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MK Orthopädie Währing
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knowledge
1. October 2026

Cru­ciate Li­ga­ment Te­ars in Soc­cer: When Is Sur­gery Recommended?

Knee pain af­ter ski­ing: Wha­t’s the cause?

A quick ch­ange of di­rec­tion, an ab­rupt stop, or an un­fort­u­nate tackle—and sud­denly the knee gi­ves out. A torn cru­ciate li­ga­ment is one of the most com­mon se­rious knee in­ju­ries in soc­cer. It is not un­com­mon for the me­nis­cus to be af­fec­ted as well. 

For soc­cer play­ers, this rai­ses th­ree main ques­ti­ons: Will my knee re­gain its sta­bi­lity? Is sur­gery ne­ces­sary? And when can I start trai­ning or play­ing soc­cer again? 

Priv.-Doz. DDr. Ma­xi­mi­lian Kas­pa­rek, MSc, is a spe­cia­list in or­tho­pe­dics and trau­ma­to­logy and an IOC sports phy­si­cian. At his pri­vate prac­tice in Vi­enna 1180, he tre­ats knee in­ju­ries and sports injuries—from tho­rough dia­gno­sis to in­di­vi­du­ally tail­o­red con­ser­va­tive or sur­gi­cal treatment.

Ty­pi­cal me­cha­nism of in­jury: The knee twists du­ring a ch­ange of di­rec­tion while the foot re­mains on the ground. Image source: Ge­ne­ra­ted by AI. 

Why do cru­ciate li­ga­ments tear so of­ten in soccer?

The an­te­rior cru­ciate li­ga­ment sta­bi­li­zes the knee joint. It pre­vents the lower leg from shif­ting too far for­ward re­la­tive to the thigh and con­trols ro­ta­tio­nal movements. 

Many cru­ciate li­ga­ment te­ars oc­cur wi­t­hout di­rect cont­act with an op­po­nent. Ty­pi­cal si­tua­tions include: 

  • a sud­den twis­ting mo­tion while kee­ping one foot planted
  • ab­rupt stop­ping or a quick ch­ange in direction
  • an un­con­trol­led landing af­ter a jump
  • a duel or a clash
  • hy­per­ex­ten­sion or se­vere twis­ting of the knee

Some peo­ple who are af­fec­ted hear or feel a pop­ping sound. The knee of­ten swells wi­thin a short time and feels unsta­ble. Ho­we­ver, a torn cru­ciate li­ga­ment can also pre­sent with less ob­vious sym­ptoms. The­r­e­fore, just be­cause so­meone can keep wal­king af­ter twis­ting their knee doesn’t au­to­ma­ti­cally mean they only have a mi­nor strain. 

Cru­ciate Li­ga­ment Te­ars and Me­nis­cus Te­ars: A Com­mon Combination

Du­ring the same twis­ting mo­tion, the me­dial or la­te­ral me­nis­cus and the ar­ti­cu­lar car­ti­lage can be in­ju­red in ad­di­tion to the cru­ciate li­ga­ment. The me­nis­cus dis­tri­bu­tes the load in the knee and acts as a shock ab­sor­ber. A tear can cause pain along the joint space, swel­ling, a fee­ling of cat­ching, or a lo­cking sensation. 

Cru­ciate li­ga­ment te­ars and me­nis­cus te­ars ex­plai­ned sim­ply. Image source: AI-generated. 

The tre­at­ment de­pends on whe­ther only the cru­ciate li­ga­ment is af­fec­ted or whe­ther the me­nis­cus or car­ti­lage is also in­vol­ved. The eva­lua­tion ty­pi­cally in­cludes a dis­cus­sion of the cir­cum­s­tances of the in­jury, a cli­ni­cal ex­ami­na­tion with sta­bi­lity and me­nis­cus tests, and ma­gne­tic re­so­nance ima­ging (MRI). The MRI fin­dings are al­ways eva­lua­ted in con­junc­tion with the patient’s sym­ptoms, sta­bi­lity, and ath­le­tic goals. 

Does a torn cru­ciate li­ga­ment al­ways re­quire surgery?

No. A torn cru­ciate li­ga­ment does not au­to­ma­ti­cally re­quire sur­gery. If the knee is sta­ble du­ring ever­y­day ac­ti­vi­ties and the patient’s ath­le­tic de­mands are mi­ni­mal, a struc­tu­red con­ser­va­tive tre­at­ment plan in­vol­ving phy­si­cal the­rapy may be appropriate. 

Ho­we­ver, soc­cer places high de­mands on the knee: sprin­ting, sud­den stops, twis­ting mo­ve­ments, and one-on-one batt­les all re­quire re­lia­ble sta­bi­lity. Cru­ciate li­ga­ment sur­gery may be a par­ti­cu­larly good op­tion if: 

  • the knee re­pea­tedly buck­les du­ring sports or ever­y­day activities
  • there is si­gni­fi­cant instability
  • the goal is to re­turn to soccer
  • there is ad­di­tio­nal da­mage to the me­nis­cus or cartilage
  • the pa­ti­ent is young or very ac­tive in sports
  • the in­sta­bi­lity per­sists de­spite tar­ge­ted phy­si­cal therapy

Age is­n’t the only fac­tor. Even re­crea­tio­nal soc­cer play­ers can place high de­mands on their knees. Tha­t’s why in­jury pat­terns, trai­ning vo­lume, po­si­tion, oc­cu­pa­tion, and per­so­nal goals are all ta­ken into ac­count in the de­cis­ion-ma­king process. 

What hap­pens du­ring cru­ciate li­ga­ment surgery?

In a cru­ciate li­ga­ment re­con­s­truc­tion, the torn an­te­rior cru­ciate li­ga­ment is ty­pi­cally re­pla­ced with a ten­don graft. The pro­ce­dure is per­for­med arthroscopically—that is, using a mi­ni­mally in­va­sive tech­ni­que th­rough small in­cis­i­ons. A ca­mera al­lows for a pre­cise as­sess­ment of the knee joint. At the same time, me­nis­cus or car­ti­lage da­mage can be treated. 

The graft is pla­ced as close as pos­si­ble to the ori­gi­nal po­si­tion of the cru­ciate li­ga­ment and se­cu­red to the thigh­bone and shin­bone. The goal is a sta­ble, func­tion­ally sound knee—but the sur­gery is only one part of the tre­at­ment. Con­sis­tent re­ha­bi­li­ta­tion is just as important. 

Which ten­don is sui­ta­ble for cru­ciate li­ga­ment reconstruction?

Va­rious ten­dons from the pa­ti­en­t’s own body can be used for the re­con­s­truc­tion, such as ten­dons from the back of the thigh, the quad­ri­ceps ten­don, or a por­tion of the pa­tel­lar ten­don. In cer­tain si­tua­tions, do­nor tis­sue may also be an option. 

Each op­tion has its ad­van­ta­ges and di­s­ad­van­ta­ges. The choice de­pends, among other things, on age, ac­ti­vity le­vel, type of sport, work-re­la­ted stress, ana­tomy, and any pre­vious sur­ge­ries. For young, ath­le­ti­cally ac­tive pa­ti­ents, a ten­don from the patient’s own body is of­ten pre­fer­red. Ho­we­ver, there is no sin­gle graft that is the best choice for everyone. 

It is the­r­e­fore im­portant to de­ve­lop a per­so­na­li­zed tre­at­ment plan with a sur­geon who spe­cia­li­zes in knee sur­gery. This plan ta­kes into ac­count not only sta­bi­lity and load-bea­ring ca­pa­city, but also po­ten­tial dis­com­fort at the do­nor site and the de­mands of fu­ture ath­le­tic activities. 

What hap­pens if a me­nis­cus te­ars at the same time?

Whe­ther a me­nis­cus tear is su­tured or par­ti­ally re­mo­ved de­pends on the type of tear, its lo­ca­tion, size, blood sup­ply, and tis­sue quality.

Me­nis­cus Suture

If the tear can be suc­cessfully re­pai­red, the me­nis­cus is pre­ser­ved and su­tured when­ever pos­si­ble. This is par­ti­cu­larly im­portant for youn­ger and phy­si­cally ac­tive pa­ti­ents be­cause the me­nis­cus pro­tects the ar­ti­cu­lar car­ti­lage over the long term. Ho­we­ver, af­ter su­tu­ring, the tis­sue must heal; the­r­e­fore, the pro­cess of gra­du­ally re­sum­ing weight-bea­ring may take longer. 

Mi­ni­mally In­va­sive Me­nis­cus Resection

If a da­ma­ged sec­tion can no lon­ger be su­tured se­cu­rely, it may be ne­ces­sary to re­move only as much tis­sue as pos­si­ble. In this pro­ce­dure, only tis­sue that can­not be pre­ser­ved is re­mo­ved, and as much he­althy me­nis­cus as pos­si­ble is pre­ser­ved. More in­for­ma­tion: Me­nis­cus Te­ars and Me­nis­cus Sur­gery in Vi­enna

When is sur­gery per­for­med af­ter a cru­ciate li­ga­ment tear?

Plan­ned cru­ciate li­ga­ment re­con­s­truc­tion usually does not need to be per­for­med im­me­dia­tely on the day of the ac­ci­dent. Of­ten, the knee should first be al­lo­wed to re­co­ver from swel­ling and re­gain its range of mo­tion. Phy­si­cal the­rapy be­fore sur­gery can im­prove range of mo­tion and mus­cle control. 

Cer­tain as­so­cia­ted in­ju­ries may re­quire ear­lier surgery—for ex­am­ple, a dis­pla­ced me­nis­cal tear that cau­ses the knee to lock. The ap­pro­priate ti­ming is de­ter­mi­ned ba­sed on swel­ling, range of mo­tion, mus­cle strength, as­so­cia­ted in­ju­ries, and oc­cu­pa­tio­nal and ath­le­tic demands. 

How does re­ha­bi­li­ta­tion work?

Af­ter sur­gery, the graf­ted ten­don needs time to heal firmly into the knee. At the same time, range of mo­tion, mus­cle strength, and sta­bi­lity are gra­du­ally re­built. How quickly the exer­cise re­gi­men can be in­creased de­pends on the type of sur­gery and any ad­di­tio­nal injuries—such as a me­nis­cus tear. The exact course of re­ha­bi­li­ta­tion de­pends on the pro­ce­dure and any ac­com­pany­ing injuries. 

Four ty­pi­cal stages of re­ha­bi­li­ta­tion: mo­bi­lity, strength and ba­lance, run­ning trai­ning, and soc­cer-spe­ci­fic trai­ning. Image source: Ge­ne­ra­ted by AI. 

  1. Re­duce swel­ling and gra­du­ally res­tore mo­bi­lity in a con­trol­led manner
  2. Im­prove Strength and Mus­cle Control
  3. Train ba­lance, sta­bi­lity, and pro­per leg alignment
  4. Gra­du­ally in­crease your run­ning workload
  5. Prac­tice jumps, ch­an­ges of di­rec­tion, and soc­cer-spe­ci­fic movements
  6. Re­turn to team prac­tice in a con­trol­led manner
  7. Cle­arance for one-on-one drills and com­pe­ti­tion fol­lo­wing func­tional tests

Af­ter ad­di­tio­nal me­nis­cus su­tu­ring, more con­ser­va­tive gui­de­lines re­gar­ding weight-bea­ring and range of mo­tion are of­ten re­com­men­ded. The­r­e­fore, the re­ha­bi­li­ta­tion plan should al­ways be tail­o­red to the in­jury as a whole and the spe­ci­fic sur­gi­cal procedure. 

When can I play soc­cer again?

A re­turn to soc­cer should not de­pend so­lely on a spe­ci­fic date. Be­fore re­tur­ning to the sport, the knee should be free of ir­ri­ta­tion and fle­xi­ble, the mus­cles should be suf­fi­ci­ently de­ve­lo­ped, and the player should have suc­cessfully pas­sed tests in­vol­ving run­ning, jum­ping, and ch­an­ges of di­rec­tion. Con­fi­dence in the knee also plays an im­portant role. 

If there are no com­pli­ca­ti­ons, a full re­turn to a sport in­vol­ving ra­pid ch­an­ges in di­rec­tion and cont­act with op­pon­ents of­ten oc­curs no soo­ner than about nine months, and in some ca­ses la­ter. Re­tur­ning to sports too soon can in­crease the risk of re-in­jury. The­r­e­fore, cle­arance should be ba­sed on spe­ci­fic cri­te­ria and de­ter­mi­ned by the trea­ting phy­si­cian and the re­ha­bi­li­ta­tion team. 

Why is the sur­ge­on’s ex­pe­ri­ence important?

Se­ve­ral fac­tors are cru­cial in cru­ciate li­ga­ment re­con­s­truc­tion: the sel­ec­tion of an ap­pro­priate graft, its ana­to­mical po­si­tio­ning and se­cure fix­a­tion, as well as the iden­ti­fi­ca­tion and tre­at­ment of any ac­com­pany­ing me­nis­cus or car­ti­lage damage.

Priv.-Doz. DDr. Ma­xi­mi­lian Kas­pa­rek, MSc spe­cia­li­zes in knee sur­gery and sports in­ju­ries. As a board-cer­ti­fied spe­cia­list in or­tho­pe­dics and trau­ma­to­logy and an IOC sports phy­si­cian, he ta­kes into ac­count not only the na­ture of the in­jury but also his pa­ti­ents’ ath­le­tic goals. Tre­at­ment is plan­ned on an in­di­vi­dual basis—from the in­itial ex­ami­na­tion th­rough the de­cis­ion for or against sur­gery to the gra­dual re­turn to sports.

Fur­ther information:
Cru­ciate Li­ga­ment Tre­at­ment and Sur­gery in Vi­enna · Knee Pro­blems and Knee In­ju­ries · Sports and Joint Injuries

Get a cru­ciate li­ga­ment tear or me­nis­cus tear che­cked out if it hap­pened while play­ing soccer

Did you twist your knee while play­ing soc­cer, suf­fer a torn cru­ciate li­ga­ment or me­nis­cus, or would you like a se­cond opi­nion on a re­com­men­ded surgery?

At the pri­vate prac­tice of Priv.-Doz. DDr. Ma­xi­mi­lian Kas­pa­rek, MSc, lo­ca­ted in 1180 Vi­enna, your test re­sults, any pos­si­ble ac­com­pany­ing in­ju­ries, and your ath­le­tic goals will be carefully eva­lua­ted. Tog­e­ther, we will de­cide whe­ther con­ser­va­tive tre­at­ment is pos­si­ble or which sur­gi­cal me­thod is best sui­ted to your situation.

MAKE AN AP­POINT­MENT NOW

Fre­quently as­ked ques­ti­ons (FAQ)

Can you still walk with a torn ACL?

Yes. Many peo­ple who have torn a cru­ciate li­ga­ment can still walk. Ho­we­ver, that does­n’t mean the knee is sta­ble en­ough. Ro­ta­tio­nal mo­ve­ments, sud­den stops, and soc­cer, in par­ti­cu­lar, can cause the knee to give way. 

Can I keep play­ing soc­cer with a torn ACL?

Soc­cer is ge­ne­rally not re­com­men­ded for peo­ple with an unsta­ble knee. Re­pea­ted buck­ling can cause fur­ther da­mage to the me­nis­cus and car­ti­lage. Whe­ther a re­turn to play wi­t­hout sur­gery is rea­li­stic must be de­ter­mi­ned on a case-by-case basis. 

Does a re­crea­tio­nal soc­cer player need sur­gery for a torn cru­ciate li­ga­ment?

Not au­to­ma­ti­cally. The key fac­tors are sta­bi­lity, sym­ptoms, as­so­cia­ted in­ju­ries, and the de­si­red le­vel of ac­ti­vity. Ho­we­ver, an­yone who wants to play soc­cer re­gu­larly places high de­mands on their knee. 

Can the cru­ciate li­ga­ment and me­nis­cus be ope­ra­ted on at the same time?

Yes. If there is also a me­nis­cus tear that re­qui­res tre­at­ment, it can of­ten be su­tured or par­ti­ally re­mo­ved du­ring the same mi­ni­mally in­va­sive surgery. 

Is me­nis­cus su­tu­ring bet­ter than par­tial me­niscec­tomy?

If su­tu­ring is a via­ble op­tion, pre­ser­ving the me­nis­cus is ge­ne­rally de­si­ra­ble. Ho­we­ver, not every tear is sui­ta­ble for this ap­proach. If the tis­sue can­not be pre­ser­ved, a mi­ni­mally in­va­sive par­tial re­m­oval may be necessary. 

Which ten­don is best for cru­ciate li­ga­ment re­con­s­truc­tion?

There is no sin­gle ten­don that is equally op­ti­mal for all pa­ti­ents. Age, type of sport, oc­cu­pa­tio­nal de­mands, ana­tomy, and prior sur­ge­ries all in­fluence the choice. 

How soon should a torn cru­ciate li­ga­ment be ex­ami­ned?

A se­ver­ely swol­len, unsta­ble, or lo­cked knee should be ex­ami­ned promptly. In ca­ses of a lo­cked knee, se­vere pain, or an ina­bi­lity to bear weight, prompt me­di­cal eva­lua­tion is par­ti­cu­larly important. 

How long is the re­co­very time af­ter a cru­ciate li­ga­ment tear in soc­cer?

Af­ter cru­ciate li­ga­ment re­con­s­truc­tion, it of­ten ta­kes at least nine months to re­turn to soc­cer wi­t­hout rest­ric­tions. De­pen­ding on the he­al­ing pro­cess, any ac­com­pany­ing in­ju­ries, and the re­sults of func­tional tests, the re­co­very pe­riod may be longer. 

For more information:

 

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Priv.Doz. DDr.
Maximilian Kasparek, MSc
haelsi Gesundheitszentrum im Achtzehnten Theresiengasse 46/2 1180 Vienna

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