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Cruciate Ligament Tear: Causes, Symptoms & Treatment
A cruciate ligament tear is a common knee injury in which one of the cruciate ligaments is partially or completely ruptured. It often results from sports or accidents.
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A cruciate ligament tear is a common knee injury in which one of the cruciate ligaments is partially or completely ruptured. It often results from sports or accidents.
What Is a Cruciate Ligament Tear?
A cruciate ligament tear refers to a partial or complete rupture of one of the two cruciate ligaments in the knee joint – the anterior cruciate ligament (ACL) or the posterior cruciate ligament (PCL). The ACL is by far the more commonly injured of the two. The cruciate ligaments stabilize the knee joint and prevent excessive forward or backward displacement of the shinbone relative to the thighbone. A tear therefore results in significant instability of the knee.
Causes
A cruciate ligament tear most often occurs due to sudden, forceful movements that overload the knee joint. Typical causes include:
- Sports injuries: Abrupt deceleration, change of direction, or landing movements during skiing, football, basketball, or other contact sports
- Twisting of the knee: Rotation of the lower leg with a fixed foot
- Direct impact: A blow or hit to the knee from the side, for example in contact sports
- Falls from height
Symptoms
A cruciate ligament tear typically causes the following symptoms:
- Sudden, severe pain in the knee at the time of injury
- An audible or palpable popping or snapping sensation
- Rapid onset of swelling in the knee, often due to bleeding into the joint (hemarthrosis)
- Feeling of instability: The knee gives way or feels wobbly
- Restricted range of motion: Pain when bending or straightening the knee
Diagnosis
Diagnosis of a cruciate ligament tear is made through a combination of:
- Clinical examination: Specific tests such as the Lachman test or the anterior drawer test assess the stability of the knee joint
- Imaging: Magnetic resonance imaging (MRI) is considered the gold standard for visualizing the cruciate ligaments and surrounding structures such as menisci and cartilage. X-rays are used to rule out bone fractures
- Medical history: A thorough account of how the injury occurred and the symptoms experienced
Treatment
Conservative Treatment
In cases of partial tears, lower physical activity demands, or older patients, conservative treatment may be sufficient. This includes:
- Rest and the RICE protocol (Rest, Ice, Compression, Elevation) in the acute phase
- Physiotherapy to strengthen the muscles that stabilize the knee
- Wearing a knee brace for added support
- Anti-inflammatory pain medication as needed
Surgical Treatment
For physically active patients, complete tears, or persistent instability, surgery is generally recommended:
- ACL reconstruction: The torn ligament is replaced using a tendon graft. Commonly used grafts include the patellar tendon or the semitendinosus tendon
- The procedure is usually performed arthroscopically (minimally invasive through small incisions)
- Surgery is followed by an intensive rehabilitation phase typically lasting 6 to 9 months
Prognosis and Prevention
With appropriate treatment and consistent rehabilitation, most patients are able to return fully to their sport. Neuromuscular training programs and targeted muscle strengthening exercises can help reduce the risk of re-injury. Complete natural healing of the anterior cruciate ligament without surgery is generally not possible, as the ligament has limited capacity for self-regeneration.
References
- Frobell RB et al. – A randomized trial of treatment for acute anterior cruciate ligament tears. New England Journal of Medicine, 2010; 363(4): 331–342.
- van Yperen DT et al. – Twenty-five-year follow-up of a randomized controlled trial comparing conservative and surgical treatment for ACL tears. British Journal of Sports Medicine, 2018; 52(15): 996–1002.
- American Academy of Orthopaedic Surgeons (AAOS): Anterior Cruciate Ligament (ACL) Injuries. OrthoInfo, 2022. Available at: orthoinfo.aaos.org
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