Cruciate Ligament Rupture

Cruciate ligament rupture, and especially of the anterior cruciate ligament, is one of the most common and serious knee injuries, especially in people who are actively involved in sports. This injury is accompanied by pain, restriction of movement and difficulty not only in walking but also in everyday life in general.

The most effective treatment option, especially if the patient is young and actively involved in sports, is surgical repair of the rupture. The operation is performed in the majority of cases with minimally invasive techniques, which enable the athlete to return to his daily life and sports, faster and with less pain.

The knee is a complex joint, which is stabilized by four main ligaments. Two of them are the anterior and posterior cruciate ligament, which are located crosswise inside the joint and hold the tibia in relation to the femur, protecting against anterior and posterior slippage.

Cruciate ligament rupture occurs when the ligament is subjected to a sharp, violent tension beyond its strength. More common is the rupture of the anterior cruciate ligament, which usually occurs during rotational movements or a change of direction while the foot is fixed on the ground. The rupture can be complete or partial, with the complete rupture being the most severe form. It is an injury that is closely linked to high-intensity sports activities such as football, basketball, handball and skiing. In a percentage that exceeds 70%, the rupture occurs without contact with another athlete, but due to sudden movements.

On the contrary, the rupture of the posterior cruciate ligament is less common and is mainly caused by direct impact in the anterior part of the tibia, such as in road accidents (e.g. impact on the board) or by intense overextension and falls in sports activities. The posterior cruciate ligament is the stronger of the two and limits the backward displacement of the tibia.

The injury mechanism usually involves rotational movement of the knee with the foot steady, sudden deceleration, uncontrolled landing from a jump or a sudden change of direction. Factors such as reduced muscle control, insufficient stability of the core muscles, proprioception disorder and muscle imbalances increase the risk of rupture in the cruciate ligaments. It should be noted that women have an increased frequency of anterior cruciate ligament ruptures due to anatomical and hormonal differences.

The rupture of the cruciate ligament is often perceived immediately: the patient describes a characteristic “crack” sound, intense pain and immediate instability of the knee. Swelling almost always occurs very quickly, which intensifies stiffness and makes charging difficult. In a subacute phase, the patient feels the knee “leaving/sliding” from its position or inability to support itself when walking or changing direction.

In posterior cruciate ligament rupture, the symptoms are similar but less pronounced initially. Swelling, mild instability and pain deep in the knee are the main characteristics. In more severe cases, lesions in the posterior corner or other ligaments may coexist, which require special attention.

The diagnosis begins with a detailed history and a special clinical examination. MRI is the imaging method of choice and confirms the diagnosis, as it highlights the ruptures and accompanying injuries.

The therapeutic approach for cruciate ligament ruptures depends on the severity of the injury, the patient’s activity level and the accompanying injuries. It should be noted that cruciate ligament rupture, especially in athletes, in the majority of cases, is treated surgically.

Conservative treatment is mainly applied to older patients, with low demands, or in cases of partial rupture without symptoms of instability. It includes unloading, physical therapy for muscle strengthening, proprioceptive retraining and control of range of motion. In some cases, it can ensure satisfactory stability and functionality of the knee in everyday life. However, it should be emphasized that the conservative approach does not prevent future damage such as degenerative meniscus damage or the development of osteoarthritis.

For athletes, restoring knee stability is imperative. Anterior cruciate ligament rupture is often accompanied by other injuries (meniscus rupture, cartilage injury or lateral ligaments), which make it necessary to fully restore joint function. Ligamentoplasty of the anterior cruciate ligament is performed arthroscopically, using an autologous graft, usually from the posterior femoral tendons or the patellar tendon. The transplant is placed in specially shaped bone channels in the femur and tibia, and is stabilized with modern implants.

Surgical treatment for the complete rupture of the posterior cruciate ligament is indicated when there is significant instability or when the injury is accompanied by injury to the posterior lateral angle. These procedures are technically demanding and require a surgeon specializing in the knee. The aim is to restore functionality, prevent long-term instability and prevent cartilage damage.

Rehabilitation begins immediately after the operation with an individualized physiotherapy protocol. The goal is to regain range of motion, strengthen and restore proprioception. The use of crutches is temporary, and gradually the patient returns to walking and daily activities. Return to sports activities, depending on requirements, is allowed at approximately 6–9 months, after evaluation by the medical and physiotherapy team.

In general, cruciate ligament rupture is a serious knee injury that unfortunately often occurs in athletes and people with high mobility. Early diagnosis, the appropriate therapeutic strategy – either conservative or surgical – and methodical rehabilitation are decisive factors for maintaining the stability and functionality of the joint and the patient’s quality of life.