A cruciate ligament tear is considered a GAU in the knee joint. Healing is slow and the risk of setbacks is high. It affects women much more often than men. In many cases, injuries can be avoided.
The greatest danger lurks in football, among other things. In this and other so-called contact sports, women are caught three times as often as men on average. Depending on age and performance level, the risk can even increase dramatically – by a factor of five to eight. Very young competitive athletes under the age of 19 are particularly affected by this, reports Dr. Natalie Mengis and Professor Thomas Pfeiffer from the German Knee Society (DKG) within the German Society for Orthopedics and Trauma Surgery (DGOU).
Knee specialists: Hormones also make the cruciate ligament more vulnerable in women
The two band specialists also analyze the reasons. These include primarily biomechanical causes – so it is, translated from medical German, to a certain extent due to the architecture of the female knee joint. It is naturally designed in such a way that the thigh muscles appear to protect the cruciate ligament less than in men and thus trigger an increased risk of injury in women. In addition, hormones could also play a role, the DKG experts report in their statement on the occasion of the current Women’s World Cup. In certain phases of the menstrual cycle, the anterior cruciate ligament in women is more prone to injury. “Ideally, the training should be adapted to the cycle. Strength training is particularly effective in the first phase of the cycle.”
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X-rays and MRIs are advisable for severe knee injuries
Treacherous: If the cruciate ligament tears, the patient does not have to notice it immediately. In many cases, the knee only swells with a little delay, and the pain can often be endured. However, the leg feels unstable – like jelly. Magnetic resonance imaging (MRI) provides clarity about the condition of the ligaments. In the case of a severe knee injury, an X-ray is also useful to rule out bony injuries – such as a fracture of the tibial plateau.
Neuromuscular training significantly reduces the risk of suffering a serious knee injury
Professor von Eisenhart-Rothe: Training programs help prevent serious knee injuries
However, knee specialists have also made an encouraging finding. In this way, a large part of the cruciate ligament tears could be avoided, explains DKG President Professor Dr. Rüdiger von Eisenhart Rothe. The head of orthopedics at the Munich University Hospital on the right of the Isar assumes that at least every third knee meltdown could be prevented through targeted training. The key to this is neuromuscular training. These special exercises promote strength, speed, balance and coordination. “This significantly reduces the risk of suffering a serious knee injury,” says von Eisenhart-Rothe. The training is also a valuable investment in the long-term preservation of the knee joint. Because cruciate ligament injuries fuel arthrosis, which in the final stage often requires the insertion of an artificial joint. Proven neuromuscular training programs are “FIFA 11+” and “STOP-X”. There is extensive information and training videos about these warm-up programs and injury prevention on the websites www.dfb.de and www.stop-x.de.
Knee specialist Prof. Philipp Niemeyer: Torn cruciate ligaments in football usually don’t happen in duels
Another interesting finding: most knee injuries in football don’t happen in tackles. “In most cases, the knee is not injured by the opponent,” explains knee specialist Professor Philipp Niemeyer from Orthopedic Surgery Munich (OCM), head of the Society for Arthroscopy and Joint Surgery (AGA). “Knee injuries often occur when landing a jump or making sudden twisting movements. The knee is bent inwards and a knock-knee develops. The foot is placed flat and turned outwards.”
In cruciate ligament surgery, tendons from the thigh muscles are used
If the cruciate ligament is torn, there is a conservative and an operative treatment option. “Young patients with high athletic demands are usually operated on,” reports von Eisenhart-Rothe. The torn ligament is not sewn up, as many people mistakenly assume, but replaced with a tendon from the thigh, or more precisely with an expendable portion of the tendon. “This is taken from the quadriceps tendon on the front thigh or from the semitendinosus tendon, the so-called hamstrings, on the back of the thigh,” explains von Eisenhart-Rothe.
Professor von Eisenhart-Rothe advises: Patience is required when returning to sport
After the operation, patients only have to use crutches to relieve their leg for a few weeks. In professional football, footballers sometimes return to the field after seven to eight months, in recreational sports it often takes a year or even longer. “Patience is really needed,” advises von Eisenhart-Rothe, “because if you start training and competing again too early, there is a risk of the cruciate ligament tearing again.”
