EN 
NL Anterior cruciate ligament injury
An injury to the anterior cruciate ligament (ACL) has a major impact - not only on sports performance, but certainly also on daily functioning. Injury to the anterior cruciate ligament requires a careful diagnosis and a well-thought-out treatment path. Especially to make possible additional damage to the knee transparent and appropriate within the rehabilitation pathway.
Every knee is different, every athlete is different - which is why customisation is our focus. Recovery from an anterior cruciate ligament injury is much more than just training muscles and building load capacity. It also requires mental resilience, perseverance and trust in one's own body. Many patients experience moments of doubt, fear of re-injury or uncertainty about the pace of recovery during their rehabilitation. This is why at Fysio Fitaal we not only pay attention to physical build-up, but also to the mental side of the process. Through personal guidance, continuous evaluation and open communication, we build recovery together - step by step, confidently moving forward.
Cause
An anterior cruciate ligament (VKB) injury occurs in most cases during sudden twisting movements or during a wrong landing during sports. The anterior cruciate ligament is one of the four main ligaments (ligaments) that provide stability in the knee. When this ligament tears, it can lead to instability and severe pain. The other ligaments are the medial band, lateral band and the posterior cruciate ligament.
Figures and statistics
An awful lot of research has been done on anterior cruciate ligament injuries. As a result, we know an awful lot about all the ins and outs of this sports injury:
- 1 in 3,000: 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 the treatment.
- 4,000 cases a 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 a year: Every year, more than 9,000 anterior cruciate ligament reconstructions are performed in the Netherlands.
Risk factors for anterior cruciate ligament rupture
Not everyone is at the same risk of developing a VKB rupture. Athletes who twist and turn a lot during their sport, such as footballers, handballers and skiers, are most at risk.
- Women are 2-8 times more likely to suffer an anterior cruciate ligament injury than men, mainly due to anatomical and hormonal differences.
- Age group 15-40: This injury is most common in people aged between 15 and 40 who play sports such as basketball, football or handball.
Type of anterior cruciate ligament surgery
A severe anterior cruciate ligament injury may require surgery. Several surgical techniques are available, the most common method being reconstruction using a hamstring graft or a bone-patellar-tendon-bone (BPTB) graft. Both techniques give good results, with a low risk of complications and restoration of passive stability of the knee.
- Hamstring graft: This involves making the new cruciate ligament from tendons taken from the hamstring.
- BPTB graft: This method uses a piece of bone and tendon from the kneecap and tibia.
While both techniques are effective, it is important to know that the recovery process is individual and varies from patient to patient. No knee is the same and there is no universal treatment that works for everyone.
Diagnosis and examination anterior cruciate ligament injury
A prompt and accurate diagnosis is essential for a good prognosis and is necessary to initiate the treatment process in a timely manner. The diagnostic process involves a combination of eliciting recognisable patterns, physical examination and imaging.
Recognisable symptoms
A VKB rupture is often characterised by an audible or palpable 'snapping' sound at the time of trauma, followed by a feeling of instability in the knee. Within hours, swelling (haematarthrosis) usually develops as a result of bleeding in the joint. In many cases, it is not possible to resume sport or put the leg under proper load. A common mechanism is a rotational movement of the upper leg relative to the lower leg, often combined with inward sagging of the knee.
Physical examination
The diagnostic process starts with a comprehensive anamnesis, in which the trauma mechanism, time course and symptoms experienced are asked out. Next, physical examination is performed. The Lachman test, anterior sliding drawer and pivot shift are common tests to possibly make a statement about the anterior cruciate ligament.
Treatment of anterior cruciate ligament injury
Treating an anterior cruciate ligament injury is not a one-size-fits-all. Every person and every knee is unique, and the recovery process must be tailored accordingly. From initial diagnosis to eventual return to sport, it is crucial to consider both the physical and mental aspects of the recovery process. At Fysio Fitaal Tilburg, we offer personalised rehabilitation programmes tailored to your needs, so that you can return to optimal performance after your injury.
At Fysio Fitaal in Tilburg, we see athletes with cruciate ligament problems on a weekly basis. Our practice specialises in treating anterior cruciate ligament injuries and has years of experience in this field. We combine clinical expertise with a data-driven approach to make the recovery process as transparent and measurable as possible. This includes objective strength measurements, jump analyses, movement analyses and structured return-to-sport criteria. Thanks to our modern facilities, we can monitor every rehabilitation trajectory in detail and make adjustments where necessary.
The risk of another anterior cruciate ligament injury
The consequences of an anterior cruciate ligament injury can be significant, both physically and mentally. Athletes who have undergone VKB reconstruction have about a 31% chance of re-injury, either to the same or the other knee. This can lead to long-term inactivity and also an increased risk of osteoarthritis, which can cause problems later in life.
Osteoarthritis: The risk of developing osteoarthritis (joint wear) after a VKB injury is up to 10 times higher than in someone without knee problems.
Besides physical rehabilitation, mental resilience also plays a big role in our recovery process. Fear of re-injury, especially in elite athletes, can make athletes less likely to reach their former level. Research shows that about 50% of athletes do not return to their former level of sport within three years. This decision is often influenced by fear of re-injury.
Preventing new injury to the anterior cruciate ligament
Although an anterior cruciate ligament injury is often unexpected, there are ways to reduce the risk. Strength and being able to react quickly in unexpected situations are part of this.
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. This injury often occurs during situations when the body has to react quickly to unexpected movements or external forces, such as during a sudden change of direction, a wrong landing, or an abrupt stop while running.
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. The body cannot adequately handle the sudden external forces due to a lack of coordination and responsiveness, and this leads to a vulnerable moment when the cruciate ligament tears.
This is exactly why coordinative training is so important in rehabilitation and not just strength training. You can still have such strong quadriceps or hamstrings, but if you are not trained to respond quickly and effectively to these external forces, you are still at great risk. The key to preventing another injury lies in improving the neuromuscular system so that muscles and brain can react and anticipate unpredictable movements faster.
During rehabilitation, specific attention should therefore be paid to training reaction skills, such as in balance exercises, plyometric training and sport-specific scenarios in which the knee is exposed to similar forces as during the injury. This helps to train the body to respond appropriately to external forces, significantly reducing the risk of re-injury.
Brute force alone is not enough. It is reaction time, coordination and the ability to absorb external forces that make the real difference in preventing another anterior cruciate ligament injury.
The Q-angle and the risk of a knee injury
The Q corner (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 (patella), and it is measured in the frontal plane of the body. This angle provides insight into the forces acting on the knee, especially during movements such as walking, running and jumping.
In women, the Q-angle is larger on average than in men, and this can affect the risk of knee injuries, such as anterior cruciate ligament (ACL) injury. The increase in Q angle in women is often attributed to a wider pelvic structure, which creates a greater angle between the upper leg (femur) and the knee.
A larger Q-angle can lead to increased lateral (outward) traction on the kneecap and increases the risk of knee problems, such as:
- Patellofemoral pain syndrome (Kneecap problems due to wear and tear or poor tracking of the kneecap).
- Increased risk of ligament injuries in the knee: A larger Q-angle may lead to a less stable knee position during sports, especially during movements with rapid changes of direction or turning movements.
In women, the Q angle is often around 15-18 degrees, while in men it is usually between 10-15 degrees lies. This larger angle is one of the factors contributing to the higher risk of knee injuries in female athletes.
Making an appointment at FysioFitaal
We work from multiple locations in Tilburg, always close by for professional and accessible physiotherapy. Fill in the contact form and we will contact you soon. Together, we will work on your recovery!
