Diagnosis of sprains
Ligament rupture is characterized by a sharp limitation of joint function and pain on palpation. Upon examination, the doctor detects hemorrhage at the site of injury, swelling and smoothness of the silhouette of the damaged joint. Unlike a fracture, when a ligament is sprained or torn, there is no deformation of the limb. A fracture or serious damage to the ligaments may be suspected if pain and difficulty moving the joint does not go away within 2 to 3 days. The doctor may take an X-ray to rule out a fracture.
If a sprain occurs in a large joint, then damage to the internal ligamentous apparatus may occur, which is expressed in sharp pain, inability to straighten the joint, clicking or crunching in the joint.
Damage to ligaments in the knee joint
The cause of rupture of the knee ligaments can be mechanical damage, for example, a blow to the shin or thigh. However, in most cases, the cause of ruptures of the knee joint ligaments is an incorrect landing when jumping, a sharp rotation of the lower leg, or braking associated with involuntary torsion of the limb. In such cases, the ligaments of the knee joint experience loads that are beyond their capacity, which leads to their damage.
Sometimes anterior and posterior cruciate ligament rupture can be observed simultaneously. In this case, surgery is the best choice. But the procedure for restoring ligaments often drags on for many months.
Degrees of sprain
Typically, the more severe the pain, the more serious the injury. Sprains range from minor to severe.
- Minor - A minor sprain causes the ligament fibers to stretch too far or tear slightly. You may feel tenderness and pain when you touch or move the affected limb. The swelling is minor. Repeated minor sprains can weaken the joint. In most cases, with a minor sprain, the limb can withstand the load and fully recovers within 2 weeks.
- Moderate - When the fibers tear, it means you have a moderate injury. Sensitivity and pain are average. Swelling and bruising may appear on the injured limb.
- Severe - If one or more ligaments are completely torn, the injury is severe. The affected limb is very painful, swollen and bruised. You cannot move or put pressure on the injured joint. When you try to move the joint, you feel it become unstable.
Synonyms
The following synonyms are used to refer to patellar tendinopathy:
- Patellar apex syndrome
- Runner's knee
- Jumper's knee
Anatomy of the knee joint
Knee-joint
is a movable connection of three bones: the femur (lat. femur), the tibia (lat. tibia) and the patella (lat. patella).
The powerful quadriceps tendon is attached to the patella from above, and from below it continues in the form of its own patellar ligament, which is attached to the tibia. The main function of the tendon is to transmit force from the extensor muscles to the lower leg, so it is subject to constant stress during sports.
Risk factors and causes
Anatomical factors
- The quality of tendon connective tissue gradually deteriorates with age
- Violation of the axis of the knee joint
- Foot deformities
- Shortening of tendons and muscles
- Structural anomalies, for example, varus/valgus of the knee joints
- Congenital weakness of the ligamentous apparatus
- Osgood-Schlatter disease
External factors
- Inappropriate shoes
- Violation of exercise technique when playing sports
- Walking on hard surfaces such as asphalt
- Excessive training duration
- Unusual stress, for example, starting to play sports too intensely
Sport
- Sports involving frequent jumping - volleyball, basketball, some athletics disciplines, such as long jump and high jump; hence the name "jumper's knee"
- Running – hence the name “runner's knee”1
- Sports involving frequent changes in direction of movement - football, handball
- Sports involving abrupt stops and starts – tennis, squash, badminton
Stages of apical patella syndrome
In a medical diagnosis, the stages of the disease are not usually indicated, but they help to better understand the clinical picture.2
Initially, pain is felt only after playing sports. Subsequently, “starting” pain appears during sports or when performing normal movements, for example, climbing stairs or standing up after a long period of sitting. A long, wave-like presence of symptoms over many months or even years is typical. Periods of mild pain are followed by intense pain after exercise. Two knee joints are affected at once in 20-30% of patients. The examination uses ultrasound examination of blood vessels, magnetic resonance imaging (MRI) and radiography of the knee joint.
Treatment
Inflammation is usually treated conservatively, without resorting to surgery. Surgery is only necessary if the ligament is torn.
Physiotherapy
With exercises you can train muscles and increase joint mobility. Exercise can speed up the healing process if done regularly. Usually a set of exercises is recommended by the attending physician. Depending on the diagnostic findings, ultrasound therapy, electrotherapy, transverse massage, manual therapy, etc. may be prescribed.
Stretching
Regular muscle stretching exercises reduce tension in the tendon.
Bandages
Specially designed bandages stabilize the knee joint. Bandages with straps, such as Genumedi PSS, are particularly effective because the straps secure the tendon and thereby reduce tension on the tendon fibers.
Cooling
Cold compresses and coolant packs reduce pain (their temperature should be around 7°).
Warm
Warming and massaging with a warm towel improves blood circulation in the area where the tendon attaches.
Drug therapy
If necessary, the doctor will prescribe anti-inflammatory drugs, such as ibuprofen or diclofenac, for 1-2 weeks.
Local treatment
Anti-inflammatory ointments and gels can be used topically several times a day. This speeds up recovery.
Insoles
Orthopedic insoles, such as igli Allround, optimize the biomechanics of the knee joint.
Massage
Massage reduces pain. An experienced massage therapist can relax muscles and improve blood circulation in the area of inflammation in several sessions.
Treatment is selected individually in accordance with the clinical picture and the individual needs of the patient.
Treatment of sprains and ligaments
For mild injuries, to restore the ligaments, it is enough to apply ice immediately after the injury, immobilize the joint and give the patient an anesthetic. The next day, you no longer need to apply ice; on the contrary, it is recommended to take a warm local bath and apply heparin ointment to the damaged joint. The ointment is gently rubbed into the skin 2-3 times a day. If after 2-3 days the pain persists and the swelling has not subsided, then you need to contact a surgeon to receive qualified help.
Treatment for ligament damage always depends on the severity of the injury. If there is a severe sprain, partial or complete tear of the ligament, resulting in severe swelling, the doctor may apply a plaster cast. If there is a large gap between the torn ends of the ligament and they do not touch each other, then the ligament will need to be surgically repaired. The operation will prevent the formation of a loose elongated ligament and chronic instability of the joint, as well as the development of degenerative arthritis.
To speed up the rehabilitation process, the patient is prescribed physiotherapeutic treatment, massage and therapeutic exercises. But restorative procedures are possible only after the acute stage of the disease is completed, that is, approximately 10-15 days after the injury.
Symptoms of Ligament Damage
As a rule, a ruptured knee ligament has established symptoms, including:
- joint pain that worsens with exercise;
- swelling of the knee joint;
- an increase in the size of the knee joint due to blood accumulated in it;
- instability of the knee joint.
Some patients note that the rupture is usually accompanied by a characteristic cracking sound.
Sometimes the injury occurs unnoticed by the patient, and the only symptom is joint instability. If such a sign appears, it is recommended to consult a specialist for a preventive examination.
When a knee ligament rupture , no anatomical changes are observed. For this reason, if you have the symptoms mentioned above, you should consult a doctor who will make a final diagnosis. An X-ray or MRI can show the extent of the ligament damage. It is important to remember that knee ligament injuries can become chronic, which subsequently makes treatment and the recovery period for the ligaments much more difficult.
What to do if a cruciate ligament rupture is suspected?
The first aid for a ligament injury is to immobilize the knee joint. If possible, the ligaments should be numbed. Then you need to apply a splint, which will allow you to transport the patient with minimal concern.
Ligament injuries are a painful injury, and therefore it is important to see a doctor as quickly as possible who will provide qualified assistance.
Cruciate ligament surgery
Almost 50% of knee require arthroscopic manipulation. Only the doctor decides how serious ligament tears . The operation is performed by experienced specialists in specialized clinics.
Treatment of ligament injuries is carried out using the latest technologies. Biodegradable implants are used that can fix the ligaments of the knee joint. This type of implant is made of polyvine and polylactic acids, hydroxyapatite. Damage to the ligaments heals itself, and subsequently the materials independently resolve and are eliminated naturally.
The cruciate ligament can also be restored surgically, using autografts and endoprostheses. With the help of these elements, the restoration procedure is significantly reduced. Over time, the ligament can fully restore its functions.
If the doctor confirms the fact of ligament rupture , then the operation makes it possible to reconstruct the entire damaged area through small incisions. Typically, surgical procedures are performed some time after the diagnosis is confirmed.
Modern medicine makes it possible to effectively treat ligament ruptures even with chronic damage. In this case, an operation is performed on the cruciate ligament according to a scenario similar to that which occurs during an acute injury. But it is worth noting that a chronic type of rupture requires a longer period of recovery.
Surgeries on the cruciate ligament are not performed if knee arthrosis develops when it is damaged. In this case, treatment is postponed until the problems accompanying the injury are resolved.
Treatment of minor ligament tears
In case of minor injuries, conservative treatment methods are used to restore the ligaments. They may include exercise therapy, where the load is gradually increased, as well as massage and physiotherapy.
In some cases, the knee joint ligament can simply be fixed in a certain position using a cast. First, the doctor removes blood from the joint. The duration of wearing a cast can take up to one month. After this, the ligament is restored according to the method described above.
Ligament damage can be repaired using a conservative method in a shorter period of time. At the same time, conservative treatment of knee ligaments is suitable for a larger number of patients, and also has no restrictions on the type of activity and age.
Who is to blame for the lack of progress?
The incomplete functional restoration of the lower limb is groundlessly blamed on the surgeon who performed the operation incorrectly. Patients complain that their knee does not straighten like a healthy leg. Incomplete extension of the knee joint is a fairly common complaint among people.
Contracture of the knee joint - the leg cannot fully straighten.
There are also cases when, even with a well-planned and implemented system of restorative therapy, the recovery process is delayed or complicated by negative pathogenesis. As you understand, here we are most often talking about the individual factor.
Do not neglect the services of rehabilitation specialists when rehabilitating the operated limb. And do not violate the rehabilitation terms: as long as you were told to adhere to a special regime of physical activity, you are obliged to comply with it. Your future quality of life will depend on all this.
Surgical wounds after knee arthroscopy.
Rehabilitation after knee surgery
A minimally invasive procedure during which the surgeon inserts a special instrument into the knee area through a small incision. The operation is prescribed to remove or restore areas of cartilage tissue, restore torn cruciate ligaments, and clean up damaged parts of articular cartilage.
Within a few hours after the procedure, the patient can go home. In some cases, the stay in the outpatient clinic extends up to 15–30 hours. During this time, the patient undergoes the following procedures:
- introduction of antibacterial drugs;
- taking anticoagulants;
- immobilization of the operated knee joint;
- hardware or manual lymphatic drainage;
- isometric set of exercises for the thigh muscles and ankle movements.
You may need to take painkillers for the first two to three days. During this period, doctors recommend keeping the knee elevated more often.
In order to reduce swelling, relieve inflammation, and relieve pain during rehabilitation after surgery, patients are prescribed non-steroidal anti-inflammatory compounds. To restore the structure of cartilage and bone tissue, medications called chondroprotectors are prescribed for long-term use.
The daily menu during the recovery period of the knee joint should be rich in foods rich in protein, sulfur, selenium, and omega-3 polyunsaturated fatty acids. A high consumption of lean meat, fish, seafood, fruits, dried fruits, vegetables, and eggs is recommended. It is important to monitor the calories you consume so that you do not gain excess weight in conditions of reduced physical activity. It is very useful to include jellied meat, jelly and other products containing collagen in your diet.
Therapeutic exercises in the first weeks after knee surgery include only exercises in a lying position:
- pendulum;
- lifting the leg with the toe pulled up;
- gluteal bridge (lifting the pelvis with the feet pressed to the floor).
Then, with your doctor’s permission, you can begin a course of training on an exercise bike.
After the patient's condition returns to normal, exercises can be started from a sitting or standing position. Their main task is to develop the joint, while simultaneously strengthening the muscles of the legs and buttocks.
The rehabilitation program may include physical therapy: magnetic, laser, electrical stimulation, electrophoresis, acupuncture. These procedures help normalize metabolic processes and restore blood flow in the operated limb.
After the pain disappears, it is useful to visit the bathhouse. To strengthen the muscular-ligamentous apparatus and improve blood flow, manual massage can be prescribed.