Resumption of sport after partial and full knee replacement: focus on skiing
Severe signs of wear and tear in the knee joint lead to knee joint arthrosis or gonarthrosis. This condition can lead to severe pain, restricted
Cruciate ligament rupture while skiing
The knee joint is exposed to very high physical and mechanical stresses in alpine skiing and is thus frequently affected by sports injuries. At about one-third, the knee is the part of the body where injuries occur most frequently.
Cruciate ligament tears are at the top of the list of top knee injuries, with a proportionate 38%.
Worth knowing about the topic of cruciate ligament rupture in skiing, possible causes as well as forms of treatment and the big question about the right time for a comeback after injury you will learn in the following blog post.
OVERVIEW
What is the cruciate ligament?
The anterior cruciate ligament, ACL for short (often referred to as ACL “anterior cruciate ligament”), is a part of the ligamentous apparatus of the knee joint and connects the femur to the tibia. Together with the posterior cruciate ligament and the two collateral ligaments, it ensures the stability of the knee joint. It mainly restricts the forward displacement of the tibia and prevents excessive internal rotation.
In addition to stabilization, it plays an important role in proprioception, i.e. information about movements, postures and the position of our body in space, due to many so-called mechanoreceptors.
Cruciate ligament rupture while skiing
How common is a cruciate ligament tear in skiing?
The diagnosis of a ruptured cruciate ligament (ACL) in the Ski World Cup is far from rare. In the absolute top of the world of ski racing, there is hardly an athlete who has not yet suffered a cruciate ligament rupture in his or her career. In the current ÖSV team, one in two has already been affected by such injuries. But not only professionals, also amateur athletes, advanced skiers and beginners often suffer from injuries of the knee joint, especially of the anterior cruciate ligament. As noted above, knee injuries account for approximately 36% of all ski injuries, with anterior cruciate ligament rupture being the most commonly diagnosed, accounting for 38% of all injuries.
Who is affected by a cruciate ligament tear?
Along with soccer, handball and basketball, alpine skiing is considered to be the sport with the greatest load on the knee joint. An ACL rupture affects both professional and novice skiers. This shows that athleticism or fitness plays only a minor role in many cruciate ligament tears. Nevertheless, preparation for the ski season is considered an essential factor for minimizing risk, especially in amateur sports; the right ski equipment and correct binding adjustment are at least as important.
Skiers between the ages of 15 and 25 are the most likely to be affected due to their presumably higher risk tolerance, and women are up to five times more at risk than men with somewhat weaker connective tissue and a tendency to develop knock knees. Skiers already injured at the anterior cruciate ligament are also at a higher risk of injury than uninjured skiers.
The risk of injury also increases due to slopes that are often groomed with artificial snow and faster, modern equipment.
Causes and risk factors of runner's knee
One injury mechanism that leads to an anterior cruciate ligament injury, especially in alpine ski racing, is the so-called “slip catch.” This is a twisting trauma in which excessive stress on the inside ski causes the outside ski to slip away (slip) and an acrobatic maneuver causes it to grip the snow again. There is flexion of the extended knee joint with simultaneous internal rotation and X-B adjustment.
In simple terms, three mechanical loading factors can be cited as common causes of ACL rupture:
- The lower leg and thigh experience opposite rotation, i.e. the lower leg rotates outward while the thigh remains in its straight position.
- The knee experiences a valgus leg axis (x-leg malalignment).
- A combination of the two points to which the knee joint cannot adequately respond with muscular stabilization.
Can I continue skiing with a cruciate ligament tear?
The anterior cruciate ligament is an essential stabilizer of the knee joint. It is possible to lead a normal and sporty life even with a cruciate ligament tear or without an anterior cruciate ligament. A well-trained musculature is able to compensate for the missing cruciate ligament without any long-term disadvantages. However, if there is a subjective feeling of instability and objective signs of instability, surgery should be performed using cruciate ligament replacement surgery. Sports such as running, swimming or cycling are certainly possible without an intact cruciate ligament, but in contact sports such as soccer, tennis, but also skiing, there is an increased risk of damage to cartilage and menisci without a functioning cruciate ligament.
Lindsey Vonn started several times in the 2013/14 World Cup season with a torn, untreated cruciate ligament, as only became known later, and even planned to compete at the Olympic Games with it, but later had to cancel this start. If the muscles are sufficiently good, it may be possible to continue skiing to a limited extent even with a torn cruciate ligament. However, the decision should always be made in consideration of all findings, possible concomitant injuries, as well as signs of wear and tear, and in consultation with your treating orthopedist. For the ambitious amateur athlete, it is recommended to repair the torn cruciate ligament with an operation.
Dr. Martin Gruber is an expert in cruciate ligament injuries!
Thanks to his years of experience as a physician in the field of sports orthopedics, Dr. Martin Gruber is your expert in the case of a cruciate ligament tear. Do you suffer from knee pain after skiing and suspect a cruciate ligament rupture? Dr. Martin Gruber takes enough time for you and your concerns in his office!
Symptoms of runner's knee
When the anterior cruciate ligament is torn, many athletes:inside feel a snap that can already indicate a cruciate ligament tear. A short time later, there is significant swelling of the knee joint. In most cases of ACL rupture, this comes from a so-called hemarthros, a bloody effusion of the joint.
Typically, “giving way attacks” signal an occurring instability due to rotational movements between the upper and lower leg.
The treating orthopedist can check the stability of the entire knee joint and a possible injury to the anterior cruciate ligament using clinical tests such as the Lachman, pivot shift test or anterior drawer. In the further immediate course, magnetic resonance imaging is required to confirm the suspected clinical diagnosis and to visualize the tear, as well as possible concomitant injuries.
Are all runners affected by runner's knee sooner or later?
The treatment and therapy of a cruciate ligament tear depends on the patient’s age, athletic ambitions, profession, and additional concomitant injuries and should always be discussed individually with the patient.
Patients with low athletic demands, older age, or preexisting osteoarthritis benefit from conservative therapy in the absence of instability. conservative therapywhich consists primarily of intensive physiotherapya strengthening of the knee flexor muscles and proprioceptive training consists.
In the case of athletically ambitious, younger patients or in the case of concomitant injuries, the therapy should be carried out surgically. Nowadays, cruciate ligament surgery is performed arthroscopically, in which a new cruciate ligament is reconstructed through very small incisions. There are essentially three different ways to do this.
In individual cases, the the body’s own cruciate ligament can be reinserted., so sew it back on. However, the success of a cruciate ligament suture depends on the patient:s age, the timing of the injury, and the location of the tear.
By means of cruciate ligament reconstruction, the cruciate ligament can be replaced by the patient’ s own tendons or so-called donor banks are used to replace the torn ligament with allografts, i.e. transplants, in order to create a stable situation in the knee joint. The autologous tendon or, if necessary, the graft is pulled into the place of the original cruciate ligament in short pre-drilled channels and fixed in the bone using different fixation techniques
How is runner's knee treated?
Regardless of whether the cruciate ligament tear was treated by conservative treatment or surgery, a rehabilitation period of several months is required after the tear of the anterior cruciate ligament.
Physical characteristics such as age or previous training, type and exact extent of injury, and type of tendon are factors that influence the exact time of recovery. Professional skiers often start their first ski training after an ACL tear about 6 months after surgery and thus much earlier than recreational athletes. A premature return to exercise undoubtedly increases the risk of re-injury or graft failure.
It is recommended for both professional and amateur athletes to return to sports only when the strength, proprioception and function are about equal to that of their healthy knee. Depending on baseline function, the type of sport played, and adherence to a solid rehabilitation program, patient:s should expect a return to full activity and sport between 8 and 12 months after surgery. In any case, a minimum of 10 months can reduce the risk of re-injury.
The right time to return to the popular hobby should ultimately be determined best in consultation with the attending physician and the:of physiotherapists:in.
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