Illustration of a torn anterior cruciate ligament, where the ligament has ruptured through its mid-substance.
How do you injure the cruciate ligament?
Cruciate ligament injuries may be 'contact' or 'non-contact' - a bad tackle in sports, forceful twisting of the upper body when one foot is firmly on the ground, tripping and hyper-extending the knee...
Usually one is unable to continue with the activity, with pain, immediate instability and early swelling.
Peer-reviewed papersQuote from peer-reviewed paper:
"...non-contact injuries are the most common and are caused by forces generated within the athlete's body...."
Citation: Rodriguez K, Soni M, Joshi PK, Patel SC, Shreya D, Zamora DI, Patel GS, Grossmann I, Sange I. Anterior Cruciate Ligament Injury: Conservative Versus Surgical Treatment. Cureus. 2021 Dec 6;13(12):e20206. doi: 10.7759/cureus.20206. PMID: 35004026; PMCID: PMC8730351.
Quote from peer-reviewed paper:
"...a decrease in femoral notch width, a decrease in the depth of concavity of the medial tibial plateau, and an increase in the posterior-inferior-directed slope of the tibial plateau, act in combination to increase the risk...It is very probable that multiple risk factors act in combination to influence injury risk...."
Citation: Smith HC, Vacek P, Johnson RJ, Slauterbeck JR, Hashemi J, Shultz S, Beynnon BD. Risk factors for anterior cruciate ligament injury: a review of the literature - part 1: neuromuscular and anatomic risk. Sports Health. 2012 Jan;4(1):69-78. doi: 10.1177/1941738111428281. PMID: 23016072; PMCID: PMC3435896.
What are the symptoms and signs of a torn cruciate ligament?
The cruciate ligaments are important stabilisers of the knee, and damage may lead to instability. The ligament has a good blood supply, so injury may also cause rapid bleeding into the knee - the blood will be contained within the capsule, leading to a balloon-like sudden swelling. A loud 'pop' may be heard at the time of the injury. There may be an immediate feeling of instability.
Peer-reviewed papersQuote from peer-reviewed paper:
"...Physical examination for the assessment of the ACL....is part of the diagnostic process. The anterior Lachman test (LT), anterior drawer test, and pivot-shift test (PST) are the most well-known physical tests used to assess the ACL's integrity...."
Citation: Rodriguez K, Soni M, Joshi PK, Patel SC, Shreya D, Zamora DI, Patel GS, Grossmann I, Sange I. Anterior Cruciate Ligament Injury: Conservative Versus Surgical Treatment. Cureus. 2021 Dec 6;13(12):e20206. doi: 10.7759/cureus.20206. PMID: 35004026; PMCID: PMC8730351.
Management of a torn cruciate ligament
The decision to repair or reconstruct is not an emergency. Once the diagnosis of a cruciate ligament tear has been made, the knee is put into a functional brace, where it is still possible to walk with some restraint but twisting movements are restricted. This period in a brace allows the knee to settle and blood to be resorbed. Then patient and surgeon can discuss the issues and decide on surgery to repair or reconstruct the ligament.
Peer-reviewed papersQuote from peer-reviewed paper:
"...non-contact injuries are the most common and are caused by forces generated within the athlete's body...."
Citation: Rodriguez K, Soni M, Joshi PK, Patel SC, Shreya D, Zamora DI, Patel GS, Grossmann I, Sange I. Anterior Cruciate Ligament Injury: Conservative Versus Surgical Treatment. Cureus. 2021 Dec 6;13(12):e20206. doi: 10.7759/cureus.20206. PMID: 35004026; PMCID: PMC8730351.
Quote from peer-reviewed paper:
"...one of the main issues is whether ACL reconstruction can minimise the risk of osteoarthritis progression....ACL reconstruction appears to reduce the incidence of OA progression, but it does not fully restore knee function comparatively with the uninjured knee"
Citation: Paschos NK, Howell SM. Anterior cruciate ligament reconstruction: principles of treatment. EFORT Open Rev. 2017 Mar 13;1(11):398-408. doi: 10.1302/2058-5241.1.160032. PMID: 28461919; PMCID: PMC5367541.
Forum discussions
- Torn ligmant [sic] advice please
A cruciate beginner wanting to understand more.