Sprain and rupture of knee ligaments: diagnosis and treatment

Damage to the lateral ligaments of the knee joint

The lateral or collateral ligaments of the knee joint are located, according to their name, along its lateral surfaces.

The external lateral or collateral fibular ligament begins from the external epicondyle (bone protrusion) of the thigh. It covers and strengthens the knee joint from the side. Below this ligament is attached to the head of the fibula. A layer of fatty tissue separates the lateral ligament from the joint.

The external collateral ligament of the knee joint is damaged less frequently than the internal one, but more often the entire ligament is torn completely or the ligament is completely torn from its attachment.

The internal lateral or collateral tibial ligament is subject to traumatic injuries more often.

However, it usually ruptures partially. This ligament starts from the inner femoral condyle. It looks like a wide band, covers and strengthens the inner surface of the knee joint, and below is attached to the tibia. In addition, some of the fibers of the internal collateral ligament are woven into the joint capsule and into the tissue of the internal meniscus of the knee joint. This attachment of the ligament leads to possible damage to the inner meniscus of the knee joint when the ligament is injured.

Damage to the collateral ligaments occurs as a result of tension when the tibia deviates. If the shin deviates outward (when walking on an uneven surface, tucking the foot in a heel, etc.), the ligaments are subject to strong tension and are torn or torn. If the tibia deviates outward, the internal ligament ruptures, and if the tibia deviates inward, the lateral collateral ligament of the knee joint is damaged.

When the lateral collateral ligament is torn, an avulsion fracture of the portion of the head of the fibula to which the ligament attaches may occur. Patients complain of pain in the area of ​​the rupture, which intensifies when trying to deviate the leg outward when the internal ligament is torn, or inward when the external ligament is torn. Partial ligament ruptures result in limited flexion in the knee joint, while complete ligament ruptures lead to excessive mobility (looseness) in the joint. The diagnosis is clarified using x-rays taken with special placement of the legs.

Treatment of injuries to the lateral ligaments of the knee joint

The injury site is numbed. If the ligaments are partially torn, a plaster cast called a plaster cast is applied to the leg from the upper third of the thigh to the level of the ankles.

Complete ruptures of the internal collateral ligament, after anesthesia, are also treated conservatively by applying a plaster cast. A complete rupture of the lateral ligament requires surgical treatment, which should be carried out in the first days after the traumatic injury. Usually these ligaments diverge over a considerable distance. They are tightened and stitched with Mylar tape or plastic surgery is performed using the biceps femoris tendon. If an avulsion fracture of the apex of the head of the fibula occurs, the fragment is fixed to the fibula with a screw. Sometimes the ligament not only ruptures, but also separates into individual fibers. Then the ligament is reconstructed using grafts.

The results of treatment are not always satisfactory, because the ligaments grow together with a scar and at the same time they increase in length. Lengthening of the ligaments affects the function of the knee joint, which becomes unstable. If this instability is compensated by other structures of the knee joint (cruciate ligament, other parts of the knee joint capsule), the function of the knee joint can be satisfactory.

In other cases, it is necessary to resort to surgical treatment - reconstruction of the collateral ligaments. Two types of surgical techniques are used: plastic surgery using tendons and grafts to strengthen the ligament, or relocation of the ligament attachment sites. The extent of the operation depends on the severity of the damage.

There are contraindications. Read the instructions or consult a specialist.

Torn cruciate ligaments of the knee

The cruciate ligaments (anterior and posterior) are intra-articular and stabilize the knee joint, preventing the tibia from moving excessively forward or backward.

The mechanism of rupture of the cruciate ligament of the knee is associated with direct trauma - a blow to the supporting shin, as a result of which it can move anteriorly or posteriorly. A rupture of the cruciate ligament of the knee is often combined with a dislocation of the lower leg. Anterior cruciate ligament rupture is one of the symptoms of the “unfortunate triad” (simultaneous damage to the medial meniscus, tibial collateral and anterior cruciate ligaments). Rupture of the posterior cruciate ligament of the knee occurs in a fight, contact sports, and football when the leg is kicked in the front.

The clinical picture of cruciate ligament rupture of the knee is always accompanied by severe pain, swelling of the knee joint and hemarthrosis. The “drawer symptom” is considered classic when the shin bent at the knee seems to move forward or backward (pathologically mobile). Intra-articular ligament injuries of the knee joint are difficult to diagnose. Ruptures of the cruciate ligaments are often combined with damage to the menisci, lateral ligaments, and avulsion of the cortical layers of bone at the attachment points. Conventional radiography is not informative.

Treatment tactics for rupture of knee ligaments due to intra-articular injuries are often surgical. Patients in whom hemarthrosis is the only intra-articular sign of pathology are treated conservatively.

In the Stolitsa network of clinics, you can undergo CT and MRI diagnostics (around the clock) and diagnostic arthroscopy (during the daytime), diagnostics allow you to visualize damage, clarifying the diagnosis. Surgical treatment is carried out under general anesthesia in the daytime. After surgical treatment, the limb is immobilized for one and a half months.

A photo from the ring is the best reward for a surgeon!

Our work is done.
But now you yourself must make efforts for a speedy recovery. In our clinic, people of different professions perform operations. But I advise you to take example from athletes. When, after a while, I receive gratitude from operated patients in the form of a video report or a photograph “from the ring” - this is the best reward for us. I admit that athletes are a grateful audience. After all, their internal motivation, active life position and desire to quickly get back into shape are sometimes stronger than others. Sport for them is daily work on the body and muscles. So I would like to say one last thing to everyone who is about to undergo surgery: “If you want to recover, work!”

"Do not enter! The operation is underway!

Now let’s clearly illustrate what happens behind the doors of the operating room during arthroscopy.
This time our patient is a football player (however, everyone is equal on the operating table). A blow to the knee during a match resulted in a torn anterior cruciate ligament. Three months after the injury, Anton decided to have surgery. He will undergo resection (removal of the damaged part) of the internal meniscus, as well as ACL repair (replacement of the damaged ligament with a new one).

Everything is ready to begin the operation. Anton was given spinal anesthesia, so if he wishes, he will be able to observe the progress of the operation. Not everything, of course, is worth looking at for the patient, but in our case there is nothing repulsive on the monitor.

Moreover, you will practically not see blood, which is usually a lot during an open operation. A pneumatic cuff and tourniquet are applied to the lower leg and thigh of the operated lower limb to bleed the operated limb and also to avoid thrombosis. The leg was placed in a special holder. This way, the hip is firmly held by the side supports, which allows the surgeon to effectively control the position of the knee joint during surgery.

Transplant from the patient's own tissue

We begin the operation by collecting the graft. Just below the knee we make a separate small incision, from where, using special instruments, we extract the tendinous part of the semitendinosus and tender muscles of the thigh, from which we form a graft. This manipulation does not affect the motor function of the limb in any way.

The tendons are very strong and powerful, they fully perform the functions of the damaged cruciate ligament. In the long term, a ligament made from its own tissue shows much better results compared to an artificial one.

Don't be alarmed, this is exactly what a freshly removed tendon looks like.

The tendon is placed on a special workstation, where it is freed from muscle tissue, folded several times, stitched with special threads and measured. The tendon remains under tension for some time. This is necessary to prevent further stretching of the joint.

Our team is a single team of professionals, where everyone does their job. During the operation, I am helped by an assistant - orthopedic doctor Andrey Andreevich Matveev; operating nurse Irina, anesthesiologist Victoria Gennadievna and assistant anesthesiologist Marina are always nearby.

Arthroscopic surgery is performed in an aquatic environment: a sterile solution constantly flows through the operated joint under controlled pressure. After harvesting the tendons for the graft, the arthroscopy itself begins, and my attention now turns to the monitor. Through two small incisions, thin instruments are inserted into the joint to remove remnants of the torn cruciate ligament and damaged part of the meniscus.

We diagnose the entire knee joint. On the monitor with high magnification, the damaged elements of the knee joint are clearly visible. You see cartilaginous rubbing surfaces - the inner condyle of the femur (hemisphere). Between them there is a fibrous formation - a damaged internal meniscus (longitudinal tear). Due to the fact that the injury occurred a long time ago, damage to the cartilage of the femoral condyle is already evident.

Anton dozed during the operation. At one point I woke up and looked at the monitor. His pupils dilated when he saw what his knee joint looked like. “What are these white rags?” – Anton asked. “That’s all that’s left of your anterior cruciate ligament,” I stated.

Using the same incision from which the graft was taken (a new incision is not needed), using specially designed instruments under the control of an arthroscope (it provides an image on the monitor), we create tunnels in the femur and tibia using special guides. The tunnels are located exactly at the attachment points of the damaged ACL. This allows you to restore the exact anatomy of the damaged cruciate ligament of the knee joint. A tendon graft is passed through the tunnels.

The transplant is fixed with special implants. Modern fixation methods help to very accurately install the ligament in its anatomical location and fix it very firmly. The canals are formed using endoscopic drills of different sizes.

The implant for femoral fixation is a small plate and a powerful loop through which the graft tendons are thrown.

For strong fixation of grafts, screws, plates, “buttons”, and pins are also used, which remain in the joint for life. In our case, we use the endobutton fixation technique. Now everything is ready for the transplant.

After performing the graft, we ensure stable, rigid fixation. Next, the graft is stretched and fixed with a screw in the tibia.

At the end of the operation, we perform arthroscopic control of the position and tension of the graft in the joint. This is what a restored anterior cruciate ligament looks like inside the joint.

Next, a clinical examination is carried out, and stability is checked using special tests. Everything is normal, the ligament is stretched. Stitches can be applied. The entire operation was performed through 2 incisions of 5 mm and 1 incision of 2–3 cm. After healing, the postoperative wounds will be almost invisible. This is another advantage of arthroscopy – the absence of a large postoperative scar.

Tendonitis treatment process

When tendonitis of the knee joint is detected, a conservative method of treatment is first used. The essence of the method is outpatient treatment using:

• rest mode - the patient excludes any physical activity, and the limb is immobilized using plaster or other fixatives;
• medications - the doctor prescribes various analgesics and anti-inflammatory drugs;
• physiotherapy - after neutralizing the main inflammation, the patient is prescribed electrophoresis, massage, exercise therapy, iontophoresis, magnetic therapy, etc.

X-ray therapy is used in cases of intense pain and severe swelling in the knee joint. Doctors may also resort to blockades with corticosteroid drugs. A fairly effective treatment for tendonitis is shock wave therapy in combination with V-actor technology.

Once treatment is complete, patients should gradually increase the amount of weight they place on the knee. It is recommended to use special orthoses to fix the joint and minimize the risk of relapse.

Surgeries are performed in case of tendon ruptures or failure of outpatient treatment. The surgical procedure involves cutting the skin in the affected area, opening the ligamentous canal and removing the affected tissue.

After the operation, the patient is prescribed antibiotics, pain medication, physiotherapy and massage. Folk remedies can enhance the effect of traditional tendonitis treatment. But before resorting to alternative treatment, you need to consult a doctor. Self-medication can be harmful to health and lead to unwanted development of inflammation.

Contraindications for surgery

Despite the fact that cruciate ligament repair of the knee joint is one of the most popular techniques due to its high efficiency and minimal invasiveness, it cannot be performed on everyone. Fortunately, there are not many contraindications:

• severe contracture of the joint;
• local skin infections, inflammations, purulent abscesses, ulcers;
• severe forms of pathology of the heart, respiratory system, veins and blood vessels of the legs;
• any chronic diseases in the acute stage;
• allergy to medications used for anesthesia.

If transplantation of own tendons from the quadriceps femoris muscle or patellar ligaments is intended, and the patient has problems with the muscle-tendon elements of the flexor/extensor apparatus, such a procedure cannot be performed. However, he may be offered one of two alternative options: allotransplantation or implantation of the Legamis system. Of course, if the clinic provides such services.

Causes

Inflammation is often triggered by jumping and is considered an occupational disease of athletes involved in volleyball, tennis, basketball, athletics, and football.
In sports medicine, there is a term called “jumper’s knee.” Provoking factors for the development of the disease are:

• heavy weight;
• jumping on a hard surface;
• flatvalgus feet;
• incorrect posture;
• shoes not suitable for sports;
• long-term antibiotic therapy;
• systemic diseases (rheumatoid arthritis, scleroderma, gout, diabetes);
• increased cholesterol levels in the blood;
• endocrine pathology.

Rehabilitation of surgery patient

After plastic surgery of the cruciate ligaments of the knee joint, you are required to move for 1 month only on crutches, without leaning on your leg. Immobilization of the operated area lasts approximately the same amount of time, which is achieved through the use of a plaster cast, splint or orthosis, rigidly fixed in a position of full extension. Loads on the joint are avoided throughout this period. Painkillers and anti-inflammatory medications are prescribed early on. Usually a certain antibiotic is injected for several days.

Over the course of 2 weeks, starting from about the 3rd day, isometric exercises are performed to contract the hip joint, flexion/extension of the ankle, and carefully lift the limb while holding it in the supine position. Additionally, the patient undergoes physiotherapy sessions: magnetic therapy; UHF, electromyostimulation, etc. After about 4 weeks, by gradually increasing the load on the leg, they smoothly switch from crutches to a cane, and then to walking without supporting devices. At this stage, the rigid fixator is replaced with a semi-rigid orthosis, preferably a frame model.

It is advisable to undergo physical therapy and a set of physiotherapeutic procedures in a rehabilitation center for at least 8 weeks under the guidance of a rehabilitation methodologist. By this time, the full range of motion in the knee should be achieved and the correct gait should be practiced. Classes are conducted in a special non-rigid knee brace. A return to normal life without restrictions is allowed only after the replacement ligament has been firmly strengthened. The final restoration of the cruciate ligament of the knee joint, if plastic surgery was used, occurs no earlier than after 3 months, sometimes only after six months.

Video of the rehabilitation protocol after knee arthroscopy:

How to treat knee tendinitis

When the first signs of the disease appear, you should not try to treat it at home.
This can lead to irreversible consequences. There is no need to bring the disease to the stage when the knee can no longer straighten; it is better to go to the doctor at the first episodes of pain. To recover, you need to stop sports training and avoid physical activity. In severe cases, immobilization of the affected joint is indicated. To relieve inflammation and pain, NSAIDs are prescribed.

After the acute process has stopped, electrophoresis, UHF, magnetic therapy, and other physical procedures are added to therapy. In cases of severe pain and swelling, blockades with glucocorticosteroids are performed.

After treatment, motor activity should be restored gradually. Therapy begins with a course of massage and exercise therapy. Athletes are advised to reconsider their exercise technique and land more softly when jumping.

If there is no result from conservative therapy within 2-3 months and in case of tendon ruptures, surgery is indicated. The canal in which the tendon is located is opened, and pathologically altered sections of the tendon are removed. When a ligament ruptures, the surgeon reconstructs it.

Diagnosis of tendinitis

Diagnosis begins with examination of the patient and analysis of the affected limb. This is usually done by an orthopedic traumatologist. Based on an analysis of the symptoms and causes of tendinitis, the doctor refers the patient for additional studies.

The examination includes the following procedures:

• X-ray of the knee joint - to exclude pathologies that have similar symptoms. In rare cases, images may show increased soft tissue volume.
• Ultrasound, MRI and CT - to visualize the knee joint and the tissues around it. The deformation of the structure, the location of tendon tears and the source of inflammation are determined.
• laboratory tests - general analysis of urine and blood. Signs of tendonitis appear in the blood if there is an infection, and if there is a metabolic disorder, the test may show increased levels of creatinine and uric acid.

Signs of tendinitis can easily be confused with other joint diseases, so diagnosing the inflammation yourself is not recommended.

Symptoms of knee tendonitis

The main symptoms of knee tendinitis are:

• pain when moving the affected limb;
• painful sensations on palpation;
• increased temperature in the area of ​​inflammation, possible redness;
• deterioration of joint mobility;
• prolonged pain, intensifying at night.

In addition to common symptoms, the stages of development of pain syndrome are also distinguished:

1. The first stage is characterized by pain in the tendon area only at the peak of physical activity. In any other circumstances there is no pain.
2. At the second stage, dull pain occurs even with standard physical activity.
3. At the third stage, the pain does not subside even after a long rest.
4. The fourth stage is the last in the development of the disease. The tendon of the knee joint loses its strength, and the tissues undergo minor tears. Rupture is possible during physical activity.

With secondary tendinitis, symptoms appear faster and pain develops more intensely. The spread of inflammation goes away in just a couple of days, and the swelling is more pronounced. Hyperemia occurs in the affected area, and in rare cases, hyperthermia of the skin.

At the first signs of tendonitis, it is strongly recommended to seek help from a specialist. Self-diagnosis can lead to serious consequences, since the symptoms of tendinitis are similar to tendinosis. However, their treatment is different.

Be attentive to yourself!

If people who suffered a knee injury had the opportunity to look inside their joint, they would lose the desire to put off treatment. When an essential item breaks, what do you do? Of course, you immediately take it to the workshop. With the knee joint, alas, this is not always the case: often we do not take care of it in the first place, and when we lose it we cry. Remember that if you do not consult a doctor in a timely manner, damage to one element of the knee joint will certainly lead to others, and some elements (for example, articular cartilage) may not be restored at all.

Patellar ligament rupture

The patellar ligament holds the patella in place and prevents it from moving when moving the knee joint. The ligament tears transversely when there is a blow to the knee or a fall on a bent knee. Clinically and radiologically, the symptom of upward displacement of the patella when trying to straighten the tibia is clearly visible. Incomplete ligament ruptures are treated conservatively. In case of complete rupture, the ligament is sutured with mattress sutures and the limb is immobilized with a splint for a month. Then they begin to develop movements, include massage and physiotherapy. The Stolitsa network of clinics has all types of physiofunctional procedures that are necessary for the rehabilitation of trauma patients. For any injuries to the knee joint, contact the traumatologists of the Stolitsa network of clinics. With us you will receive diagnostic and therapeutic assistance in full and will be able to reduce the recovery time after injury.