You felt or heard a distinct ‘snap’ in your knee while playing sports and now your knee is thick and painful. Having torn an anterior cruciate ligament is quite a setback, especially if you are an active athlete. At Fysio Fitaal, we understand the frustration and uncertainty this injury brings. Fortunately, you are not alone. With the right guidance and a targeted plan, we will work together on your recovery so that you can soon move again with confidence.
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.
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.
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.
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 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:
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.
Recovery from an anterior cruciate ligament injury requires a lot of patience and commitment. 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 the treatment chosen (conservative or surgical). Especially if you want to return to a field sport with a lot of rotational movements, you will go through a long-term process in which we build up your muscle strength, stability and self-confidence step by step.
In most Dutch hospitals, knee braces are no longer prescribed after standard anterior cruciate ligament reconstruction. The policy nowadays focuses on activating the leg muscles as soon as possible to restore natural stability. A brace is often only advised nowadays if there are additional injuries that need extra protection, such as when the meniscus has been sutured or with injuries to the lateral 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.
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 (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.
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.
Do you suspect that your anterior cruciate ligament is torn, or are you looking for specialised guidance after your knee surgery? Don't keep walking unnecessarily with doubts or pain. Our experienced sports physiotherapists at the Reeshof, Zuid, West and Noord locations are ready to work with you on your recovery. Contact us directly to make an appointment for a detailed intake.
In the first days after the injury, walking is often very painful and you usually use crutches to relieve the knee. Once the swelling goes down, many people are able to walk normally again in a straight line, although the knee often continues to feel unreliable during unexpected twisting movements.
Yes, whether you choose surgery or not, physiotherapy is always a set step in your process. At our anterior cruciate ligament rehabilitation in Tilburg we help you safely rebuild muscle strength, mobility and full control of your knee.
The acute, sharp pain and throbbing swelling usually subside considerably after a few weeks. How the pain and stiffness progress thereafter depends closely on the treatment you choose and how well you continue to load the knee in a dosed manner.
Rest, elevating the leg and letting the swelling go down are the top priority in the acute phase. As soon as the worst pain allows, gently bending and stretching the knee is the most important exercise. This will prevent the joint from becoming stiff. For example, sit on the floor or on the bed and gently slide your heel to your buttocks and back again. Above all, being able to fully stretch of the knee is an important early goal in your recovery, but never force it through the pain.
This depends on objective measurements and not just time. Although a rehabilitation programme usually lasts 9 to 15 months, you may not return to full sports until you meet specific Return to Sport criteria. Here, we test whether the strength in both legs is almost equal, whether you land stably after a jump and whether you no longer feel mental fear when making unexpected movements. Only when all lights are green will you safely re-enter the field.
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