Anterior cruciate ligament tear in Hamburg Anterior cruciate ligament tear – causes, symptoms, diagnosis & treatment

Two central stabilizers run through the knee: the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL). They connect the thigh bone (femur) and the shinbone (tibia) and prevent uncontrolled forward or backward sliding of the tibia. They stabilize the knee in translation (anterior/posterior movement), rotation, and support control during flexion and extension movements.

A cruciate ligament tear involves a partial or complete rupture of one of these ligaments. In most cases, the anterior cruciate ligament is affected. Cruciate ligament tears occur particularly in sports involving rapid changes of direction, stop-and-go movements, or jumping—such as soccer, handball, basketball, tennis, skiing, or gymnastics.

At our sports orthopaedic private practice at LANS Medicum Hamburg, we offer precise diagnostics and individualized treatment strategies—both in conservative therapy and in rehabilitation following cruciate ligament surgery.

In Germany, approximately 30,000 cruciate ligament surgeries are performed each year. In sports that place high stress on the knee joint, anterior cruciate ligament tears are among the most common reasons for an extended break from sports. Extrapolated to a population of 100,000 people, the incidence is around 35–40 ACL ruptures per year. In countries with well-documented injury statistics, such as Sweden or Norway, registry studies have reported an incidence of up to 78 per 100,000 inhabitants—with an increasing trend in recent years, particularly among younger adults. In the 15–25 age group, the incidence is even as high as 100 per 100,000 inhabitants.

A cruciate ligament tear can easily be confused with other knee injuries in the acute phase, as many symptoms—such as pain, swelling, or a feeling of instability—are nonspecific. Possible differential diagnoses include:

• Meniscus tear: Especially during twisting movements under load, a meniscus injury can cause similar pain and a “locking” sensation in the joint.
• Medial or lateral collateral ligament rupture: Pain and instability usually occur on the sides of the knee, often after varus or valgus stress.
• Patellar dislocation: The kneecap slips out of its groove, often with visibly noticeable misalignment and pain at the front of the knee.
• Bone bruise or edema: Following a fall or impact, sometimes with significant swelling, but without mechanical instability.
• Sprain or partial cruciate ligament tear: Can present similarly to a complete tear but is functionally much more stable.

Accurate clinical examination and imaging diagnostics (e.g., MRI) are essential to reliably differentiate these conditions.

The diagnosis of a cruciate ligament tear is based on a combination of several complementary examination methods. The goal is to reliably identify the injury, detect accompanying injuries, and enable an informed treatment decision:

• Clinical function tests: These include the Lachman test, Pivot-Shift test, and the anterior/posterior drawer test. They assess the passive stability of the knee and indicate whether the anterior or posterior cruciate ligament is injured. The Lachman test, in particular, is considered the most sensitive test for acute ACL rupture.
• Ultrasound diagnostics: Ultrasound can detect joint effusions, soft tissue injuries, and indirect signs of a cruciate ligament tear in the acute phase—such as anterior tibial shift. It is radiation-free, quickly available, and provides initial insights, but it does not replace MRI.
• Magnetic resonance imaging (MRI): MRI is the gold standard for imaging-confirmed cruciate ligament tears. It allows assessment of the ligament itself and reveals associated injuries such as meniscus tears, bone edema, or cartilage damage—crucial for treatment planning.
• Instrumented measurements: Devices like the KT-1000 or Lachmeter quantify the anterior or posterior translation of the tibia under defined force. This objective measurement of joint laxity is particularly useful for monitoring progression, evaluating conservative therapy, or assessing postoperative function.

In our practice, we use a structured, multi-step diagnostic approach that combines clinical expertise with modern imaging and functional tests. Our orthopedic and sports medicine specialists have years of experience in diagnosing complex knee injuries—whether in acute sports injuries or chronic instability—ensuring a well-founded and transparent treatment recommendation.

The duration of rehabilitation after a cruciate ligament tear varies individually, but we can provide a general guideline:

Initially, a multimodal therapy over 6–8 weeks is recommended, followed by testing of the knee joint. Daily activities without crutches are usually possible after 4–8 weeks. The further timeline depends on the type of treatment performed.

With continued conservative therapy:

• Jogging: after 3–4 months
• Contact sports: after 6 months (if stable)

After anterior cruciate ligament surgery:

• Daily activities: after 2–4 weeks (possibly with a brace)
• Jogging: after 3–4 months
• Sport-specific training: after 6 months
• Return to sport: after 9–12 months (after testing)

The exact timing for returning to sports without restrictions is determined based on your progress in rehabilitation. Once certain milestones are reached, we conduct our cruciate ligament test, which allows a well-founded decision on return to sport.

During rehabilitation, we also perform sports science assessments at our practice:

• Maximum strength testing
• EMG analysis
• Jump tests

The goal is not only to return to sport but to ensure safe and sustainable joint stability and load capacity.

Our private practice at LANS Medicum Hamburg specializes in the diagnosis and treatment of cruciate ligament injuries—both conservative and post-surgical.

Whether you are a professional athlete or a recreational sports enthusiast, we take the time to understand your situation and work with you to develop a structured treatment plan.