Knieknacken 3 Jahre nach ACL-Riss: Ursachen, Diagnose und Behandlung

Persistent knee popping/clicking years after ACL reconstruction (or non-operative management) has several potential etiologies:

• Post-surgical scar tissue (arthrofibrosis) – Causes mechanical catching, stiffness, audible crepitus.
• Meniscus tear or degeneration – Residual or new tear from altered biomechanics; mechanical symptoms (clicking, locking, giving way).
• Patellofemoral pain syndrome (PFPS) – Maltracking from quad atrophy, graft placement, or cartilage wear; crepitus with stairs/squatting.
• Post-traumatic osteoarthritis – Accelerated cartilage loss from initial injury, meniscectomy, or malalignment; grinding, stiffness, effusion.
• Graft issues – Laxity, impingement, or tunnel widening.

Recommended Workup

• Weight-bearing X-rays (AP, lateral, Merchant, tunnel views).
• MRI (3T preferred) for meniscus, cartilage, graft integrity, bone edema.
• Dynamic assessment by sports PT or orthopedist.

Conservative Management

• Activity modification (avoid provocative loads).
• Ice, compression, elevation for flares.
• Targeted strengthening: quads (VMO), glutes, hamstrings, core.
• Neuromuscular/proprioceptive training.
• Bracing for instability episodes.

If mechanical symptoms (locking, giving way) persist or function declines, surgical evaluation (arthroscopy, revision ACL, osteotomy) may be indicated.