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Torn ligaments • Duration, symptoms & how long sick?

A ligament tear in the knee is one of the most feared injuries on the ligaments in athletes. How do you recognize a ligament tear in the knee, when is an operation necessary and when are you fit again?

Ligament tears on the knee are often caused by heavy loads in sports.
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At a glance:

How to protect your knees

How to protect your knees

Complex knee joint: resilient and flexible

Our knee is the largest joint in the human body, composed of two individual joints: the kneecap joint between the thigh bone and the kneecap and the knee joint between the thigh bone and the shin.

This structure enables us to stretch and bend the leg. The knee joint is subjected to a particularly high load because we put it to use all day long: when running, climbing stairs, exercising, turning around, even when sitting and standing. Depending on the activity, six times our body weight is sometimes on the joint. For an adult weighing 80 kg, this corresponds to a load of 480 kg.

Ligaments and tendons ensure stability of the knee joint

Various ligaments and tendons ensure stability. They consist of elastic, but relatively firm connective tissue fibers. The ligaments of the knee connect the thigh bone and the shin to each other and keep the bones and the kneecap in position.

The outside and inside bands, the so-called side bands, run on the outside and inside of the knee. The anterior and posterior cruciate ligaments cross inside the knee joint between the ends of the femur.

Causes: Where does a ligament tear in the knee come from?

The ligaments in the knee are only elastic up to a certain limit; If you strain them further, the ligament will stretch or become strained. The cause is usually a strong twisting of the knee joint.

If the force exerted on the ligaments is particularly great, for example when there is a strong rotational movement or the knee joint is overstretched, the ligaments can tear or tear completely. One speaks of partial or partial ruptures or of complete ruptures.

Sports accidents: common cause of ligament tears at the knee

Ligament tears in the knee are particularly common during skiing. In the event of a fall, the feet, which are fixed in firm boots, can point in different directions. The long skis act like a lever on the knee joint and thus ensure that the rotation is too strong. Even in sports with fast changes of direction as well as start-stop and turning movements such as handball, basketball, soccer or squash, there is often a ligament tear in the knee joint.

Even in everyday life, a quick change of direction, an inattentive kick or a collision can put too much strain on the knee joint. Being overweight increases the risk of a ligament tear.

Forms of ligament tears on the knee

  • Internal ligament tear: The rupture of the approximately seven to ten centimeters long band on the inside of the knee is particularly common. In many cases, an inner ligament tear occurs combined with another knee injury, such as meniscal damage. The meniscus in the form of two cartilage discs serves as a shock absorber in the knee joint and is partially connected to the inner ligament. An internal ligament rupture often occurs in combination with a tear in the anterior cruciate ligament.

  • Outer ligament tear: The outer band is thinner than the inner band and secures the knee against buckling outwards. Outer ligament ruptures are less common than inner ligament ruptures and usually occur as a more complex injury to the capsular ligament apparatus and cruciate ligaments. Partial ruptures of the outer ligament are very rare.

  • Anterior cruciate ligament tear: Rupture of the anterior cruciate ligament is a typical and quite common sports injury. An anterior cruciate ligament tear occurs individually or in combination with other knee injuries such as an internal ligament tear.

  • Posterior cruciate ligament tear: Rupture of the posterior cruciate ligament is less common than rupture of the anterior cruciate ligament. Triggers are usually external influences, such as sports collisions or traffic accidents. A tear in the posterior cruciate ligament often occurs in combination with injuries to other joint structures.

Symptoms: signs of a ligament tear in the knee

If there is a ligament tear in the knee, severe pain usually occurs immediately. When ligaments or vision break, a noise can sometimes even be heard. Most often there is also swelling of the joint. This can be caused by joint effusion due to increased fluid accumulation or bleeding into the joint.

Staining of the tissue due to bruising, i.e. hematoma, is also not uncommon. Due to the pain and swelling, certain movements are no longer possible, the knee may also appear to be "blocked" in one direction or particularly unstable.

Symptoms of a torn ligament:

  • sudden pain in the knee

  • Pressure, strain, or movement of the joint make the pain worse

  • swelling

  • Blue staining of the tissue, bruising, hematoma

  • Knee effusion, especially if the anterior cruciate ligament is ruptured

  • Instability, feeling of "wobbling" or "slipping"

  • Restriction or unusual extension of mobility, blockage in a certain direction

  • Cracking or popping noise

  • Warming an area on the knee

Localization of pain varies

If the affected person can localize the pain in the knee joint more precisely, this can be an indication of which ligament is torn at the knee.

  • Outer ligament tears are particularly felt on the outside of the knee.

  • An inner ligament rupture is shown by increased pain on the inside of the knee.

  • If the posterior cruciate ligament is affected, the tibia shifts backwards in relation to the thigh.

  • If the anterior cruciate ligament is torn, on the other hand, the thigh moves backwards relative to the lower leg. This is particularly noticeable when you want to go down stairs.

Are there also ligament tears in the knee without pain?

If the sideband was injured a long time ago, chronic sideband instability can result. Acute symptoms such as swelling, pain and bruising are usually absent. Often the knee only hurts when stressed. However, the instability of the knee joint and the increased mobility inwards or outwards remain.

Diagnosis: how does the doctor determine a ligament tear in the knee?

If you do not have a ligament tear on your knee treated early, you risk wearing out your knee joint and thus osteoarthritis. If you suspect a ligament injury, it is important to see an orthopedic surgeon, trauma surgeon or sports doctor as soon as possible.

They discuss the accident process, the symptoms and any previous injuries. When scanning, the doctor checks which ligament structures are painful. In some cases, a tended X-leg position of the affected person already indicates inner ligament damage to the knee, while injured outer ligaments on the knee are more likely to lead to bow legs.

Orthopedic tests

In order to assess the ligament tear on the knee, specialists examine the stability of the knee joint. For example, an unnatural outward or inward movement could indicate an injury to the lateral ligaments. The so-called valgus stress test shows whether there is an internal ligament tear on the knee.

The patient lies on his back with his leg stretched first and then with his knee bent by 20 to 30 degrees. The examining doctor holds the thigh in both examination steps while carefully moving the lower leg inward into an X-leg position. An inner ligament rupture shows greater freedom of movement than a healthy joint. If you suspect an external ligament rupture, slowly move the lower leg outward into an O-leg position.

Degrees of instability indicate injury

Physicians refer to the increased mobility outwards or inwards as opening the knee joint. The strength of the fold-out applies to both the inner ligament tears and the outer ligament tears as a measure of instability. They are divided into three levels of severity:

Grade 1: A deviation of up to five millimeters compared to the healthy knee speaks for a strain or overstretching of a lateral ligament (distortion).

Grade 2: A deviation of up to ten millimeters compared to the healthy joint indicates a partial tear of the side ligament (partial rupture).

Grade 3: From a deviation of ten millimeters compared to the healthy opposite side, a complete side ligament tear (rupture) is assumed.

Assessment of swelling

The swelling of the knee can also provide information about the type of injury. If the anterior cruciate ligament is affected, in most cases there is an effusion of the knee, i.e. an increased fluid accumulation within the capsule of the knee. In the posterior cruciate ligament, there is rarely an effusion. In the case of side ligament tears, local swellings without effusion are more common.

X-rays, ultrasound and MRI for torn ligaments in the knee

Imaging methods are suitable to confirm the diagnosis and rule out further damage to the knee joint: X-rays show whether there are bony injuries such as torn ligaments or fractures. The bands themselves cannot be shown on X-rays.

The ultrasound method is well suited to locating fluid accumulations in the joint. The course of the sidebands and thus possible sideband tears can also be shown by doctors in an ultrasound examination. However, any additional injuries to the meniscus, for example, do not show up in ultrasound diagnostics.

Using magnetic resonance imaging (MRI), the doctor creates various sectional images of the knee joint that provide information about the condition of the ligaments, menisci, cartilage and tendons.

Treatment: therapy of the ligament tear on the knee

In general, conservative and surgical therapies are available for torn ligaments. In addition to the exact diagnosis, it is also crucial how old the person concerned is and whether he is an active athlete. Lifestyle, future plans and a possible overweight are also important factors. First of all, the right first aid measures are always important.

Torn ligaments: Conservative therapy

Internal ligament tear at the knee

If the ligament in the knee is only stretched or pulled, doctors usually recommend a splint (orthosis) to immobilize it for a few days. A torn inner band usually heals very well with a splint if no additional structures are affected. The patients then wear the orthosis for about six weeks and regularly cool the injured region.

While wearing the knee brace, it is advisable to move the knee regularly without stress. After about four weeks, light physiotherapy exercises are recommended. After the sixth week there is a load-dependent training therapy with strengthening of the surrounding muscles to stabilize the knee joint. Physiotherapy is important and has a great impact on the healing process and the duration.

Initially, the physiotherapeutic exercises focus on improving the extension and flexion of the knee joint. Furthermore, it is important to strengthen the structures around the joint and to stabilize the knee joint.

Outer ligament tear at the knee

If it is a simple external ligament tear with intact soft tissue and preserved knee stability, doctors usually recommend conservative treatment with a knee orthosis, which the affected person wears for about six to eight weeks. The knee should also be cooled and relieved a little when walking using crutches. If the state of healing allows it, special physiotherapeutic exercises for strengthening follow.

Trained athletes can often start training again after only six months. However, it can take up to a year for the knee to become fully resilient and fit for sports.

However, if there is damage to the bones, cartilage, meniscus or cruciate ligaments in addition to the external ligament tear on the knee, surgical methods are usually sensible.

Torn ligaments: surgical therapies

Often, not only one of the side straps breaks in the event of an accident. Other joint structures such as the joint capsule, a cruciate ligament or the meniscus are often involved in the injury. Especially in the case of complete outer ligament ruptures, serious accompanying injuries occur in many cases. The result is a permanently unstable knee joint, which in turn can lead to consequential damage such as high-grade joint wear.

Surgery may be necessary in the following cases:

  • The injury is complex and affects other knee structures.

  • One or more bones are involved in the injury.

  • The knee joint remains unstable.

  • The affected person is an athlete and will put a lot of strain on his knee after healing.

  • The person concerned has a job that puts a lot of strain on his knees.

What happens during knee surgery?

Knee operations are usually minimally invasive and outpatient or inpatient with a short stay in the hospital. In arthroscopy, surgeons make several small incisions instead of one large incision. Doctors therefore speak of the keyhole method.

The soft tissues, i.e. muscles, tendons and the surrounding tissue remain largely intact. This has a positive effect on the healing time, mobilization and scarring. How the surgeon does the knee surgery depends on the type and severity of the injury.

Outer ligament tear: If, for example, the outer ligament in the knee tears off with its bony anchoring, doctors fix the affected bone with special screws and sew the outer ligament.

Complete outer belt tear: If the outer ligament in the knee tears completely (outer ligament rupture), a seam of the outer ligament would not hold in many cases. In these cases, surgeons replace or strengthen the outer ligament with the body's own tendons and muscles.

Cruciate ligament tear or cartilage damage: If a cruciate ligament tear or damage to the meniscus is involved in the injury, doctors usually insert part of the body's tendon or an artificial implant. Sewing the torn cruciate ligament is usually not enough to anchor the structures sufficiently in the bone again.

What happens after knee surgery?

After surgery to tear the ligaments on the knee or the complex knee injury, those affected should not fully strain their knee joints for about six to twelve weeks. If there is pain after the operation, cooling with ice, raising the leg and possibly pain medication will help.

A knee brace (usually for about six weeks) and crutches (usually for about three weeks) support the healing process in this phase. If any trans or implants have grown in, physiotherapeutic exercises and physiotherapy ensure mobility, coordination and resilience.

Orthopedic surgeons usually also advise you to start walking or simply cycling shortly after the procedure, i.e. without effort, such as when driving uphill. However, the knee should not be fully strained until after about three months – in consultation with the doctor treating you. Sports that are particularly stress-intensive usually wait six to twelve months.

Are there home remedies for torn ligaments?

If you suspect a ligament tear in the knee, there are other home remedies in addition to the ice for cooling that can provide relief right at the beginning of the injury:

  • arnica For example, in the form of ointments, compresses or a tincture, it can support the healing process and relieve pain or hematoma.

  • Comfrey should support the healing process in the form of teas in the event of a ligament tear on the knee Drink a liter of tea throughout the day.

  • Quark wrap can cool, decongestant and relieve pain on the knee injury.

Course of torn ligaments: What influences healing?

How long it takes to heal a ligament tear in the knee depends on many factors. The decisive factor is whether, for example, there is only a simple inner ligament tear or a complex injury with various damaged joint structures. Important factors are also whether conservative therapy was chosen or surgery.

The age and fitness level of the person concerned also play a major role.

If the knee ligament tear is treated and cooled immediately and the physiotherapy takes place successfully, the chances of an uncomplicated healing in the event of a ligament tear on the knee are good.

Sick leave after torn ligaments?

How long the affected person is unable to work depends on the degree of his injury and his profession. Anyone who does sedentary work may be able to work again after a few days or a week. Older patients usually receive sick leave of around ten to fourteen days. After operations of more complex knee injuries or after the insertion of implants, sick leave of two months is not uncommon. Affected people with standing professions stay at home for an average of three months. When you are on sick leave, it is also decisive whether you can go to work or go to school without too much stress.

Torn ligaments: when can you drive a car again?

Driving a car is not possible with a ligament tear in the knee. Doctors only recommend driving a car after a ligament tear in the knee when the knee can be fully loaded again. This can take a few weeks for minor injuries and several months for more complex injuries. When the time is reached in the individual case, the treating doctor should absolutely check and assess. Getting in and out of the car, switching gears or braking hard can otherwise lead to problems such as pain and negatively affect the healing process

Torn ligaments: Are there late effects?

The prognosis for torn ligaments is usually good. However, untreated and overlooked injuries can cause long-term damage. Even if treatment is delayed, long-term consequences such as permanent joint instability and long-term pain threaten. This in turn can lead to premature wear of the knee joint, an arthrosis.

Can you prevent torn ligaments?

In general, whoever trains fitness and coordination on a regular basis not only reduces the risk of torn ligaments. Trained leg muscles, ligaments and tendons are stronger and ensure the stability of the knee joint. Coordination and balance exercises, for example on a wobble board or a foam pad, train the interplay of muscles, tendons and ligaments and thus protect the joint from injuries.

Stretching exercises can also help prevent torn ligaments. For example, if the thigh and lower leg muscles are shortened, strong tensile forces act on the knee joint. This can be counteracted by daily stretching the front and back of the thighs and calves for about two minutes.

Orthopedic surgeons or sports doctors can also check whether suitable sports shoes are available and may recommend pads or bandages to prevent future injuries to the knee ligaments.

Kinesio tapes: typical applications

Kinesio tapes: typical applications