Knee injuries - cruciate ligament

Reviewed by Mr Dai Rees, consultant orthopaedic surgeon

Elevation
The leg must be elevated above heart level if possible. It is most comfortable to lie down and elevate the limb with a few pillows. If you are sitting down, the legs can be raised on a chair or a table.

This elevation should be maintained as much as possible for a few days.

The knee should be examined by a doctor.

How does the doctor make a diagnosis?
The doctor will look for all possible injuries to the knee. However, in the acute phase, the knee may be so swollen that it is impossible to examine properly. The doctor may decide to put a splint on the leg and examine the leg again after 10 days.

To diagnose a cruciate ligament lesion, the doctor will look for instability of the knee joint. The doctor will examine whether it is possible to drag the shin bone slightly forward in relation to the thigh bone. This will be examined with the leg in various positions.

After an arthroscopy some patients may be told that their anterior cruciate ligament is only partly torn across, but functionally speaking this is usually the same as a cruciate ligament that is totally torn across.

If the lesion of the cruciate ligament is combined with an injury of the meniscus and/or a lesion of the outer ligament, it may be necessary to investigate with an arthroscopy as quickly as possible.

Is surgery always necessary?
No. This will depend on the patient's level of activity, job, age and especially how much trouble the knee causes.

Often the injury causes so few problems that training and strengthening exercises will be enough to prevent the need for complex surgery.

But even if surgery is not required, the patient should undergo a three-month programme of rehabilitation to strengthen the muscles that stabilise the knee. It is also important to continue to exercise in the future.

How is surgery carried out for a cruciate ligament injury?
Surgery is usually carried out under a general anaesthetic. The doctor will perform an arthroscopy of the knee and will look for any other damage that can be repaired at the same time.

The doctor will construct a new cruciate ligament using either the patella tendon or two of the hamstring tendons. This new ligament will be placed in the knee joint in a manner that gives it the same shape as the original ligament.

What kind of recovery can be expected after surgery for a cruciate ligament injury?
The patient will be able to walk again the day after surgery and may be given a hinged splint to wear.

It is important that the knee and muscles are as functional as possible after a surgical operation and it will be necessary to undergo a rehabilitation programme lasting at least three months. However, during the first week after surgery, exercise should be limited or it will make the knee swell up.

Static cycling commences in the first few weeks after surgery. After three months, running and unlimited gym work are permitted. The earliest return to competitive sport is six months.

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