Rupture of the knee ligaments is a very common injury, which is characterized by a complete or partial separation of the ligamentous fibers that hold the bones of the lower leg and thigh in a stable position. According to statistics, such injuries account for about 85% of all traumatic joint injuries. And knee injuries account for approximately 50% of all ruptures.
This pathological phenomenon in itself does not pose a threat to life, but the severe pain caused by it and the inability to walk provoke a short-term but permanent disability. With complex torn knee ligaments, some patients will never be able to return to their usual activities if they are associated with high loads on the injured knee.
Thanks to the huge variety of modern medicines and medical technologies, any problem can be cured. For partial ruptures, conservative treatment is used, and for complete ruptures, surgical treatment is used. Therapyorthopedic traumatologists deal with this pathology.
The mechanism of injury and its causes
The only factor in causing a knee ligament tear is trauma. Therefore, the initial criterion on which a diagnosis is based is the circumstances under which it was obtained.
In an injury that contributes to ruptures, the movement performed by a person and the load on the joint, as a rule, does not correspond to the maximum possible amplitude that a particular joint can carry out. In this case, excessive tension occurs in a certain area of the knee, which provokes damage to the fibers of the ligamentous structures. Often a similar situation is observed when:
- direct and side impacts to the knee joint area;
- jumping from a height onto an incorrectly bent or straight limb;
- falling with emphasis on a limb bent at the knee;
- tucking the lower leg to the side;
- excessive rotation of the body relative to the lower leg fixed in a certain position.
The mechanism of traumatization determines which knee ligament will be damaged. The strength of the ligamentous apparatus and the strength of the injury determine whether the ligament is ruptured - complete or partial.
Varieties of pathology
In medical practice, the classification of knee ligament tears is extremely important, since it is the basis for the main methods of therapy and diagnostic criteria for the type of injury.
Thus, there are gaps:
- Depending on the damage to the ligament. Cruciforms (anterior and posterior), which are localized inside the knee and provide stability to the knee in terms of displacements forward or backward; collateral (lateral) ligaments, which are located on the outer or inner surface of the joint and keep it from shifting to the sides; meniscofemoral ligaments and the transverse ligament of the menisci, which fixes them; patella, which provide stability to the patella.
- Depending on the degree of damage. Partial rupture of the knee ligaments - a change in the integrity of some fibers; complete, which is characterized by the intersection of all fibers; osteoepiphysiolysis, in which small fragments of bone are torn off.
There are also combined ones, in which several ligaments are injured to varying degrees.
General symptoms
Now let's explore the next aspect. The most common symptoms of knee ligament tears are:
- bright pain syndrome, when the patient has a strong burning pain in the affected area;
- pronounced swelling in the area of the affected joint;
- appearance of looseness and unnatural mobility of the joint;
- disturbances in functional activity (impossibility to carry out habitual movements, limitation of mobility);
- hematoma (subcutaneous hemorrhage) or hyperemia of the skin in the area of the injured joint, which often spread to the surrounding tissues.
Specificsigns
There are several specific symptoms of knee ligament rupture. They are:
- When the collateral external ligament is damaged, pain is noted when pressing on the lateral outer surface of the knee. In addition, you may notice abnormal lateral movement of the lower leg relative to the femoral axis (inward).
- When the internal collateral ligament is injured, point pain is noted along the inside of the knee. In combination with pathological mobility of the lower leg in the process of abduction to the outside and a stable thigh. What are the other symptoms of a knee ligament tear?
- You should listen to your feelings. If there is a rupture of the anterior or posterior cruciate ligament of the knee, the patient experiences severe pain inside this joint, severe swelling along its perimeter with “balloting” of the patella (pressure on the patella with a straight leg causes it to move inward, and after the pressure stops, this structure returns to normal position), excessive mobility of the lower leg.
- If the injury affected the ligaments of the menisci, then the general symptoms of the pathological condition are supplemented by clicks, instability and jamming during movements of the knee joint. Often this group of ligaments is injured in combination with collateral ligaments. As well as the menisci themselves.
The larger the area of damage, the more pronounced the symptoms of rupture of the ligaments of the knee joint (accordingly, with complete signs of injury, the signs of injury are more pronounced than with partial ones). It's quite natural.
Lateral knee ligament injury
Two lateral (collateral) ligaments are localized on the sides of the knee. The fibular collateral (lateral lateral) ligament strengthens the knee from the outside. Above it is attached to the external femoral condyle, below - to the head of the fibula. The tibial collateral (medial-lateral) ligament, respectively, is located on the inner surface of the knee joint. Above, it is attached to the internal femoral condyle, below - directly to the tibia. In addition, some of its fibers are attached to the internal meniscus and joint capsule, and therefore injuries of the lateral internal ligament are very often combined with injuries of the internal meniscus.
The external lateral knee ligament is much less frequently injured than the internal. Damage to the ligamentous apparatus of the knee joint can occur with excessive deflection of the lower leg inward. For example, while twisting the legs. Lateral knee ligament tears are often complete. May be associated with avulsion fractures of the head of the fibula.
In case of damage to this group of knee ligaments, the patient complains of severe soreness of pain in the area of damage, which increases significantly when the lower leg is deflected inward. Limb movements are severely limited. The knee joint is edematous, hemarthrosis is determined. The severity of symptoms depends on the degree of injury to the ligamentous structures. With a complete rupture, looseness in the joint is determined.
Sidethe internal ligament is injured much more often, however, its damage is usually incomplete. Such injuries occur when the lower leg is excessively outward. Such damage to the knee ligaments is often combined with ruptures of the internal meniscus and damage to the joint capsule, which can be easily diagnosed by MRI of the knee joint. The knee is very swollen. In addition, some soreness is determined in the process of probing, with the deviation of the lower leg outward, during movements. A photo of a ligament rupture of the knee joint is presented below. But the doctor must make a diagnosis.
Therapy for injuries of the lateral knee ligaments
Complete or partial rupture of the ligamentous apparatus of the knee joint in traumatology is treated with conservative methods. Doctors anesthetize the injury site with a novocaine solution. With severe internal bleeding, a puncture is performed into the joint cavity. A plaster splint is placed on the leg from the ankle to the top of the thigh.
Complete rupture of the lateral internal ligament is also treated in traditional ways. In case of injuries of the external lateral ligament, surgical intervention is necessary, since its ends, when ruptured, are greatly separated from each other, and their natural fusion becomes, as a rule, impossible. During the operation, a lavsan suture of ligamentous fibers or tendon autoplasty is performed. Grafts are used when a ligament dissection develops.
In an avulsion fracture of the head, a bone fragment is fixed tofibula with a special screw. When the fibers are fused, the length of the ligament often increases due to scar tissue. As a result, its strengthening function decreases, the knee joint loses stability. If other structures of the joint (cruciate ligaments, capsule) do not compensate for this instability, a reconstructive operation is performed. During which the attachment site is moved or tendon plasty is performed. Treatment of knee ligament ruptures should be comprehensive and timely. This is important!
Cruciate ligament injuries
This ligament group is located inside the knee joint and connects the articular integument of the femur and tibia. The anterior cruciate ligament is attached to the posterior upper surface of the femoral condyle, passes through the joint anteriorly and inward, and then attaches to the tibial cover in its anterointernal region.
The posterior cruciate ligament is attached to the anterior superior surface of the femoral condyle. It passes in the articular cavity from behind and outward, after which it is attached to the surface of the tibia in its posterior outer zone. The anterior cruciate ligament keeps the lower leg from slipping forward, while the posterior cruciate ligament keeps it from slipping back.
Anterior cruciate ligament tear is caused by a strong blow or excessive pressure on the back of the lower leg when the leg is bent at the knee. The posterior cruciate ligament can be damaged when overextendedshin or when struck on its front surface. Anterior ligament injuries are the most common. In addition, the occurrence of the "Turner triad" is often observed, which is characterized by a combination of ruptures of the anterior cruciate and external lateral ligaments. As well as damage to the inner meniscus.
What other symptoms of a knee ligament rupture are possible? The photo cannot show the whole picture. Therefore, you should not delay visiting a doctor.
Symptoms of cruciate ligament injury
With this injury, the knee begins to swell strongly, there is a sharp pain. In the joint cavity, or outside it, the presence of fluid (hemarthrosis) is determined. The most common clinical symptom of cruciate ligament rupture is the "drawer" sign, characterized by excessive movement of the lower leg forward and backward. When diagnosing, the specialist bends the patient’s relaxed limb at an angle of 90 degrees, supports the thigh with one hand, and moves the lower leg back and forth with the other. If it shifts forward, this indicates, first of all, a violation of the integrity of the anterior cruciate ligament. If the lower leg moves backward, it means that the cruciate posterior ligament has ruptured. With a partial rupture of the cruciate ligaments, the described symptom may be absent. For the most complete study of combined, diagnostic arthroscopy of the joint is performed.
Cruciate ligament injuries. Therapy
In case of a partial rupture of the kneeligaments treatment is conservative: puncture of the joint, as well as the imposition of a plaster splint. Full is considered an indication for surgical intervention. The integrity of the ligamentous fibers can be restored in the traditional way (through open access) or endoscopically (using an arthroscope). Arthroscopic surgeries are considered the least traumatic. What else can be treated for a torn knee ligament?
In case of chronic injuries, lavsanoplasty is performed. Either replacement of the ligamentous apparatus with an autograft from the patellar ligament of the same patient, fresh injuries of the knee ligaments, the end of the ligament is sutured to the bone. The operation in this case should be performed no later than 5-6 weeks from the moment of rupture. At an earlier date, surgical intervention is not performed, since it can cause the development of contractures (limitation of mobility). In general, the treatment of ruptures of the cruciate ligament of the knee joint is not an easy process.
Rupture of the meniscus
Meniscus is a specific cartilaginous formation, which is located inside the articular cavity in the zone of connection of bones. Their main function is to increase the contact areas of the joint surfaces and the most uniform distribution of loads. The functions of the meniscus also include reducing friction and cushioning in the area of cartilage surfaces.
Menisci, and there are only two of them - internal and external, are injured very often. They are covered with cartilage and are attached by ligaments to the tibia. When bending the knee, the menisci areabout 80% of the load, so their integrity is extremely important for normal movement.
There are two types of meniscal injury:
- traumatic, as a result of blows to the knee, falls and more;
- degenerative, due to metabolic and age-related disorders.
What is most often combined with a ligament tear in the meniscus of the knee joint? The doctor will be able to answer this question in more detail. But mostly it is combined with damage to the anterior cruciate ligaments and with a fracture of the condyle of the tibia (often the inner meniscus is affected).
Tears of the meniscus are usually caused by strenuous exercise or sports injuries. This causes the following symptoms:
- joint pain, swelling;
- fluid accumulation inside the joint;
- feeling of friction or clicking in the knee;
- blockade of the joint, accompanied by the movement of the meniscus inwards, as well as the impossibility of extension of the limb.
If such an injury is suspected, a detailed examination of the knee by an orthopedic doctor is necessary. If the presence of fluid interfering with the diagnosis is detected in the cavity of the knee joint, the specialist makes a puncture of the joint and anesthetizes the area of injury. In addition, in order to conduct a more accurate diagnosis, it is required to remove the swelling of the damaged area.
Multiple views are also required. This helps to exclude the presence of bone fractures, subluxation of the patella, damage to the articular surface. If necessary, an MRI is prescribed to obtain an image of the meniscus zone and the level of its damage, as well as the conditiontendons, ligaments and cartilage.
Arthroscopy is considered necessary - a technique for examining the knee joint from the inside by inserting a special instrument with lighting and a camera into it.
The area of injury, the age of the patient, the period of time since the injury and other factors are taken into account to select the method of meniscus tear therapy.
When a meniscus is torn, as well as when ligaments are torn, two methods of treatment are used - surgical and conservative. The conservative method involves unloading the joint. Namely, the imposition of fixing bandages, cooling, elevated position of the leg and physiotherapy. The operation for a torn knee ligament involves various manipulations in which doctors try to achieve maximum matching of the torn parts of the meniscus.
First aid
It is important for the victim to provide the necessary assistance. In this case, the following algorithm of actions should be observed:
- After a rupture of the ligaments of the knee joint, immobilization of the injured limb is important. Initially, it is necessary to immobilize the injured area - fix it with a special splint, an elastic tight bandage or a splint from improvised means, an orthosis (knee brace), and a plaster splint.
- Cooling the damaged area. To do this, apply ice or cold water compresses, which help reduce pain and swelling.
- Taking pain medication. To relieve pain, the patient must takeanalgesic and anti-inflammatory drug: "Tempalgin", "Ketorol", "Analgin", "Ketanov", "Nimesil", "Diclofenac" and others.
- Transporting a patient to a medical facility.
Diagnostic measures
First of all, after the patient is admitted to the hospital, he is examined by a doctor. During the examination, various tests are performed that help determine the nature of the injury, the stage of damage, and so on. After examining the victim for confirmation, the traumatologist may prescribe the following diagnostic procedures:
- CT, MRI;
- radiography;
- Ultrasound.
These techniques allow you to accurately determine the degree of traumatization of the ligaments and establish possible combined damage to the knee joint (dislocation, fracture, etc.). Based on the information received, the specialist draws up a plan for further therapy.
What else does the treatment of knee ligament ruptures involve?
Further therapy
Throughout the entire period of treatment, fixation of the injured knee is necessary, which can last from 3-4 weeks to six months. At the beginning of therapy, the knee joint is fixed more rigidly than at the end (for example, first it is fixed with a plaster splint, and later with an elastic bandage).
In addition, various anti-inflammatory drugs are used throughout the entire treatment period: Revmoxicam, Movalis, Diclofenac and various ointments based on their components.
Very successful treatment of partial cruciate ligament tears of the knee jointthrough physiotherapy. These methods include UHF, magnetotherapy, electrophoresis and other methods. It is important to remember that physiotherapy procedures are only allowed to be carried out a week (minimum) after the injury.
If there is even the slightest suspicion of a rupture of the anterior ligament of the knee joint or any other, loads on the injured limb are categorically contraindicated. Otherwise, the resulting damage will be further aggravated. What can provoke the transformation of a partial rupture of the ligament into a complete one. Therefore, when receiving such injuries, it is recommended to strictly observe rest and follow medical recommendations.
We looked at the symptoms and treatment of a knee ligament tear. We hope the topic has become clearer to you.
