Diagnosis of the cruciate tear or strain may not be immediate, if the injury does not appear to be major. Sometimes damage to other tissues may mask the cruciate injury, or make it seem a lesser priority even if it is recognized. Treatment for the injured ligament depends largely on the surgeon.
There may be an immediate decision to operate to repair or reconstruct the ligament if it is badly torn and the surgeon feels surgery will be successful. If there is multiple damage inside the knee, perhaps to a cartilage as well as a cruciate ligament, the surgeon may opt to deal with the cartilage and leave the cruciate ligament to be treated conservatively.
Conservative treatment may be the option chosen if the ligament is stretched or only partly torn, or if the patient is not particularly active in sports. Conservative treatment involves strengthening the knee’s controlling muscles and working at co-ordination exercises, especially involving the hamstring muscles. It takes time for the programme to have its effect, so the patient has to commit at least six months to the remedial exercise regime.
In some cases the knee seems to recover well following the injury, except that it occasionally feels unstable, as if it is about to give way. This happens in very specific situations, for instance when the patient is standing up and turns slightly to the side. In this case, the patient should be referred back to the surgeon, or sent for a second opinion, as surgery may be the best option for correcting this.
Surgery for cruciate ligament damage is complex, and many different techniques are used, according to the nature of the injury and the surgeon’s preference and level of expertise. If the ligament has torn away its bony attachment, it may be re attached with a screw.
If the ligament itself is broken it may be stitched back together, or reinforced with tissue taken from another structure like the patella tendon. Various materials have been used to create artificial replacements for the cruciate ligaments. In some operations, which are probably used less often now than previously, the damaged ligament is not touched, but the joint mechanic’s are stabilized through tightening up other structures, for instance at the outer side of the knee in the case of damage to the anterior cruciate.
Following surgery, the patient may be kept in bed fro a period, or may be allowed up using crutches, with the operated leg protected in a plaster cast or, more usually nowadays, in a wadded damage. Remedial exercises are started straight away and functional activities are gradually increased.
Full recovery takes up to a year or more, and the remedial exercise have to be maintained throughout the recovery period and preferably long afterwards. Even after full recovery, the patient may use a specially fitted knee brace for extra protection in high risk sports such as skiing.