Anterior cruciate ligament torn

What is an anterior cruciate ligament injury?

The anterior cruciate ligament (VKB) is an important connective tissue ligament central to your knee joint. This ligament connects the upper leg to the lower leg and prevents the lower leg from sliding too far forward. The anterior cruciate ligament also provides stability during rotational movements. In an anterior cruciate ligament rupture (the medical term for a torn cruciate ligament), this ligament is completely or partially split down the middle. This leads to an unstable feeling, as if you are sinking through your knee.

How does a torn anterior cruciate ligament occur?

This sports injury to the knee is common in sports with unexpected and explosive movements. These include football, hockey, basketball and skiing. Usually, the anterior knee ligament tears the moment your foot is firmly on the ground, while your knee or upper body suddenly twists away. A hard landing after a jump, sudden braking, or a direct blow to the knee can also cause torn knee ligaments.

Figures and statistics on cruciate ligament injury:

• 1 in 3000: Every year, 1 in 3,000 people suffer an anterior cruciate ligament rupture.
• 9 to 15 months: The rehabilitation period for an anterior cruciate ligament injury can range from 9 to 15 months. This depends on the severity of the injury and treatment.
• 4,000 cases per year: More than 4,000 cruciate ligament injuries are recorded every year in the Netherlands. This number is in football alone.
• 70% non-contact injuries: About 70% of VKB injuries occur without physical contact. This is also known as a “non-contact” injury. This means that this injury usually occurs without an opponent or collision with an object.
• 9000 reconstructions per year: Every year, more than 9,000 anterior cruciate ligament reconstructions are performed in the Netherlands.

Symptoms of a torn cruciate ligament

Immediately after the incident, most people experience a sharp pain and an audible or palpable snap in the knee. Substantial swelling often develops within a few hours. Walking is very difficult and painful in the first few days. Once the worst swelling subsides after several weeks, the most characteristic symptom is the feeling of instability. Your knee feels unreliable and you feel like you could collapse through it just like that, especially when climbing stairs or making unexpected movements.

Diagnosis and examination in Fysio Fitaal

To make the right diagnosis, we perform a comprehensive physical examination at Fysio Fitaal in Tilburg. We use specific tests for this purpose, such as the Lachman test and front drawer test, to assess the clearance in your knee joint. Because we specialise in ultrasound diagnosis and examination, we can in many cases look directly at the surrounding tissues and rule out other injuries. An MRI scan at the hospital is often needed to definitively assess the damage to the cruciate ligaments and any damage to the meniscus.

Treatment torn cruciate ligament: Surgery or not?

Treatment for a torn cruciate ligament can be initiated in two ways: conservatively (without surgery) or surgically (an anterior cruciate ligament reconstruction). Conservative treatment focuses on firmly building muscle strength in the legs, especially the hamstrings (the muscles at the back of your thigh) and the quadriceps (the muscles at the front). By training these muscles optimally, they take over some of the stability of the knee.

Surgical treatment is often chosen by active athletes who want to return to sports with lots of rotational movements, or when the knee remains too unstable in everyday life. Various surgical techniques are available:

• Hamstring graft: In this process, the new cruciate ligament is made from tendons taken from the hamstring.
• BPTB graft: This method uses a piece of bone and tendon from the kneecap and tibia.

Both techniques give good results, with a low risk of complications and restoration of the passive stability of the knee. Our sports physiotherapists will guide you intensively with both choices.

Driving a car with torn knee ligaments

Driving a car should not be allowed again until you can safely make an emergency stop. This means you should have full control and muscle strength back in your leg and be able to walk pain-free without crutches. After surgery, this takes on average 4 to 6 weeks, depending on which leg was operated on and whether you drive a car. Also, always check the terms and conditions of your car insurance; if you get behind the wheel with crutches or a functional impairment, you may not be insured in an accident.

Risk factors and preventing new injuries

Not everyone is at the same risk of developing a VKB rupture. Athletes who twist and turn a lot during their sports, such as footballers, handballers and skiers, are most at risk. This injury is most common in people aged between 15 and 40. In addition, women are 2-8 times more likely to suffer an anterior cruciate ligament injury than men, mainly due to anatomical and hormonal differences.

The Q-angle and the risk of a knee injury

The Q angle (quadriceps angle) is a biomechanical measure used to assess the alignment of the knee. It is the angle formed between the line of the quadriceps muscle and the kneecap. In women, the Q angle is often around 15-18 degrees, while in men it is usually between 10-15 degrees. A larger Q-angle can lead to a less stable knee position during sports, which is one of the factors contributing to the higher risk of knee injuries in female athletes.

Neuromuscular training

The moment when an anterior cruciate ligament tears often has nothing to do with insufficient strength, but everything to do with the speed of reaction to external forces. When the anterior cruciate ligament tears completely, the load on the knee is so sudden and intense that the muscles do not react quickly enough to stabilise the knee. Brute force alone is therefore not enough. The key to preventing another injury lies in improving the neuromuscular system so that muscles and brain can react and anticipate unpredictable movements faster. Therefore, coordinative training, such as balance exercises and plyometrics, is a crucial part of rehabilitation.