Orthopedics-Online

OP of an anterior cruciate ligament tear

Therapy options

As almost always in therapy, there are two options: either conservative or operational.
The therapy must be based on the individual circumstances and requirements of the patient. A competitive athlete will want to get up on his feet as quickly as possible and want a knee that is stable even under high stress situations. The 60-year-old chess player will be able to do without it and thus be happy without an operation. Some medical professionals are of the opinion that after a cruciate ligament rupture without surgery, always one arthrosis comes in, it's only a matter of time. That is why the various therapies are always hotly debated. Therefore an overview is given below. Those affected must discuss the advantages and disadvantages with their treating doctor in detail.

Operative therapy

The decision for a cruciate ligament rupture operation depends on many factors:

Age (see also: Cruciate ligament tear in the child)
activity
job
Accompanying injuries (Meniscal tear)

The most common surgical methods for one Cruciate ligament tear are the so-called Cruciate ligament surgery. During this operation, a piece of the body is made tendon implanted in the knee as a replacement. These should not be carried out immediately, as the risk of joint scarring and restricted mobility is particularly high in the first few days after the accident. The previously common cruciate ligament sutures are left out except for the bony tear and the supply of the posterior cruciate ligament. But the operation alone is not enough, a similarly exhausting one Follow-up treatment of the cruciate ligament tear - OP is necessary and the six weeks, which should always be enough for our soccer stars, should be the commendable exception. Generally are 3 months a good cut.

How is an anterior cruciate ligament tear treated?
At a anterior cruciate ligament rupture it is important to restore the lost inner support of the joint.To do this, the anterior cruciate ligament must be reconstructed as anatomically as possible. The new cruciate ligament should imitate the properties and function of the natural anterior cruciate ligament as much as possible.
As a substitute material, the use of the so-called kneecap tendon (Patellar tendon), as well as the so-called Hamstring (Seeing the Semitendinosus muscle and Gracilis muscle) proven.

The patellar vision:
Here, an approx. 1 cm wide piece of tendon is removed from the middle third of the patellar tendon, with a 2 x 1 cm wide bone block attached to both ends. The advantage of using this patella tendon is that it can be easily fixed: The attached bone blocks are fixed in the drill channels with so-called interference screws made of titanium or sugar. The installation and fixation of the transplant is nowadays done purely arthroscopically (by a Knee arthroscopy).
The semitendinosus tendon (Tendon that is taken near the knee joint on the inside of the thigh).
These tendons are removed through a small skin incision on the inside of the tibial head and doubled each time so that a quadruple graft results. The primary tear force of a Quadruple Hamstring Graft (quadruple-placed tendon graft) is approximately twice as high as the tear strength of the normal human anterior cruciate ligament.
The advantages of Semitendinosus- and Gracilis-Transplants in cruciate ligament rupture surgery are the low complication rate, the lower pain after removal of the tendons and the only small, cosmetically favorable skin scar.
Furthermore, this graft is more likely to achieve rigidity than a normal anterior cruciate ligament. It has been proven that movement restrictions are less common. The maximum tear force of the quadruple hamstring graft is even higher than that of the patellar tendon.
A disadvantage is the slower healing of the tendons in the bone canals compared to the patellar tendon. The bony blocks of the patellar tendon grow within 3-6 weeks one, the squat tendons need for this 10-12 weeks.

Which of the available techniques of cruciate ligament replacement is ultimately used in a cruciate ligament rupture operation depends on many factors such as Age, gender, sport activity, height, weight and tissue structure. The fixation is done either with so-called interference screws (also available in dissolvable materials) or with titanium clips.
Although the technique seems relatively complicated, the success rates after such procedures are good, especially if there are no significant additional injuries. This aspect also speaks in favor of repairing such a situation as early as possible.

Please also read: Cruciate ligament tear duration.

Appointment with a knee specialist?

I would be happy to advise you!

Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
Various television programs and print media report regularly about my work. On HR television you can see me every 6 weeks live on "Hallo Hessen".
But now enough is indicated ;-)

The knee joint is one of the joints with the greatest stress.

Therefore, the treatment of the knee joint (e.g. meniscus tear, cartilage damage, cruciate ligament damage, runner's knee, etc.) requires a lot of experience.
I treat a wide variety of knee diseases in a conservative way.
The aim of any treatment is treatment without surgery.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

You can find me in:

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Further information about myself can be found at Dr. Nicolas Gumpert

Crucial for the operative success of an anterior cruciate ligament surgery using Semitendinosus tendon or Patellar tendon is the anatomical reconstruction of the original course of the anterior cruciate ligament. As an example, the optimal course of an inserted semnitndinosus plastic can be seen on the right. The ends of the tendons are fixed on the bone with a so-called endobutton. This initially only fixes the graft temporarily, in the postoperative course the tendon graft must then grow into the bone.

Folded semitendinosus tendon in the knee joint

The two standard plates for one Cruciate ligament surgery are the Patellar tendon as well as the Semitendinosus / Gracilis tendon.

Patellar vision generally involves harvesting the middle third of the patellar tendon with a block of bone at either end.

In order to remove the semitendinosus tendon, the tendon is separated from the bone through a small opening in the skin and then removed from the muscle belly with the stripper. The residual tendon scars with the environment without any significant detectable loss of function.

Internal reinforcement operation

In acute and subacute cases, i.e. if the accident was not too long ago, one treatment option is to internally strengthen the "old" anterior cruciate ligament with a new structure and thus restore conditions that come very close to the original conditions. This technology, which is rarely offered, has the following advantages:

The "own" anterior cruciate ligament can with its so-called proprioceptors, i. Nerve receptors, which are very important for the fine-tuning of movement and muscle use, are largely preserved, which of course would not be possible in an anterior cruciate ligament operation with the so-called patellar tendon.
The transplanted tendon material (semitendinosus tendon fourfold) is coated from the beginning, which creates ideal conditions for the transplanted material to grow in.

Unfortunately, this special technique is not suitable for chronic instabilities, some of which were years ago, since in these cases the "old" anterior cruciate ligament is usually no longer present. Unfortunately, there are no long-term results, so that this surgical technique cannot be recommended unreservedly at this point in time.

Is cruciate ligament surgery possible on an outpatient basis?

In the Cruciate ligament surgery it is a minimally invasive procedure that is now very routinely carried out in everyday medical practice.
About 30,000 interventions of this kind are carried out annually in Germany carried out; many of them also on an outpatient basis. Nonetheless, in-patient treatment is recommended in most cases. There are several reasons for this:

For that, the operation usually makes a number of Preliminary examinations, from X-ray image up to MRI, which can be carried out more easily in everyday clinical practice. There are also other factors, such as complications that occur before the operation and the good postoperative physiotherapeutic treatment in the clinic.
An effective therapy for pain and possible complications after the operation are also better given in the clinic.

Since the cruciate ligament rupture operation has developed into a very sophisticated procedure in recent years, many patients still opt for outpatient care under certain conditions. For outpatient treatment, among other things, a young age of the patient and a probably a complication-free operation, as well as the quickest possible reintegration into everyday work.

How long in the hospital

For cruciate ligament tears, the duration of the inpatient stay after the surgical treatment in the hospital is usually between 2 to 3, rarely up to 5 days. During this time, the wound and lymph fluid are drained and the pain is treated effectively.
Physiotherapy treatment is started as early as 24 hours after the operation in order to restore the affected leg to everyday suitability as quickly as possible.

Duration of the operation

The exact duration of a Cruciate ligament surgery depends on various factors. The most important thing is what kind of tendon transplant has been chosen and how much experience the surgeon has already gained with the procedure.
Depending on this, the operation time can be between 45 minutes and an hour, rarely up to two hours.

In addition, there are about one to two hours in the recovery room, during which the effect of the anesthetic drugs will wear off and the patient's pain can be treated.

Cost of a cruciate ligament surgery

The cost of a cruciate ligament rupture operation is approximately 5,000 to 10,000 euros.
This amount depends primarily on which surgical method is chosen and how extensive it is OP preparations and the post-operative follow-up of the patient.

These costs are fully covered by the statutory and private health insurance companies. As far as aftercare is concerned, more precisely the assumption of sick pay and the costs of the subsequent rehabilitation measures, statutory and private health insurances differ from one another.
For example, the costs of rehab are no longer covered by the statutory health insurance companies. When it comes to additional costs, the health insurances sometimes differ even more. In any case, you should inquire directly with the health insurances whether special applications for household help, shock wave or magnetic field therapy are accepted.

Pain after cruciate ligament surgery

A major concern for most patients is experiencing pain after surgery.
Although pain can now be treated quickly and without problems, it is not uncommon for pain to occur in the recovery room immediately after the operation. This is mainly due to the fact that the pain sensation is very individual, which is why it is difficult to estimate during the operation how high the pain medication should be. Other factors, such as the duration and type of surgical technique, also play a role here.

Fortunately, nurses are always on hand in the recovery room to administer pain medication or treat other problems such as nausea.
A corresponding infusion, for example with Novalgin, then provides relief within a short time.

Further information on this topic can be found at: Pain after knee surgery

Conservative therapy

After the acute pain has subsided, a for Cruciate ligament tears suitable plastic splint regular physiotherapy prescribed. This improves the stability of the affected knee joint with muscle strengthening and coordination exercises.
Further general information on the subject of physiotherapy can also be found at: physiotherapy

In addition, with

Stimulation current
Ultrasound and
Ice treatment

can be treated individually or in combination. This improves blood circulation and alleviates pain. However, it is important to know that lifelong, consistent, independently performed muscle training is required so that the muscles can take over the task of the torn cruciate ligament. Because of this, it may fail with one or the other.

Physical therapy

Function improvement, muscle building, improvement of coordinative skills, Prevention of contractures, dampening of stimuli after conservative or surgical treatment of the cruciate ligament rupture.
physiotherapy, Joint protection training, cryotherapy (cold therapy) and ultrasound therapy, Occupational therapy, manual lymph drainage

Orthopedic technology

Stick or forearm crutches
Rubber knee cap for conservative therapy
Knee braces, in individual cases, in the postoperative treatment and, if necessary, in sports with conservative therapy.

Appointment with a knee specialist?

I would be happy to advise you!

The knee joint is one of the joints with the greatest stress.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

You can find me in: