Ligament ruptures are among the most common types of traumatic injuries to the knee joint. In terms of frequency, this injury is in second place, after meniscus tears. Approximately 45% of patients who see an orthopedist or traumatologist for a knee injury are diagnosed with a knee ligament rupture. The anterior cruciate ligament (ACL) is much more commonly injured. Much less often - rear or lateral. While ACL disruption can occur in isolation, rupture of other ligaments is usually associated with other knee injuries.
ligament tears
ligament tears
Most people strive to recover without surgery. After all, surgery is always associated with some discomfort. Such treatment is expensive and requires lengthy recovery. However, most clinical cases of knee ligament ruptures require surgical treatment. Whether surgery is needed depends on which ligaments are torn, whether the rupture is complete or partial, and how much joint function is preserved. If a person needs surgery but does not receive it, this is fraught with serious consequences:
- development of post-traumatic gonarthrosis;
- chronic pain;
- instability of the joint.
There are several ligaments inside the knee. These are the anterior and posterior cruciate, lateral, and patellar ligaments. The prognosis largely depends on which ligamentous structures are damaged.
When a complete rupture occurs, joint instability always develops. Because the ligaments no longer limit his mobility. There are three forms of instability:
Compensated form. Most indicators are normal. Muscle atrophy is not detected clinically. Joint dysfunction can only be detected through instrumental studies.
Subcompensated form. There is pain, crunching in the joint, and the thigh muscles atrophy. On the affected side, the thigh circumference is 3-4 cm smaller. But clinically, instability manifests itself only under heavy load: running, squats, etc. The radiograph reveals signs of grade 1 gonarthrosis.
Decompensated form. Constant pain, unsteadiness when walking, obvious clinical signs of joint instability. Many people use a cane. The patient complains of pathological joint mobility. An x-ray can reveal grade 2-3 gonarthrosis.
Clinic of Dr. Glazkov. Treatment of the knee and shoulder joint.
Clinic of Dr. Glazkov.
Treatment of the knee and shoulder joint. Knee ligaments are connective tissue bands whose main function is to strengthen the joint. They are quite strong formations, they have little elasticity.
When exposed to excessive mechanical force aimed at increasing their length, the fibers of the connective tissue cord are stretched. With further exposure to force, micro-tears of the fibers or a violation of the integrity of the entire ligament appear.
This condition is accompanied by a violation of the functional state of the knee joint, as well as an inflammatory reaction. The possibility of restoring damaged anatomical structures of the knee depends on the degree of integrity damage. If the ligaments are torn, their independent restoration without adequate treatment is impossible.
Collateral ligaments
Collateral ligaments
As soon as the patient is admitted to the hospital, he undergoes a puncture of the joint. The doctor's task is to eliminate hemarthrosis (accumulation of blood inside the knee) and also relieve pain. To reduce pain, after washing the joint, local anesthetics (for example, 0.5% procaine) are administered orally.
A plaster splint is placed on the knee. The patient wears it for about 1 week. The plaster is removed after the swelling of the joint is eliminated. Then it is changed to a circular bandage. It goes from the groin to the toes. The limb is fixed in a state of excessive deviation of the tibia towards the affected ligament.
Limb immobilization is carried out for up to 2 months. After eliminating acute inflammatory phenomena, the doctor prescribes physiotherapy. They improve blood circulation in the joint and normalize regenerative processes. Physical therapy is used. It is aimed at strengthening the thigh muscles. In addition, physical activity also stimulates blood flow, improving the trophism of knee tissue.
How can a foreign patient make an appointment and the operation itself?
You will first be asked to provide current MRI scans as well as X-ray results. This way the doctor can assess the condition of the knee joint. After we receive all the necessary documents through our website, within 1-2 days we will send you a preliminary treatment plan and cost estimate.
The Orthopedic Medical Center Gelenk-Klink provides foreign patients with the opportunity to make an appointment within a short time. We will be happy to help you with obtaining a visa after the advance payment specified in the preliminary cost estimate has been received into our account. In case of refusal to issue a visa, the advance payment is refunded in full.
For patients from abroad, we try to reduce the time between the preliminary examination and the operation itself. This way you will not need to come to the clinic several times. During both outpatient and inpatient treatment, you will be accompanied by qualified medical personnel who speak several foreign languages (English, Russian, Spanish, Portuguese). We also provide assistance in finding a translator (for example, into Arabic), which is paid for by the patient separately. We will be happy to help you organize a transfer, find a hotel and tell you how to spend your free time in Germany interestingly for you and your family members.
medical request
Cruciate ligaments
When the “crosses” rupture, in the vast majority of cases it is not possible to do without surgical treatment. Ligaments do not heal on their own. And under no circumstances should you walk with torn ones: this leads to joint dystrophy, a decrease in muscle volume, and can result in chronic pain.
There are only two situations when surgery is not performed:
- partial rupture of the cruciate ligament (that is, only part of the fibers was damaged; this type of injury is also called a sprain);
- medical contraindications to surgery.
In the early period after injury, the joint is swollen and the pain is severe. Therefore, it is clinically impossible to determine whether the ligaments are completely torn. Adequate research is possible only after hemarthrosis has been eliminated and the knee has been anesthetized. To do this, a puncture is performed. The joint cavity is washed. After removing blood and clots from it, anesthesia is performed with a solution of local anesthetics. A solution of procaine with a concentration of 0.5% or 1% can be used, which is administered in an amount of 25-30 ml.
An instrumental study is required. It is likely that more than just the ligaments are damaged. At a minimum, the doctor does an x-ray. With its help, avulsion fractures (when a bone fragment is torn off at the site of attachment of the ligament) and damage to the condyles of the femur and tibia are excluded.
After carrying out the necessary therapeutic and diagnostic manipulations, the limb is immobilized. A plaster cast is applied for 2 months. As a rule, swelling is severe in the first week. It increases the volume of the limb. At the time of applying the plaster, it is always swollen, so after the swelling subsides, the bandage weakens. It needs to be changed after 5-7 days.
Next, the recovery process begins. Painkillers, exercise therapy, and physiotherapy are used. The patient is recommended to perform static loads on the thigh muscles. Intra-articular injection of hyaluronic acid and platelet-rich plasma can be used to accelerate regenerative processes and prevent degenerative changes in the knee cartilage.
x-ray examination
x-ray examination
- 1st degree – the integrity of the structures is preserved. Partial rupture of several fibers occurs (this degree of rupture is also called stretching).
- Grade 2 – a more severe rupture with a significant amount of damaged connective tissue fibers. In general, the anatomical relationship of the ligaments and their integrity are preserved.
- Grade 3 – severe injury with complete rupture of one or more ligaments. This severe injury is usually accompanied by damage to the meniscus of the knee or the articular processes of the femur, tibia or fibula.
Dividing the injury into severity levels is possible after an objective diagnosis with visualization of the tissues and structures of the joint.
Arthrotherapy
Arthrotherapy
- with conservative management of patients;
- after surgical treatment.
Conservative treatment is sometimes the primary treatment option for patients with knee injuries. This happens not only in cases of sprains. Some patients are contraindicated for surgery. Others simply refuse it. The reasons are different: fear of surgical intervention, false belief in the possibility of ligament fusion without surgery, underestimation of the consequences of injury, etc. In any case, if a person refuses the operation, then he cannot be forced. But you can help with all available means. There are methods that can speed up the patient's recovery. Although, with a complete rupture of the ligamentous structures, they do not provide the ability to eliminate instability of the knee joint.
Arthropathy is one of the most effective methods of drug treatment. The essence of the technique is that two drugs are injected into the knee:
1. Hyaluronic acid. It is a “lubricant” for the joint. Softens friction of articular surfaces, reduces pain, slows down degenerative processes in cartilage tissue. Cartilage destruction is almost inevitable in patients who have required but not undergone surgical ligament repair. Thanks to hyaluronic acid, it is possible to delay the onset of arthrosis and reduce its severity.
2. Platelet-rich plasma. If the patient buys hyaluronate at the pharmacy, then there is no need to purchase a second drug for arthrotherapy. It is prepared from the patient's blood immediately before injection into the knee. To do this, the doctor takes blood from the cubital vein. The formed elements of blood are removed from it, leaving only platelets. Due to the removal of fluid, their concentration is several times greater than what is contained in the blood. This plasma is injected into the knee.
How it works?
Will I feel pain after surgery?
Every surgical procedure may involve pain. Surgery to treat a ruptured cruciate ligament of the knee joint is no exception. Thanks to the high professionalism and long-term experience of our surgeons, we are able to reduce the patient’s pain to a minimum. Before the operation, the anesthesiologist gives a special injection that numbs the knee joint for approx. for 30 hours. After this, the pain decreases and the patient’s treatment continues with conventional medications. The goal of the medical staff of the Gelenk Clinic is to ensure a painless postoperative period for the patient
Diagnostics
Visualization of the mechanism of anterior cruciate ligament rupture.
After an injury, there is no need to delay going to the clinic. When visiting a doctor, the patient talks about how this happened. Details matter a lot. Then the doctor conducts a detailed examination, performing functional tests to identify instability, the presence of abnormal fluid, and limited mobility. When diagnosing, the best visualization in great detail is provided by magnetic resonance imaging or computed tomography.
Rehabilitation
After arthroscopic plastic surgery, the patient goes home on the day of surgery. It is recommended to apply cold to the knee for 24 hours and immediately fix the leg with an orthosis. Then they begin to perform exercises, which are given with a gradual increase in load. Physical therapy is a set of exercises developed individually for each person. At first, the exercises are performed when visiting a clinic, then independently at home. Mechanotherapy - exercises on simulators are given in a later period of rehabilitation. Physiotherapeutic procedures, including electromyostimulation, magnetic therapy, and electrophoresis, also provide significant assistance. After arthroscopic surgery, recovery is faster and easier than after open knee surgery.
Forecast
The vast majority manage to fully restore the functionality of the limb after treatment and rehabilitation, and athletes are able to return to training. However, this is a rather slow process and takes about six months on average. It is important to adhere to the recommendations of specialists and not to provoke new injuries.
This patient suffered an ACL and collateral ligament injury 2.5 months ago. In this video, he is undergoing conservative treatment for anterior cruciate ligament injury. Subjectively, the knee is stable, but we continue to use various rehabilitation tools, such as flossing.
Classification
Because the anterior cruciate ligament has two bundles, only one or both of them can be damaged. There is a possibility of complete tearing off along with a section of the bone at the place of its attachment to the lower leg (Segond fracture).
There are three degrees of ACL rupture:
- The first is characterized by stretching, accompanied by moderate pain and swelling. As a rule, the ligament is restored after such cases.
- Second , there are also small tears. Recovery is longer and the regimen plays a decisive role. However, relapses are likely due to a decrease in its strength.
- The third degree is a complete break. The pain is sharp, intense, accompanied by limitation of movement and joint instability. Hemarthrosis (free blood due to vascular damage) is most likely. In this situation, the issue of surgical treatment is resolved.
Also, according to age, fresh ruptures are distinguished - up to 3-5 days, stale - up to 3 weeks and old - more than three weeks. The choice of treatment tactics depends on the determination of these parameters.