CRUCIATE LIGAMENT
What is a cruciate ligament?
In the knee there is a front cruciate ligament and a posterior cruciate ligament. Medically, these are called the Anterior Cruciate Ligament - ACL (anterior cruciate ligament) and the Posterior Cruciate Ligament - PCL (posterior cruciate ligament). Its function in the knee is to stabilize forward and backward sliding, respectively. 90% of all cruciate ligament injuries affect the anterior cruciate ligament. One of the reasons why the posterior cruciate ligament is injured so much less often, is that the ligament is clearly thicker than the anterior one. In connection with a cruciate ligament injury, the meniscus and cartilage in the knee can also be damaged.
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Why is the cruciate ligament damaged?
An injury to the anterior cruciate ligament is essentially a sports-related injury. In sports where contact with other players occurs, anterior cruciate ligament injuries are more common.
The most common cause of anterior cruciate ligament injury is that you run, stop suddenly and quickly change direction with a slightly bent knee. A type of movement that is often found in, for example, football, handball, floorball. The risk increases further with good grip in the sole or studs that fix the foot to the surface.
Women are affected more often than men. Why, is a bit unclear. Reasons being discussed are that women's cruciate ligaments are thinner than men's. Women often have more mobile knees than men. Some studies point to hormonal factors, where one seems to be able to see an increased risk of cruciate ligament injury before menstruation.
An injury to the posterior cruciate ligament often occurs in connection with a trauma to the knee where the lower leg is forcibly pushed back in relation to the thigh or the knee is stretched under heavy load. Here, a relatively large force is required at the time of the accident for the posterior cruciate ligament to be damaged or fall off. For example, in a car accident where you hit your knee in the dashboard or if you are riding from the front in ice hockey and hit the lower leg with a bent knee.
Symptoms of cruciate ligament injury
Anterior cruciate ligament injury: Usually marked pain in the knee at the time of injury. A relatively rapidly increasing swelling in the knee, with difficulty in stretching the knee as a result. It is not uncommon for the knee to feel unstable under load.
Rear cruciate ligament injury: Usually a little more diffuse symptoms than with anterior cruciate ligament injury. Swelling often less pronounced. Likewise stiffness and pain in the knee. The pain is not infrequently localized to the back of the knee. Feeling of instability in the knee not so common with posterior cruciate ligament injury.
Treatment of cruciate ligament injury?
Immediately at the time of injury, it is good to apply compression with a solid elastic wrap around the knee for about 30 minutes, with the knee above heart level. Then continue a little lighter pressure around the knee for the next 24 hours. During that day, it is recommended to rest and relieve the knee. Then gradually increased load. It is important to calmly start moving the knee without provoking further pain and swelling. If you can not walk without lameness, then one or two crutches are recommended to relieve the knee when walking.
Our physiotherapists have the competence to test and examine the knee. In case of suspicion of cruciate ligament injury, we further refer the patient to an orthopedist. The patient often undergoes a magnetic camera examination and a decision on whether surgery is taken. In normal cases, the patient returns to us for rehabilitation training of the knee. If you basically have a stable knee, you can do well without surgery. What is crucial is if the knee bends to and from or if you are going back to sports that include stops, starts and twists in the knee, then surgery is usually performed.
The rehabilitation time after an operation of the anterior or posterior cruciate ligament injury varies, depending on whether the injury also included the meniscus and / or collateral ligaments. Under optimal conditions, you can count on at least 6 months before you are back at the activity level as before the injury. In tests, we want you to have 100% of power and function in the operated bone, compared to the undamaged bone. This is what will be decisive for when full return to demanding activity is to be recommended by us.
Rehabilitation is, as always with us at Alta Vita Physiotherapy, individually tailored. The goals are set according to the desire for activity level after completion of rehabilitation. The goal is to optimize mobility, coordination and load tolerance in the knee. We set up a treatment plan, support and assist the patient in the increase and development of rehabilitation.
What is the prognosis for cruciate ligament injuries?
Of people who have played sports at a high level and operated on a new cruciate ligament, between 60-90% return to sports at the same level as before the injury. 2 years after the operation, 75-95% of the patients are satisfied with the result.
If you have suffered a cruciate ligament injury, the risk increases that in the future you will get wear and tear injuries to the cartilage in the knee, osteoarthritis. Whether surgery is performed or not does not seem to affect the risk of osteoarthritis.
Differential diagnoses for cruciate ligament injury
Meniscus damage, collateral ligament damage, cartilage damage in the knee, damage to the plantar muscle.
