Orthopedics-Online

Symptoms of an anterior cruciate ligament tear

Symptoms

A Torn anterior cruciate ligament (Ligamentum cruciatum anterius; ligamentum = lat. tape, anterius = lat. front) is often noticeable at the time of the injury by a noise - similar to a cracking - as a typical symptom. As a rule, the person affected also feels it Cruciate ligament tear.

The following symptoms develop after the anterior cruciate ligament tear:

pain in the area of the knee, due to the tear and the subsequent stretching of the joint capsule (Articular capsule) Nerves that convey the sensation of pain are damaged
Furthermore, an anterior cruciate ligament rupture leads to instability of the knee, which, however, only becomes apparent after a few days when the swelling has subsided. Initially, the instability resulting from a torn anterior cruciate ligament is masked by reflex tension in the muscles.

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After a few days, in almost every case (approx. 95%) an effusion of the knee joint develops as the most important symptom. Blood accumulates within the joint capsule, which is known as hemarthrosis. Due to the rupture of the blood vessels supplying the knee joint, it bleeds into the capsule when an anterior cruciate ligament ruptures. This can be seen from the outside as swelling of the knee.
When examining the fluid contained in the knee joint (knee joint examination), the blood may also have greasy eyes. This is a sign of a concomitant bony injury to the anterior cruciate ligament tear, with the fat being released from the marrow of the affected bone, for example from the thigh bone (Humerus) or the shin (Tibia).
Alternatively, the fat can also develop as a result of a crush injury to the Hoffa fat pad of the knee (lat. corpus adiposum infrapatellare) exit. The Hoffa fat body is a connective tissue structure with fatty tissue below the kneecap (lat. patella).
In addition, a tear in the anterior cruciate ligament limits the mobility of the leg and the affected person is no longer able to move the knee normally. Rather, a person affected by an anterior cruciate ligament rupture takes a protective posture of the leg: the injured knee is held in a flexed position.
When examining the knee for symptoms of a cruciate ligament tear, a typical sign of an anterior cruciate ligament tear - the anterior drawer phenomenon - comes to light. This manifests itself when the knee is bent by 90 degrees when the examiner pulls the lower leg forward. In healthy people, no movement is possible, but with an anterior cruciate ligament tear, the lower leg can move relative to the thigh. A similar test is also positive for an anterior cruciate ligament tear. This is the front Lachmann test. In principle, it is carried out like the front drawer test, but with only 30 degrees of flexion.

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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.
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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.

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"Front drawer" test

Figure front drawer test

Left picture with kind permission of Prof. J. Jerosch, Neuss

consequences

The symptoms described in an anterior cruciate ligament tear usually subside after about a week. However, if an anterior cruciate ligament tear is not treated (Torn cruciate ligament therapy), permanent instability develops after a few weeks. This is caused by wear and tear on the joint, the capsule-ligament apparatus of the knee, the menisci and the articular cartilage of the knee joint. The permanent instability after an anterior cruciate ligament tear is known as giving way symptoms.
In this case, the affected person kinks the leg in the knee area with the lower leg slipping out. The extent of this instability - like the impairment of stability at the beginning of the symptoms of an anterior cruciate ligament tear - depends on the strength of the knee joint structures, which include ligaments, muscles and joint capsules.
An anterior cruciate ligament tear is often accompanied by other injuries. This is the case for around 80% of all those affected. Often times the inner or outer meniscus or the Collateral ligaments of the knee (Collateral ligaments) injured at the same time. Other accompanying injuries represent damage to the articular cartilage or the joint capsule. Bony avulsion fractures (fracture = Fracture) are among the injuries associated with an anterior cruciate ligament tear.
The so-called is typical Segond fracturecaused by a bony tear in the joint capsule at the point of the tibia plateau (Tibial plateau, upper end of the tibia).
A special form of disease with involvement of the anterior cruciate ligament is the symptom - combination "unhappy triad"(" Unfortunate triad "). In addition to an anterior cruciate ligament tear, there is also damage to the inner ligament and the inner meniscus.

Pain in a cruciate ligament tear

In addition to symptoms like swelling, instability and Effusion the pain is an important key symptom of the cruciate ligament tear.
The Pain in the knee after a traumatic event are diagnostic indicators of a torn cruciate ligament.

The pain caused by a cruciate ligament tear occurs immediately after the rupture event. The pain is usually described by those affected as moderately strong to very strong, with light stabbing Pain character.
The pain inside the knee then usually subsides a little. However, as soon as the knee and thus the torn cruciate ligaments are loaded again, the pain increases again.
The pain generally arises naturally on the one hand from the cruciate ligament rupture in itself.
On the other hand, a torn cruciate ligament also leads to swelling in the knee as a result of a vascular injury with bleeding into the knee joint (= so-called Hemarthrosis).

The stretching of the knee joint capsule through the swelling then ensures that a pain sensation occurs via stretch receptors and nerves that transmit information.
Puncturing the knee joint relieves pressure and thus relieves pain. In order to alleviate the pain caused by the cruciate ligament tear, only conservative or surgical treatment is possible. (please refer: Operation of a torn cruciate ligament)

Symptoms in the child

It is very common for children to tear the anterior cruciate ligament.
However, the symptoms of a cruciate ligament tear in children do not differ significantly from a cruciate ligament tear in adults. Classic symptoms are also in children:

Pain
swelling
Effusion

In addition, the knee is very unstable due to the cruciate ligament rupture and the stretching movement is no longer possible. With these two limitations comes the general loss of function of the knee.
In children in particular, pain in the knee with corresponding additional symptoms does not immediately come to the mind of a cruciate ligament tear. The correct diagnosis is very important, however, since an untreated anterior cruciate ligament tear in childhood can have serious consequences for the child's knee.

In this case, permanent damage was accompanied by symptoms such as recurring pain and a feeling of instability as well as a limping gait.
The pain intensity may be perceived as more intense, especially by younger children, because the stabbing pain inside the knee joint is very uncomfortable and also unknown in connection with instability in the knee.
It should also be taken into account that the symptoms can be more pronounced in children. This is because the child's bones are even weaker than the ligamentous apparatus, i.e. the cruciate ligaments.
It is therefore typical for a child's cruciate ligament tear that the bony attachment is torn out at the same time. This means that both ligament and bone structures are injured and the pain sensation is therefore more intense.

Symptoms in the hollow of the knee

In general, the hollow of the knee is part of an area of the knee joint, so that lesions on structures in the rear part of the knee joint can manifest themselves symptomatically in the hollow of the knee.
Depending on which cruciate ligament is torn, the localization of the pain varies:

At a Posterior cruciate ligament rupture For example, the pain in the hollow of the knee is very characteristic. The reason for this is "Effusion symptom“With a cruciate ligament tear.
The effusion usually only causes swelling. However, if the effusion is very far back in the popliteal region, as is typical with a posterior cruciate ligament tear, the effusion fluid oozes (Blood and lymph) in the hollow of the knee and the lower leg. The drained effusion then provokes a feeling of tension and pressure pain in the hollow of the knee.
With all cruciate ligament tears, the pain sensation is primarily localized in the capsule region and the hollow of the knee. In addition to the pain in the hollow of the knee, the bruise responsible for the pain can also be seen there after inspection.

Symptoms of anterior cruciate ligament tear

The human Knee joint has 2 cruciate ligaments on each side, one anterior (VKB) and a posterior cruciate ligament (HKB).
These can both tear independently of one another and each trigger symptoms.

If the ACL ruptures, one also speaks of a "front cruciate ligament tear". Classically, symptoms such as Pain, swelling, Effusion and instability.
The last-mentioned aspect in particular is important with regard to certain movement restrictions in the injured knee joint. If the crack is at the front, the lower leg can be pulled forward like a drawer with the thigh fixed. One then speaks of the presence of a "front drawer“At the VKB.
Further instability criteria are the inhibited extension movement in the knee and a certain gait uncertainty.

Those affected always have the feeling of buckling away. Therefore, one tries to automatically compensate for the instability by a reflex contraction of the thigh muscles. The pain with ACL is usually localized inside the knee and subsides after several days. It goes without saying that it reappears more and more intensively through stress and requires adequate treatment of the ACL.

Posterior cruciate ligament tear symptoms

The posterior cruciate ligament (HKB) can tear just like the anterior cruciate ligament.
The "cruciate ligament tear at the back" is, however, much rarer than the "cruciate ligament tear at the front".

The symptoms also range from primary pain to swelling, effusion and instability in the knee with accompanying restricted mobility and unsteady gait.
A characteristic feature of the posterior cruciate ligament tear is Pain in the back of the knee This results from the fact that the fluid from the effusion flows back into the hollow of the knee when the posterior cruciate ligament ruptures.
There is actually no space for increased fluid accumulation, so that the mass causes pressure pain. In addition, there is a bruise in the hollow of the knee in the case of a "cruciate ligament tear". A HKB can also be abnormally movable. The so-called rear drawer phenomenon is positive when the lower leg can slide backwards against the fixed thigh.

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: