Knee ligament rupture: types, symptoms, diagnosis, treatment

The knee joint is the most complex and largest joint in the human body. He is subjected to enormous loads. Knee ligament rupture is diagnosed in approximately 40% of patients who see a doctor with knee pain. This injury is in second place in frequency after meniscus injuries. Most often, athletes involved in volleyball, basketball, football, and martial arts come to traumatologists with similar problems. Ligaments can be torn not only during sports, but also in an accident, a simple fall or other everyday situations.

Symptoms of a torn knee ligament

A ruptured knee ligament is always a sharp pain, sometimes accompanied by a characteristic crunch.

Also signs of injury will be:

swelling and redness of the skin;
feeling of unsteadiness while walking;
instability of the joint with a complete rupture, since the ligaments no longer limit its mobility. There are three forms of instability:

In the compensated form, dysfunction of the joints does not manifest itself visually. The problem can only be detected through instrumental research.
The subcompensated form is accompanied by pain, crunching, and atrophy of the thigh muscles. Instability is detected only during exercise: squats, running, and the like. An x-ray will show signs of first-degree gonarthrosis.
The decompensated form is expressed in pathological joint mobility, constant pain, lameness, and instability when moving. X-ray will determine gonarthrosis of the second or third degree.

General information

One of the most common types of injuries is sprained ligaments , most often of the ankle or knee joint.
The main cause of sprains is sudden movements in the joints that exceed their normal amplitude. It is important to distinguish between sprains of ligaments and tendons, because the latter are connections between muscles and bones, while ligaments are the elastic connecting link of bone formations. Moreover, they are capable of regeneration, therefore, when restored, they are given time to grow on their own, even if they are completely torn.

The structure of the ligamentous-capsular apparatus

Most often, simple sprains, tears of the lateral (medal), cruciate ligaments, and damage to the meniscus , and complex injuries are also possible, combining damage to the internal ligaments and the meniscus, including the cruciate ligaments. For example, a sprained tibia is a severe injury to all or almost all the ligaments of the knee joint.

Diagnosis and treatment of knee ligament ruptures

At the appointment, an orthopedic traumatologist examines the damaged joint and conducts functional tests. With a closed fracture and sprain, the symptoms may be similar, so in some cases the doctor will order an MRI, ultrasound and x-ray.

After assessing the damage, the specialist draws up a treatment plan. It depends on the severity of the injury and which ligaments are damaged. The knee joint has four ligaments: lateral (external and internal) and cruciate (anterior and posterior). The anterior cruciate ligament is the most commonly affected

First aid for knee ligament injuries

rest of the injured joint,
cold to relieve pain and swelling,
a tight bandage to reduce swelling and minimize movement of the injured limb,
a pillow under the knee to improve the outflow of venous blood,
taking painkillers.

Treatment of collateral ligament ruptures

If only one of the collateral ligaments is damaged, conservative therapy will be sufficient in most cases.
The patient undergoes a puncture to relieve pain and eliminate the accumulation of blood inside the joint (hemarthrosis).
Local anesthetics are injected into the knee.
A plaster splint is placed on the joint and must be worn for at least a week.
As soon as the swelling subsides, the plaster is changed to a circular bandage from the groin to the toes.
The leg is secured in the position of excessive deviation of the tibia to the injured ligament.
The patient spends up to 2 months wearing a circular bandage.
Once the acute inflammation has been eliminated, it is time for physiotherapy, which helps improve blood circulation in the injured knee. Exercise therapy is also used to strengthen the thigh muscles, stimulate blood flow, and improve tissue trophism.

Treatment of cruciate ligament ruptures

In the vast majority of cases, surgery is required. The operation is not performed if there is a partial rupture of the ligament, or if there are contraindications to the procedure.

In the first time after the injury, significant swelling and severe pain are observed, which makes diagnosis difficult: it is not clear whether the ligaments are completely or partially torn.
A puncture is performed to relieve pain and eliminate hemarthrosis. The cavity is washed, the blood is removed, and the pain is numbed with an anesthetic solution.
An instrumental examination is performed to rule out a fracture.
Your doctor may recommend arthrotherapy. The essence of the method is the injection of hyaluronic acid and platelet-rich plasma into the knee joint. Hyaluronic acid inhibits degenerative changes in cartilage tissue, alleviates pain, allows you to delay the onset of arthrosis and reduce the severity of its manifestations. Plasma stimulates faster healing and tissue repair.
In severe cases, with complete rupture of the ligaments, operations are performed - arthroscopy with reconstruction or replacement of the ligaments. This is a minimally invasive surgical technique. Among its advantages is a short rehabilitation period, which allows you to return to your previous lifestyle within eight months after the intervention.

In many cases, knee ligament rupture is a serious injury, the consequences of which cannot be underestimated. Therefore, it is so important to listen to the doctor’s recommendations and carefully follow all points of treatment during the recovery period.

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Periarthrosis or old damage to the meniscus of the knee joint

Ph.D., V.G. Fedorov, E.G. Salankina

GUZ 1 Republican Clinical Hospital of the Ministry of Health of the Udmurt Republic, Izhevsk

Differential diagnosis of these diseases is necessary, since damage to the meniscus ends with resection of the meniscus, and periarthrosis is treated successfully with conservative methods. Resection of the meniscus for periarthrosis leads in the postoperative period to local tissue angiotrophoneurosis (involving cartilage and bone tissue). Angiotrophoneurosis contributes to the development of joint contracture, which is difficult to treat conservatively, with the rapid (2-3 years) development of deforming arthrosis of the knee joint, which often has a progressive course (the vicious circle in this case must be interrupted by treating not only the knee joint, but also osteochondrosis and angiotrophoneurosis).

There is no history of obvious trauma with periarthrosis; pain or discomfort appears in the area of the knee joint, accompanied by soreness (tendonitis) of the distal ends of the muscles around the knee joint with clicks, initially reminiscent of clicks of a blocked meniscus (important for differential diagnosis). Then some patients localize pain in the area of the internal joint space, similar to damage to the internal meniscus. With detailed localization of pain points, the maximum pain is revealed not along the meniscus, but in the area of the femoral condyle, along the muscle tendons (usually the semitendinosus, semispinalis, and, accordingly, in the area of the “crow’s foot”). In the absence of effective therapy, lameness appears when walking, which intensifies when walking down stairs (reminiscent of the “staircase” symptom when a meniscus is damaged - it is necessary to clearly differentiate - because often the patient ends with an operation to resection the meniscus, and for the surgeon - dissatisfaction with the result) , when trying to move quickly, run, or make quick turns. All this is associated with a violation of reciprocal innervation - slow movements are easier to correct during flexion and extension (the patient makes movements not at the level of discoordinated muscle-motor reflexes, but with the direct participation of the cerebral cortex). Both with damage to the meniscus and with periarthrosis of the knee joint, pain is characteristic at night, when the patient has to “look for a place for the sore knee” for a long time.

In the clinical picture of periarthrosis, there is a discrepancy between subjective severe pain and relatively low pain in the tissues that form the joint, with the exception of triggers, upon palpation of which severe pain occurs, reminding the patient that it is she who is bothering him. Almost always, with periarthrosis, muscle syndromes of the diseased limb are detected, both separately and in combination: piriformis syndrome, tibial flexor syndrome, tibialis-iliac tract syndrome, gluteus minimus and medius syndrome, convulsive syndrome of the gastrocnemius muscles. In periarthrosis of the knee joint, the following neurological changes were identified:

1) – radiculopathy of the root (L5-S1) (sciatic nerve which includes autonomic fibers involved in trophic processes, with symptoms of a decrease in the Achilles reflex on the side of the affected joint, inconsistent loss of sensitivity on the side of the innervation of the L5-S1 root (this depends on the degree irritation of the L5-S1 root);

2) – in the absence of pronounced clinical changes, a loss of sensitivity appears in the form of a stripe in the area of the knee joint affected by periarthrosis (reminiscent of Turner’s symptom when the meniscus is damaged).

With a long-term irritative process (vegetative-irritative syndrome of the lumbosacral level), the soft tissues of the knee joint are subject to trophic disorders. The skin becomes thinner, interstitial edema appears in painful soft tissues with the further formation of fibrous changes in them and fatty degeneration (in a histological study, “in the preparation there is coarse fibrous fibrous and adipose tissue with mild chronic inflammatory infiltration”), joint contracture appears, which is even stronger resembles a partial block of the knee joint when the meniscus is damaged. It should be noted that the contracture is not pronounced - extension to an angle of 165-1700, flexion to 600.

Of the 92 patients we consulted with a diagnosis of meniscal damage, 77% were diagnosed with periarthrosis of the knee joint and received effective conservative treatment.

Thus, periarthrosis of the knee joint or periarthrosis syndrome of the knee joint is a local or general degenerative-dystrophic change in the soft tissues involved in the movement and fixation of the knee joint (fascia, muscles, tendons, ligaments, menisci) with the formation of pain triggers in them (single or multiple) as a result of a violation of the reciprocal innervation of muscles in the phase of residual manifestations of lumbosacral osteochondrosis of the spine, leading in the absence of proper therapy to deforming arthrosis.

Pathogenesis

Usually the lateral ligaments of the knee are susceptible to injury - the rupture occurs in the area of the joint space or at the place of their attachment, causing pain on the part of the damaged ligament. This is caused by a violation of their physiological elasticity, when the tension in the ligament is too strong, this leads to tearing, rupture or separation of the ligament from its place of attachment. Pathologically and anatomically, the sprain is close to a bruise , but is supplemented by disintegration and rupture of individual fibers.

Damage to the ligaments, menisci and other structures of the knee joint causes rapid atrophy of the thigh muscles, a decrease in their tone, strength and ability to voluntarily contract the quadriceps muscle, therefore it is extremely important to carry out the correct treatment to restore full extension of the joint, as well as to ensure that it stays in this position sustainability.

Important! Despite the good regenerative properties of ligament tissue, no replacement tissue formed during restoration can fully provide the same strength and function of the natural ligament, and it will differ both in structure and size. This can lead to stiffness, stiffness, instability and a high likelihood of re-injury, therefore, to obtain the best result, it is necessary to carry out adequate treatment and restoration of the anatomical integrity of the ligaments under the supervision of a qualified physician.

Causes

In addition to sudden movements and actions with a large amplitude, which are unusual for the knee joint, a sprained ligament can cause:

forced rotation of the lower leg or foot outward, and the hips inward;
lifting heavy weights, such as during powerlifting;
sports such as running, jumping, basketball, hockey, football and others;
falling on the knee or being hit, for example, as a result of an accident;
hereditary disease - Ehlers-Danlos syndrome , which causes defects in collagen and increases the risk of injuries such as dislocations , sprains and strains.

Symptoms of a knee sprain

Depending on the degree of injury, the mobility of the joint changes. A moderate injury leads to significant limitation of mobility, while a more serious injury makes the joint excessively mobile and unstable, causing pathological instability. Such moderate-to-severe injuries occur with a characteristic sound - a pop, which indicates rupture of the fibers in the ligament.

Symptoms of a knee sprain are usually local and include:

local (in the knee area) redness or hematoma , a bruise may appear on the 2-3rd day, and slightly below the location of the injury;
increasing tissue temperature in the stretched area;
the occurrence of gradually increasing swelling of the knee joint, possibly a significant increase up to a size resembling an “elephant look”;
pain – significantly increasing when the knee is turned in the direction of sprain, as well as when palpating and pressing on the area of the stretched ligaments and their attachment to the bones;
constant crunching and clicking sounds;
lameness.

In addition, pain may occur when trying to step on a leg with an injured knee. The pain can be so severe that a person can neither lean on his leg nor take a step.