ANTERIOR CRUCIATE LIGAMENT

The anterior cruciate ligament prevents displacement between the thigh and lower leg and controls the joint against rotational movements and shear forces. A sudden overload, e.g. rotation of the thigh with the foot fixed at the same time, can result in a cruciate ligament rupture. The rupture of the cruciate ligament is a frequent injury during contact sports such as football or skiing.

Immediately after the rupture of the cruciate ligament, slight pain, an effusion and a feeling of instability may develop.

Since the extent of rotation increases considerably after a cruciate ligament rupture and the load peaks in the knee joint shift, this can lead to meniscus and/or cartilage damage. However, not every tear has to be treated with a cruciate ligament operation. This depends above all on the everyday demands, the degree of instability and the accompanying injuries. A distinction is made between cruciate ligament ruptures with instability in one or more planes. Ultimately, it is also a decision of the patient whether or not the cruciate ligament rupture must be treated surgically with regard to the individual performance profile and the subjectively perceived instability. Prof. Schoettle and his team assess each case individually and advise their patients according to their expectations.

CRUCIATE LIGAMENT RUPTURE - NON-OPERATIVE THERAPY

In particular, in the case of partial ruptures of the anterior cruciate ligament, conservative therapy should initially be recommended in our eyes.

The primary aim of conservative/non-surgical cruciate ligament rupture treatment is to strengthen the deep abdominal and back muscles through manual and physiotherapeutic exercises so that they are able to reduce the forces acting on the knee. In addition, a movable orthosis should be used to prevent rotation overload of the knee joint.

At the same time, shockwave therapy to relief local stemcells and additional cell therapy– either in the form of blood plasma/growth factors (ACP, PRP) or, due to the significantly higher anti-inflammatory and regenerative effect, fat derived stem cells – are initiated to maximize the chances of self-healing.

We determine the success of a non-surgical cruciate ligament rupture treatment by a 4 D gait analysis and a KT 2000 stability analysis before the start of more intensive physio / sports-therapy 6 weeks afterwards. However, if there is still a subjective and objectively measurable instability of the knee joint after a period of 6 weeks, the necessity of a cruciate ligament reconstruction can still be discussed without losing any time.

In any case, we will perform a return to sport test before you will go back into action.

CRUCIATE LIGAMENT PRESERVING SURGERY

Depending on the time and type of cruciate ligament rupture, we have the expertise to apply the individually perfect technique for cruciate ligament surgery.

In the cruciate ligament treatment with the “Bracing technique”, which preserves the cruciate ligament, the injured ligament structures of the anterior cruciate ligament rupture are not removed and replaced by a free tendon graft, but reinforced in an arthroscopic mini operation and brought to a quick and almost painless self-healing. A “fibre tape” is braided into the injured cruciate ligament and thus the cruciate ligament is fixed to the bone again without destroying the blood supply to the cruciate ligament. In addition, it is reinforced with another tape in the sense of an inner splint.

The advantages are obvious: The blood supply to the cruciate ligament is maintained – and healing can take place quickly. By preserving its own cruciate ligament, its unique biomechanics and, above all, the cruciate ligament-specific nerve fibre, a faster healing and resumption of sporting activity is achieved. The procedure can be performed with 3 stab incisions, which are no longer visible after a few weeks.

The advantage of the anterior cruciate ligament surgery in the bracing technique lies in the early resumption of sport activities – where training can be started after about 6 weeks – with a resumption of contact sports already after 4 months.

In this procedure, which is based on biological healing, we strongly recommend a combination with cell therapy, which we begin already during the surgery and can be followed up on an outpatient basis. The maximum effect can also be achieved by the additional use of stem cells from your own body fat. We will be happy to provide you with detailed information about the possibility of cell therapy at our institute at any time.

After the operation, crutches should be used for 1-2 weeks depending on the accompanying injuries. During the day, the knee is also limited and stabilized in its mobility at 90° for 6 weeks with a special movable and stabilizing orthosis for the anterior cruciate ligament.

RECONSTRUCTION AFTER ANTERIOR CRUCIATE LIGAMENT RUPTURE

Depending on the shape and time of the anterior cruciate ligament rupture, we have the expertise to apply an individualized technique to cruciate ligament surgery in Munich.

If “bracing” is no longer possible, but surgical stabilization is necessary, the cruciate ligament is reconstructed using a body’s own tendon. We perform this arthroscopically, which has many advantages for the patient.

We have been highly specialized in the field of cruciate ligament reconstruction for 20 years and have been distinguished as the best physician by the “Focus”, German most popular independent rating system. We have performed the cruciate ligament surgery technique arthroscopically from the very beginning. Prof. Schoettle was one of the pioneers for the application of the medial portal and pioneer of the cruciate ligament surgery in double bundle technique. Athletes rely on Prof. Schoettle’s expertise because his technique allows them to move freely and become active on the day of the operation.

In most cases we use the Semitendinosus tendon for the reconstruction, which is fixed at the insertion sites of the cruciate ligament. For faster healing, we consistently use additive cell therapeutic PRP to reduce pain and inflammatory reactions intraoperatively and to reduce the infection rate through antibacterial function.

In order to enable a fast exercise under completely painless conditions, Prof. Schoettle performs this cruciate ligament operation in Munich with an inpatient stay of 2 nights. Already on the day of surgery you will be mobilized with the help of his team of sports therapists, and learn to reactivate your muscles immediately. You should use crutches for almost a week. The wearing of a special stabilizing cruciate ligament splint is strongly recommended during the day for 6 weeks. After the 6 weeks you will only need the splint for sports activities such as cycling or jogging, which is started now. Prof. Schoettle will assess together with you when a full activity with alternating direction and contact sports is possible on the basis of special examinations.

REVISION OF THE ANTERIOR CRUCIATE LIGAMENT

Revision procedures are necessary when either a new cruciate ligament injury of the already operated cruciate ligament has occurred or the stability desired by the operation could not be achieved.
In some cases, a revision may also occur due to pain or movement restrictions if the positioning of the ligament is not exactly individualized.
In any case, these procedures must be intensively diagnosed, discussed and decided on an individual base. This requires a very good preparation and will be planned together with you.
Due to his high specialization in the knee joint and his many years of experience as head of the knee team at the Sports Orthopaedics Department of the Technical University of Munich, Prof. Schoettle has a great deal of experience in these highly complex procedures, which is why many patients from all over the world place their trust in his expertise, passion and precision during this procedure.

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Prof. Dr. med. Philip Schoettle
KNEE AND HEALTH INSTITUTE
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