Damage to the tibial and fibular collateral ligament

Causes of injury

Let us first consider the mechanism of injury to the medial collateral ligament. As already mentioned, she gets injured quite often. The situation in which this occurs is a blow just below the knee from the outside of the shin. In this case, the leg is usually in an extended position and is more susceptible to injury (happens more often in football players). Otherwise, this can happen during falls, when the lower leg is fixed, and the body moves relative to it to the side with torsion on the leg (injuries of skiers and snowboarders). When the external collateral ligamentous fibers are torn, on the contrary, the blow should fall on the inner surface of the lower leg, and also excessive extension of the knee or internal rotation of the body on the supporting leg should occur.

ANATOMY

Ligaments are strong structures of connective tissue that connect bones to each other. The knee joint is strengthened by two collateral (side) ligaments, which prevent excessive abduction and adduction of the tibia. The medial collateral ligament is located on the inner surface of the knee joint, that is, on the side facing the other knee joint. The lateral collateral ligament is located on the outside of the knee joint. Excessive stretching of these ligaments as a result of injury can result in their rupture. The tear line can be located anywhere in the ligament, both in the center of the ligament and at the place where it attaches to the bones. With significant trauma, combined damage to the collateral and intra-articular ligaments of the knee joint can occur.

Most often in clinical practice, a combination of rupture of the medial collateral and anterior cruciate ligaments is observed. The anterior cruciate ligament is located inside the knee joint, in its central part, and its function is to limit the anterior movement of the tibia relative to the femur. The incidence of medial collateral ligament rupture is higher than that of the lateral collateral ligament, but the likelihood of developing knee instability is higher with the latter type of traumatic injury. One reason for the high incidence of joint instability with lateral collateral ligament rupture is that the medial portion of the tibial plateau has a deeper depression. On the contrary, on the side of the lateral collateral ligament, the tibial plateau has a flat surface, and therefore the amplitude of bone movement in this part of the joint is higher.

The force that causes a rupture of the collateral ligament inevitably leads to damage to the soft tissue near the knee joint. As a result, bruising occurs and traumatic swelling of the joint area develops. Some patients experience damage to intra-articular blood vessels, which causes hemarthrosis - accumulation of blood in the joint cavity. The injury causes pain and stiffness in the joint. Many patients, already in the “acute” period of injury, are worried about instability of the joint: the leg twists if the patient transfers body weight to it. Chronic instability of the knee joint as a result of damage to the collateral ligaments is a fairly common pathology. Instability can occur either as a result of complete disruption of the integrity of the collateral ligament, or due to insufficient function of the ligament due to its incomplete or improper consolidation.

Degrees of ligament damage

Different degrees of damage produce both differences in the clinical picture and require different treatment tactics. Highlight:

First degree- This is a partial rupture of the surface fibers. Pain occurs at the site of deformation, and swelling is possible.
• The second is damage to most ligamentous fibers. The pain is more widespread, swelling of the joint increases quickly, may be associated with hemarthrosis, and a hematoma occurs on the lateral surface of the joint.
• The third is a complete break. In addition to the above symptoms, joint dysfunction and instability appear.

physiotherapy

physiotherapy
Additional treatment methods:

• physiotherapy – many methods are used that can improve blood circulation in the joint, accelerate the elimination of swelling, and normalize regenerative processes;
• physical therapy - static gymnastics is prescribed from the third day, in the recovery period (after removing the cast) they move on to dynamic exercises aimed at strengthening the muscles of the limb;
• arthrotherapy - injections of hyaluronate and platelet-rich plasma into the joint, accelerate tissue regeneration and prevent cartilage degeneration.

Treatment of collateral ligament ruptures

Treatment of isolated deformities of the external and internal ligaments is usually carried out using conservative methods. Here it is important to provide fixation to the joint in the first time after injury by using an orthosis. It is better to avoid stress. A course of nonsteroidal anti-inflammatory drugs will relieve inflammation and relieve pain. For rapid regeneration, injections of platelet-rich plasma are used. The rehabilitation period is aimed at gradually increasing the load with strengthening the muscles and without additional injury to the lateral ligaments. Kinesiotherapy, mechanotherapy, taping and physiotherapeutic procedures are used.

Arthroscopy for ligament rupture

It happens, especially with extensive damage, that after the injury instability occurs, which worries during exercise (for athletes and other patients with an active lifestyle). In such cases, reconstruction is performed surgically. Arthroscopy is the most gentle type of surgery. In addition, recovery after it is quick and easy. Sometimes the ligament can be sutured (with fresh partial ruptures); in other cases, fixators are used to the bone if the rupture occurred at the site of attachment of the ligament to it. Another method of reconstruction is ligament plastic surgery using autografts (own tissue). The tendons of the muscles of the popliteal region are used. In the vast majority of cases, the prognosis after such operations is favorable. Patients quickly undergo rehabilitation and return to sports and normal life. When damage to the collateral ligament is combined with injuries to other structures of the knee, their arthroscopic restoration and all necessary surgical procedures are usually carried out in one operation.

DIAGNOSTICS

A physical examination (examination, palpation, study of lower limb mobility) allows the doctor to make a presumptive diagnosis of collateral ligament rupture. Physical examination is a valuable diagnostic method, allowing the identification of intra-articular or periarticular ligament rupture in most patients. In the acute period of injury, physical examination is difficult due to severe pain and swelling of the knee joint. In these cases, rest for 5-7 days is prescribed for the injured limb, analgesic medications, and cold (ice packs) on the area of ​​the damaged joint. During this time, the pain subsides and the swelling decreases, which makes it possible to conduct a full physical examination of the knee joint.

X-rays of the knee joint are performed to exclude possible bone fractures due to injury to the knee joint. In order to diagnose a collateral ligament rupture in the presence of symptoms of instability, functional (stress) radiography is necessary. In this case, an x-ray of the joint is taken when the radiologist's assistant moves the patient's lower leg to the side (medially or laterally). The diagnosis is confirmed if widening of the joint space is noted on the side of the collateral ligament rupture. If combined damage to periarticular and intraarticular ligaments, menisci or articular cartilage is suspected, magnetic resonance imaging is indicated. In this case, the image of the knee joint takes the form of a series of longitudinal and transverse sections, which are obtained as a result of digital processing of signals obtained using electromagnetic waves. Magnetic resonance imaging is especially the “gold” standard for diagnosing damage to the soft tissue structures of the knee joint (cartilage, ligaments, tendons). This completely safe and painless research method can be especially useful if the doctor has doubts about the presence of damage to the structures of the knee joint.

Content

• 1 Main signs of tibial collateral ligament rupture
• 2 Prevention
• 3 Clinical picture 3.1 History and complaints
• 3.2 Physical examination
• 3.3 Radiation diagnostics
• 3.4 Special methods

Symptoms of patellar tendinitis

The first sign of patellar tendonitis is pain. It is usually localized in the area that is located between the patella and the attachment of the tendon to the tibia. Pain in the knee joint initially appears only during physical activity or after intense exercise. It can intensify to such an extent that it reduces sports and physical activity. Ultimately, the patient is unable to climb stairs or get out of a chair independently.

If you ignore the warning signals the body is sending and try to continue working, the tendon rupture will increase. Pain localized in the patella area intensifies with flexion and extension of the knee, or displacement of the kneecap by hand. Swelling appears in the area of ​​the knee joint, limitation of movements, and a feeling of weakness in the thigh muscle. If factors that contribute to the development of patellar tendonitis are not addressed, knee pain and decreased function may persist. In this case, the disease will progress and patellar tendinopathy will develop. If pain in the knee joint occurs, it is necessary to implement self-help measures, namely: apply an ice pack to the affected area and temporarily reduce the activity that causes pain, or completely abandon it.

Prognosis and return to sports[edit | edit code]

For isolated injuries of the tibial collateral ligament, conservative treatment usually gives good results. Thus, 98% of football players with an isolated injury to the tibial collateral ligament who underwent conservative treatment returned to professional sports.

Literary sources:

• Gardiner JC et al: Strain in the human medial collateral ligament during valgus loading of the knee. Clin Orthop Related Res 2001;391:266.
• Mazzocca AD et al: Valgus medial collateral ligament rupture causes concomitant loading and damage of the anterior cruciate ligament. J Knee Surg 2003; 16(3): 148.
• Nakamura N et al: Acute grade 111 medial collateral ligament injury of the knee associated with anterior cruciate ligament tear. The usefulness of magnetic resonance imaging in determining a treatment regimen. Am J Sports Med 2003;31(2):261.
• Robinson JR et al: The posteromedial corner revisited. An anatomical description of the passive restraining structures of the medial aspect of the human knee. J Bone Joint Surg B 2004;86(5):674.
• Sawant M et al: Valgus knee injuries: evaluation and documentation using a simple technique of stress radiography. Knee 2004; 11(1):25.
• Wilson TC et al: Medial collateral ligament utibiar injuries: indication for acute repair. Orthopedics 2004;27(4):389.

Kinds

For ease of diagnosis and prescribing adequate therapeutic tactics, all ACL ruptures are divided into several types. According to the severity of the damage, they are distinguished:

• Microdamage (1st degree) – only single connective tissue fibers are torn.
• Partial rupture (2nd degree) - the overall integrity of the ligament is not compromised, but a portion of the connective tissue fibers rupture.
• Complete rupture (grade 3) – the integrity of the entire ligament is disrupted with a pronounced impairment of the functional state of the knee.

Also, the rupture can be isolated (only the cruciate ligament is damaged) and combined with the involvement of other structures of the knee - rupture of the posterior cruciate ligament, lateral (lateral) ligaments, meniscus tear.

Complications[edit | edit code]

The transition to predominantly conservative treatment significantly reduced the number of complications associated with injuries of the tibial collateral ligament. The main complication of conservative treatment is weakness of the ligamentous apparatus during valgus loading and pain in the medial part of the joint. Radiographs may reveal residual calcification of the ligament (Pellegrini-Stida syndrome). After surgical treatment, cicatricial deformation of the joint, inflammation, damage to the saphenous nerve and vein, and weakness of the ligamentous apparatus are possible.