic Surgeon Anastasios Lilikakis is the Director of the Third Orthopaedic Clinic of the Athens Euroclinic and the President of the Department of Reconstructive Hip & Knee Surgery of EEHOT.

Contact us and schedule your appointment so that you receive a comprehensive diagnosis and a personalized treatment plan, tailored to your needs and activity.