Surgical treatment of anterior knee instability

Joint stability is a necessary condition for its normal functioning. It is capable of making movements of a certain amplitude in certain directions, while all loads are distributed correctly. Stability is ensured by the joint capsule, the ligamentous apparatus of the joint, and the normal state of the articular cavity. Instability of the knee joint leads to redistribution of loads. As a result, not only the joint itself suffers, but also neighboring structures.

The main cause of knee instability is damage to the cruciate ligaments. They are located in the joint cavity and connect the articular surfaces of the tibia and femur. Often, damage to the cruciate ligaments occurs during an injury and is combined with damage to the menisci and hemarthrosis (accumulation of blood in the joint cavity).

At CELT you can get a consultation with a traumatologist-orthopedic specialist.

• Initial consultation – 3,000
• Repeated consultation – 2,000

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Causes

Often the pathology appears after serious injuries due to a traffic accident or professional participation in the following sports: football, hockey, running, cross-country skiing. The following actions lead to the appearance of the disease:

• Sharp extension and flexion.
• Impacts to the knee joint.
• Dislocations.

People with a genetic predisposition (poor development of the ligamentous apparatus) are most susceptible.

Symptoms of the disease

Immediately after a fall or blow to the joint capsule, severe pain, swelling and stiffness appear, which leads to decreased mobility. After fixing the joint in a trauma center, it is possible to reduce discomfort. This procedure is recommended for preliminary preparation for diagnosis (at an early stage it is impossible due to acute pain).

Typically, a patient comes to the doctor complaining of pain while walking, a feeling as if the knee is “sagging.” With a long course of the disease, the thigh muscles become weaker and decrease in volume.

The doctor examines the patient and conducts special tests. Typically, joint instability is diagnosed during a medical examination without additional testing.

Types and degrees of pathology

The development of the disease often occurs in athletes due to working with heavy weights and due to high loads on the quadriceps femoris muscle. There are 3 degrees of joint instability:

• Mild – there is local deformation of the articular capsule and displacement of the femur and tibia by no more than 5 millimeters. The weakening of the ligaments is minor.
• Moderate – there is a serious deformation of the cruciate ligament and a displacement of a maximum of 10 millimeters.
• Severe – diagnosis reveals a rupture of the posterior or anterior cruciate ligament with severe displacement (more than 10 millimeters).

Note! Displacement is measured not only in millimeters, but also in degrees. For a mild degree it is up to 5o, and for a severe degree it is more than 8o.

The following types of instability are distinguished depending on which ligament is damaged:

• Lateral.
• Medial.
• Combined.
• Rear.
• Front.

Additional subspecies are used:

• Atypical.
• Simple.
• Difficult.
• Total.
• Compensated.
• Subcompensated.
• Decompression.

Knee ligament instability

Home › Services › Knee ligament instability

The ligaments of the knee joint perform a vital function in the human musculoskeletal system. The knee ligaments connect the shin bone to the thigh bone and perform a stabilizing function of the knee joint during various movements (walking, turning, squats, etc.).

The stability of the knee is provided by a large number of ligaments that perform different functions. The most functionally significant ligaments are:

• anterior cruciate ligament (ACL);
• posterior cruciate ligament (PCL);
• fibular collateral ligament (MCL) – external collateral ligament;
• tibial collateral ligament (TCL) – internal collateral ligament;
• patellar ligament.

Knee instability is caused by damaged or torn knee ligaments.

Knee instability is also characterized by impaired muscle trophism, which initially manifests itself as hypotension, and then muscle atrophy. Taking into account the degree of muscle atrophy, the stages of the process are determined. Athletes with joint instability experience the most rapid development of muscle atrophy.

Degrees of knee ligament damage

Ligaments are made up of fibers, and the extent of their damage determines the degree of ligament rupture. In medical practice, gaps of several degrees are distinguished:

• 1st degree – the structure of some of the fibers is damaged, but the overall integrity of the ligament is not compromised;
• 2nd degree - more than half of the fibers are injured, ligament tears occur, and stiffness in movements in the knee joint appears;
• 3rd degree - the ligaments are completely torn, pathological mobility occurs in the knee, due to such changes the structure of the joint is disrupted and its instability occurs. With this degree, damage to other structures of the knee joint - capsule, meniscus, cartilage - is often observed.

In traumatology, cases of simultaneous damage to the cruciate and collateral ligaments are often encountered. With such ligament ruptures, hemorrhage into the knee joint with the formation of hemarthrosis is possible, so the recovery period of the joint functions increases significantly.

Causes of knee ligament rupture

Damage to the knee ligaments occurs most often among young people involved in active sports. Knee ligament ruptures occur due to excessive loads on the joint and active movements in it (for example, twisting the limb along the axis, hyperextension, etc.). Ligament damage can also occur as a result of a direct blow to the knee area or strong pressure on the lower leg.

Certain types of movements can cause a particular ligament to tear. For example, if the shin is in a bent position and directed to the inside, and at this moment the back surface of the knee is subjected to excessive stress, then a rupture of the anterior cruciate ligament occurs. A tear of the lateral collateral ligament is characterized by an inward tilting of the shin and sudden awkward movements of the leg, twisting or stumbling.

Symptoms of knee ligament damage

Signs indicating knee ligament damage are:

• the appearance of sharp pain in the knee (severe pain, as well as hemarthrosis and synovitis are often observed in the acute period of ligament rupture);
• the occurrence of swelling in the knee area (increase in the size of the knee joint);
• limited or, on the contrary, too loose movements in the joint;
• instability of the knee joint, characterized by a feeling of displacement of the bone structures and “weaving” of the legs due to awkward movement or acceleration);
• a feeling of dislocation of the lower leg anteriorly or to the side when injured;
• faint crackling sound when the ligament is damaged;
• moving weight on the injured leg is extremely difficult or impossible when walking, getting out of bed, chair, etc.;
• pathological mobility of the patella, etc.

Diagnosis of knee ligaments

If a knee ligament rupture is suspected, diagnosis begins with an examination of the patient by a traumatologist who palpates the knee joints. Specific stability tests of the knee joint are also used to identify ligamentous disorders. For example, the McIntosh and Houston tests can confirm the diagnosis of a torn anterior cruciate ligament. The "posterior drawer" test is a symptom of a ruptured posterior cruciate ligament, etc.

Traumatologists complement the examination of the patient with instrumental diagnostic methods to make a diagnosis and choose treatment tactics. Very often, specialists resort to the following diagnostic methods:

• Magnetic resonance imaging;
• X-ray of the knee;
• Ultrasound of the knee joint;
• diagnostic arthroscopy.

With the help of instrumental studies, it is possible to detect changes in the structures of the knee, confirm or refute the presence of bone fractures and soft tissue damage in cases of knee injury.

Specialists at the New Medicine Clinic select the most optimal treatment for each case, taking into account the results of diagnostic methods and functional tests, the degree of joint instability and the presence of damage.

Treatment of knee ligament instability

When treating ruptures of the ligamentous structures of the knee, conservative and surgical treatment methods are used depending on the severity of the damage. If the patient is diagnosed with grade 1 or 2 damage, then treatment is possible using conservative methods. In cases of grade ligament rupture, surgical treatment is used. For grade 1-2 ruptures, conservative treatment is possible, which consists of immobilizing the joint with a plaster or orthosis, followed by exercise therapy, massage, and physiotherapy. In addition, if hemarthrosis is present, joint puncture is possible.

Conservative treatment of knee ligament instability includes the following methods:

• immobilization of the joint (plaster or orthosis);
• therapeutic exercises (restores muscle strength, has a strengthening effect on the body);
• massage (relieves pain and swelling in the legs);
• physiotherapy (electrophoresis, UHF therapy, paraffin therapy);
• cryotherapy (exposure to cold on blood vessels contributes to their narrowing, which is why;
• drug treatment (use of non-steroidal anti-inflammatory drugs to relieve swelling and inflammation);
• rest (if you receive an injury to the injured leg, it is necessary to reduce physical activity, if possible limit any movements in order to prevent subsequent injuries, reduce pain, relieve swelling and speed up the healing process).

Surgical treatment is indicated in situations where one or more ligaments of the knee joint are completely torn and in cases where conservative treatment has failed. The New Medicine Clinic performs minimally invasive operations using arthroscopy. Arthroscopy restores the integrity of the ligamentous apparatus through 2 micro-incisions using special instruments. All actions inside the knee joint are displayed on the monitor, allowing the doctor to exercise full control over the progress of the operation.

After surgical treatment, the patient must undergo a recovery course, which includes exercise therapy and massage, interstitial electrical stimulation to prevent muscle wasting. The joint begins to function fully after 6-8 months.

You should know that knee ligament instability is a serious pathology that needs to be treated as early as possible. If you receive a knee injury or rupture of the ligaments, an early visit to the doctor will help you avoid complications, choose the most optimal treatment tactics and speed up the process of restoring the functions of the knee joint.

Diagnostics

In order to clarify the diagnosis of instability of the knee joint and exclude other diseases, the following set of studies is carried out:

• X-ray of the knee joint.
• Magnetic resonance imaging.
• Arthroscopy - endoscopic examination of the joint cavity - is the most informative diagnostic method. The doctor can examine almost the entire joint cavity and detect pathological changes in the cruciate ligaments and other structures, and also perform therapeutic manipulations during arthroscopy if indicated.

3. Symptoms and diagnosis

In typical cases, the clinical picture includes, in addition to instability itself (see above), the following manifestations:

In addition to collecting anamnesis, direct clinical examination and palpation, today there are a number of informative and fairly reliable methods for diagnosing articular pathology. Thus, radiography, MRI or CT, ultrasound, arthroscopic examinations, and laboratory tests are used to assess the degree and nature of inflammation. In some cases, for the purpose of differential diagnosis, a puncture biopsy and histological analysis of a selected tissue sample are performed.

About our clinic Chistye Prudy metro station Medintercom page!

Our doctors

Samilenko Igor Grigorievich

Traumatologist - orthopedist, doctor of the highest category

24 years of experience

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Zubikov Vladimir Sergeevich

Traumatologist-orthopedist, Doctor of Medical Sciences, doctor of the highest category, professor

44 years of experience

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Marina Vitaly Semenovich

Traumatologist-orthopedist, head of the minimally invasive traumatology and orthopedics service

Experience 36 years

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Poltavsky Dmitry Ilyich

Traumatologist-orthopedist

Experience 28 years

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Treatment

Treatment of cruciate ligament injuries without surgery can be performed immediately after the injury. Typically, a traumatologist punctures the affected knee joint with a needle, removes blood from it, and applies a fixing bandage to the leg.

In the future, the patient is prescribed physiotherapy, massage, physical therapy (as indicated). If signs of instability persist or appear some time after treatment, surgery is usually required. If the ligaments are completely torn, the traumatologist usually immediately prescribes surgery.

Experienced specialists at the multidisciplinary CELT clinic perform cruciate ligament replacements of any complexity.

Our expert:

Chronic lateral (external) instability of the patella is the cause of limitation of motor activity in a fairly large number of patients. As a rule, chronic instability of the patella, or habitual luxation of the patella, as it is also called, worries patients and, most often, young and middle-aged patients, significantly worsening the quality of life. Chronic lateral instability of the patella of the knee joint After all, for active sports, a full and painless range of motion of the knee joint is critical, which cannot be achieved if the patella, which forms a key link in the knee joint extension apparatus, is unstable.

The cause of chronic patellar instability is, as a rule, inadequate diagnosis of primary lateral (external) patellar dislocation and, as a consequence, incorrectly chosen treatment tactics. The importance of diagnosing primary or acute external patellar dislocation cannot be overestimated. The doctor must analyze not only the mechanism and circumstances of the injury, but also pay attention to the normal anatomy of the patient, because in some cases conservative treatment is absolutely futile and surgical intervention is required.

Prevention

To prevent knee instability, you need to follow 5 rules:

• Choose the right shoes, strictly in size, made from natural materials and with soft soles. Experts often prescribe orthopedic shoes, which are used for flat feet. It is important to firmly fix the foot in a comfortable position.
• It is recommended to use a special bandage during running, football, and hockey. When practicing powerlifting, you need to reduce the load and always use elastic bandages. Training should moderately strain the quadriceps femoris muscle and not cause pain.
• You need to reconsider your diet and add more foods high in magnesium, calcium, zinc, and fluoride. It is advisable to additionally consume a vitamin-mineral complex.

• If weakening of the ligaments and displacement of the joint is detected, you should abandon professional sports and avoid excessive stress.
• The presence of weakness, clicking and pain in the knees is a reason to contact a specialist and undergo an MRI or. Never delay consultation and diagnosis, as the disease can be successfully treated at the initial stage.

In our clinic, this type of surgical intervention is performed endoscopically, without a large incision and without opening the joint. This is the same arthroscopy, during which the surgeon reconstructs the damaged ligament. Modern equipment and endoscopic instruments help to carry out the intervention quickly and effectively, without complications.

Treatment of lateral instability

Treatment of chronic patellar instability in one way or another is essentially surgical. The absolute majority of cases of habitual patellar dislocation require arthroscopic revision (comprehensive examination) of the knee joint and removal of cartilaginous (chondral) loose and fixed bodies. They are formed from numerous traumatic impacts of the patella and femoral trochlea, and the cartilaginous cover of the inner or central part of the patella most often suffers.

To ensure proper functioning of the knee joint in a state of chronic instability, it is necessary to restore the mechanical ability of the patella to resist external displacement: restore the medial (internal) femoral-patellar ligament.

Rehabilitation

When restoring the medial (internal) femoral-patellar ligament, an experienced surgeon stabilizes the kneecap with an autograft (one of the patient's tendons), preventing repeated dislocations. This elegant operation is currently the “gold standard” in the treatment of chronic lateral instability of the patella, allowing the patient to quickly return to their previous exercise regime. After this type of surgery, as a rule, long-term immobilization of the knee joint is not required; on the contrary, in the early stages after surgery it is necessary to begin active rehabilitation in order to restore range of motion and muscle strength as quickly as possible. Full load on the lower limb is allowed after this surgical intervention. This type of surgery has replaced the Yamamoto medial retinaculum suture and lateral patellar release, offering superior aesthetics and less likelihood of postoperative patellar instability.

Since this surgery uses autograft (own tissue), the likelihood of graft rejection tends to zero, but this surgery imposes additional responsibility on the surgeon due to the limited amount of plastic material to restore the femoral-patellar ligament. Therefore, the choice of surgeon should be approached very carefully.

Chronic instability of the patella significantly reduces the motor activity of patients, increasing the rate of destruction of the articular cartilage of the patella. Habitual lateral dislocation of the patella is perfectly compensated after an elegant surgical operation, which, when performed by a competent and experienced surgeon, makes it possible to quickly return to an active life and practice familiar and favorite sports, no matter how extreme they may be.

Orthopedics and traumatology services at CELT

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