Cruciate ligament tear: should one operate or not?

Dr Calzoni, what is a cruciate ligament tear? 
The knee joint is made up of various different components, including two cross-shaped ligaments that are responsible for keeping the joint stable. These ligaments are called the anterior and posterior cruciate ligaments. A cruciate ligament tear occurs when one of these ligaments tears or partially detaches from the knee.

What poses the greatest risk of acquiring this kind of injury? 
Cruciate ligament tears typically occur in sports that require rapid changes of direction, coming to an abrupt stops or making sudden movements. For example, football, basketball, handball or skiing, among others. Some 70,000 football accidents occur in Switzerland every year while the three-month skiing season clocks up to 50,000 accidents. Although not all accidents involve knee injuries, it is often the case that the knee joint will be affected. Due to anatomical differences in the knee joint, women are slightly more susceptible to this kind of injury than men. However, a cruciate ligament tear usually does not occur as an isolated injury, but is accompanied by other injuries to the meniscus, the collateral ligaments or the cartilage layer.

What options are there for treating the injury? 
In the case of a cruciate ligament tear, surgery is often unavoidable, especially if it is combined with other injuries. This means that if, as well as the cruciate ligament, the medial or lateral ligament or the meniscus is torn, the stability of the knee joint cannot be restored without surgery. What’s more, the younger and more athletic patients are, the more likely it is that they will undergo surgery. The operation involves replacing the torn cruciate ligament with a fragment of tendon from the patient’s own body or a graft. This is followed by intensive rehabilitation to restore the knee joint to its full range of mobility and strength. 
If it is the case that it is just the cruciate ligament that has been torn, one can try to repair it without surgery. A cruciate ligament tear may also be treated in a conservative way even with the elderly or patients with a relatively inactive lifestyle. In this case, the affected knee joint is stabilised by a brace or orthotic device and the patient may have to refrain from sport or physical activity for a few weeks or months.

Myths concerning cruciate ligament tears
There are a number of myths and false ideas concerning cruciate ligament tears that we would like to clear up here:

Myth: Every cruciate ligament tear requires surgery. 
Correction: No, there are cases where surgery is not required and the cruciate ligament tear can be treated using conservative therapeutic methods. The main emphasis is on developing a personalised treatment plan together with each patient.

Myth: Due to their weaker muscles and greater instability of their knee joints, women are more susceptible to cruciate ligament tears. 
Correction: While women tend to have a higher injury rate than men owing to anatomical differences, weaker muscles are not the only contributing factors. Strength training and improving flexibility and technique can reduce the risk of cruciate ligament tears in women.

Myth: A cruciate ligament tear always entails a lengthy break from exercise and sport. 
Correction: The length of the break from exercise and sport depends on a number of factors, such as how severe the injury is, the type of treatment and the pace at which each individual patient recovers. And it also depends on the type of sport. Female footballers and skiers certainly do need to take a break of three to six months if they do not have surgery. If surgery is carried out, the break will be for at least nine to twelve months. With low-impact sports such as cycling or walking, patients can usually resume their sports activities within six weeks after an injury.

Myth: You can help reduce the risk of a cruciate ligament injury by stretching and warming up. 
Correction: Although warming up and stretching are important, they cannot completely prevent a cruciate ligament tear from occurring. The risk can be reduced by a combination of strength training, flexibility training and improving technique.

Myth: A cruciate ligament injury always results in chronic knee pain and reduced mobility. 
Correction: Proper treatment and physiotherapy can help to reduce or prevent pain and restricted mobility. A prompt diagnosis and treatment are important, however, to facilitate a full recovery.

Myth: Not operating on a cruciate ligament tear is more likely to lead to osteoarthritis in the knee. 
Correction: That is not true. The development of osteoarthritis is linked to the severity of the injury, especially in the case of damage to the cartilage that is not yet apparent. 

To summarise, a cruciate ligament tear is a serious injury that often requires a surgical procedure. A specific course of physiotherapy is key to restoring the knee joint to its full range of mobility and strength. The risk of a cruciate ligament tear can be reduced by a combination of strength training, flexibility training and improving technique.

What is the difference between a cruciate ligament tear (rupture), partial cruciate ligament tear and sprains? 

Cruciate ligament tear (rupture): 
A cruciate ligament tear is the most serious injury and means that the cruciate ligament is completely ruptured. This injury usually occurs during sudden, forceful movements, such as when landing after a jump or falling on the knee. A cruciate ligament tear usually requires a surgical procedure to repair or replace the torn ligament.

Partial cruciate ligament tear 
A partial cruciate ligament tear is an injury where the cruciate ligament is partially torn or over-stretched. This injury usually occurs during less intense movements or in conjunction with a lower impact injury. A cruciate ligament tear can be treated surgically or non-surgically, depending on how severe the injury is.

Over-stretching 
A cruciate ligament sprain is the mildest injury and means that the cruciate ligament has been over-stretched but not torn or ruptured. A cruciate ligament sprain often occurs during a sudden, but not very high-impact movement. This injury can usually be treated without the need for surgery and usually requires a course of conservative physiotherapy to restore the strength and stability of the knee joint.