Cruciate ligament

The most common injury from skiing was once the spiral fracture of the tibia. With today’s high-collared ski boots, coupled with modern security bindings, this injury has become quite rare. In current skiing styles, more stress is transmitted to the ligaments of the knee joint. These are relaxed under moderate flexion and thus more susceptible to injury. During forced rotational motion of the lower leg against the thigh, together with a shearing force, the most common combination injury can occur – tearing of the medial collateral ligament and the anterior cruciate ligament. Usually, the medial meniscus is also injured. The medial collateral ligament is located outside of the joint and may heal spontaneously. This is not the case with the anterior cruciate ligament. Reconstructive surgery is imperative for physically active individuals; ligamental suturing is not possible due to the poor blood supply. The untreated instability would result in damage: without stabilisation, first the medial meniscus would give out under the increased load, and later the lateral meniscus. With degeneration of the menisci and persistent instability, the development of osteoarthritis is inevitable.

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Cruciate ligament tears are often caused by dive bombing with carving skis. With a particular radius of curvature, the edge grip can cause the individual’s legs to be pulled apart on a slightly uneven surface, resulting in a fall. Tearing of the medial collateral ligament is usually in the area of the femoral insertion and is highly sensitive to pressure, even through clothing. Tearing of the anterior cruciate ligament does not manifest itself immediately. The descent is just about possible, the knee is painful and swelling increases. Medical attention is essential. The x-rays are normal, and a joint tap shows a bloody effusion. Joint stability can then be assessed and an anterior cruciate ligament tear is diagnosed – but what is the best approach to treatment?

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Technically demanding operation

Cruciate ligament reconstructive surgery is highly demanding for the surgeon. In the most common method, a strip of tissue from the patellar tendon is used. This strip is removed with a bone block from the tibia and another from the patella. These bone blocks heal into the insertion sites of the former cruciate ligament. This takes around six weeks. They are secured with screws for initial stability, which allows for aggressive early functional post-operative treatment.

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Centre for Joint and Sport Surgery
Pyramid Clinic
Bellerivestrasse 34
CH-8034 Zürich

+41 44 388 16 16
+41 44 388 16 00

zgs@pyramide.ch


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