Rupture of the knee ligaments is a very common injury, which is characterized by complete or partial separation of the ligamentous fibers that hold the bones of the lower leg and thighs in a stable position. According to statistics, such injuries account for about 85% of all traumatic joint injuries. And knee damage accounts for about 50% of all breaks.
This pathological phenomenon in itself does not pose a threat to life, but the severe pain caused by it and the inability to walk provoke a short-term, but permanent disability. With complex ruptures of the knee ligaments, some patients will never be able to return to their usual activities if it is associated with high loads on the damaged knee.
Thanks to the huge variety of modern medicines and medical technologies, any problem can be cured. For partial ruptures, conservative treatment is used, and for complete ruptures, surgical treatment is used. Therapy of this pathology is performed by orthopedists-traumatologists.
The mechanism of injury and the causes of its occurrence
The only factor causing rupture of the knee ligament is injury. Therefore, the initial criterion on which the diagnosis is based is the circumstances in which it was received.
In case of trauma, which contributes to tears, the movement performed by a person and the load on the joint, as a rule, do not correspond to the maximum possible amplitude that a particular joint can carry out. In this case, excessive stress arises in a certain section of the knee, which provokes damage to the fibers of the ligamentous structures. Often a similar situation is observed when:
- direct and side impacts in the area of the knee joint;
- jumping from a height to an improperly bent or straightened limb;
- falling with emphasis on a limb bent at the knee;
- tucking the legs to the side;
- excessive rotation of the body, relatively fixed in a certain position of the lower leg.
What kind of knee ligament will be damaged depends on the mechanism of trauma. From the strength of the ligamentous apparatus and the strength of the injury depends on what the ligament rupture will be - full or partial.
Varieties of pathology
In medical practice, the classification of ruptures of the knee ligaments is extremely important, because it is the basis for the main methods of therapy and diagnostic criteria for the type of damage.
Thus, gaps are:
- Depending on damage to the ligament. Cruciform (front and back), which are localized inside the knee and ensure stability of the knee in terms of displacements forward or backward; collateral (lateral) ligaments that are located on the outer or inner surface of the joint and keep it from moving to the sides; meniscus ligaments and the transverse ligament of the menisci, which fixes them; patellar, which ensure the stability of the patella.
- Given the degree of damage. Partial rupture of the knee ligaments - a change in the integrity of some fibers; full, which is characterized by the intersection of all fibers; osteoepiphysiolysis, in which there is a separation of minor bone fragments.
There are also combined, in which several ligaments are injured to varying degrees.
Common symptoms
Now we examine the following aspect. The most common symptoms of rupture of the knee ligaments are:
- bright pain syndrome, when the patient develops a strong burning pain in the affected area;
- severe swelling in the affected joint;
- the appearance of looseness and unnatural mobility of the joint;
- impaired functional activity (inability to carry out habitual movements, limitation of mobility);
- hematoma (subcutaneous hemorrhage) or hyperemia of the skin in the area of the injured joint, which often spreads to surrounding tissues.
Specific features
There are several specific symptoms of rupture of the knee ligaments. They are:
- If the collateral external ligament is damaged, pain is observed when pressure is applied along the lateral outer surface of the knee. In addition, abnormal lateral mobility of the lower leg relative to the femoral axis (inward) can be seen.
- When injuring the inner collateral ligament, point pain is observed along the inner part of the knee. In combination with pathological mobility of the lower leg during abduction and a stable thigh. What other symptoms are there with a rupture of the ligaments of the knee joint?
- It is worth listening to your feelings. If there is a rupture of the anterior or posterior cruciate ligament of the knee, the patient experiences severe pain inside this joint, pronounced swelling along its perimeter with “balloting” of the patella (pressure on the patella with a straight leg causes it to move inward, and after the cessation of pressure, this structure returns to normal position), excessive mobility of the lower leg.
- If the injury affected the ligaments of the menisci, then the general symptoms of the pathological condition are supplemented by clicks, instability and jamming during movements of the knee joint. Often this group of ligaments is injured in combination with collateral ligaments. And also by the meniscus itself.
The larger the area of damage, the more pronounced the symptoms of rupture of the ligaments of the knee joint (respectively, with full signs of injury are more pronounced than with partial). This is quite natural.
Damage to the lateral knee ligaments
Two lateral (collateral) ligaments are localized on the lateral sides of the knee. The fibular collateral (lateral lateral) ligament strengthens the knee from the outside. At the top, it is attached to the external femoral condyle, from below - to the head of the fibula. The tibial collateral (medial lateral) ligament, respectively, is located on the inner surface of the knee joint. At the top, it is attached to the inner femoral condyle, below - directly to the tibia. In addition, some of its fibers are attached to the inner meniscus and articular capsule, and therefore damage to the lateral inner ligament is very often combined with injuries of the inner meniscus.
The external lateral knee ligament is damaged much less frequently than the internal. Damage to the ligamentous apparatus of the knee joint can occur with excessive deviation of the lower leg inward. For example, while tucking the legs. Tears of the lateral ligament of the knee joint are often complete. May be combined with tear-off fractures of the head of the fibula.
In case of damage to this group of knee ligaments, the patient complains of severe pain in the damage zone, which is significantly amplified when the lower leg is inward. Limb movements are very limited. The knee joint is characterized by swelling, hemarthrosis is determined. The severity of symptoms depends on the degree of injury to the ligamentous structures. With a complete break, looseness in the joint is determined.
The lateral internal ligament is injured much more often, however, its damage is usually incomplete. Such injuries occur with excessive deviations of the lower leg to the outside. Such damage to the knee ligaments is often combined with ruptures of the internal meniscus and damage to the joint capsule, which can be easily diagnosed by means of an MRI of the knee joint. The knee swells strongly. In addition, a certain pain is determined in the process of palpation, with the tibia deflected outward, with movements. A photo of a knee ligament rupture is presented below. But the doctor must make a diagnosis.
Therapy for injuries of the lateral knee ligaments
Complete or partial rupture of the ligamentous apparatus of the knee joint in traumatology is treated with conservative methods. Doctors anesthetize the injury site with a solution of novocaine. With severe internal bleeding, a puncture is performed in the joint cavity. A gypsum splint is applied to the leg from the ankle to the upper thigh.
Complete rupture of the lateral internal ligament is also treated by traditional methods. In case of injuries of the external lateral ligament, surgical intervention is necessary, since its ends, when ruptured, are far removed from each other, and their natural fusion becomes, as a rule, impossible. During the operation, the lavsan suture of the ligamentous fibers or tendon autoplasty is performed. When ligament stratification develops, grafts are used.
In a tear fracture of the head, a bone fragment is fixed to the fibula using a special screw. When fibers are fused, the ligament length often increases due to scar tissue. As a result of this, its strengthening function decreases, the knee joint loses stability. If other joint structures (cruciate ligaments, capsule) do not compensate for this instability, reconstructive surgery is performed. During which the attachment site is moved or tendon plastic is performed. The treatment of knee ligament tears should be comprehensive and timely. It is important!
Cruciate Ligament Damage
This group of ligaments is located inside the knee joint and connects the articular integument of the femur and tibia. The anterior cruciate ligament is attached to the posterior upper surface of the femoral condyle, passes through the joint in front and inward, and then attaches to the tibia in its anterior-inner section.
The posterior cruciate ligament is attached to the anterior superior surface of the femoral condyle. It passes in the articular cavity from the back and out, after which it is attached to the surface of the tibia in its posterior outer zone. The anterior cruciate ligament does not allow the lower leg to slide forward, and the back - keeps it from sliding backwards.
The cause of the rupture of the anterior cruciate ligament is a strong blow or excessive pressure on the posterior surface of the lower leg when the leg is bent at the knee. The posterior cruciate ligament can be damaged when the leg is bent or when it is struck on its front surface. The most common lesions of the anterior ligament. In addition, the occurrence of the “Turner triad” is often observed, which is characterized by a combination of ruptures of the anterior cruciate and external lateral ligaments. As well as damage to the inner meniscus.
What other possible symptoms of rupture of the ligaments of the knee joint? The whole picture cannot be reflected in the photo. Therefore, you can not delay with a visit to the doctor.
Symptoms of Cruciate Ligament Damage
With this injury, the knee begins to swell strongly, there is a sharp pain. In the joint cavity, or beyond, the presence of fluid (hemarthrosis) is determined. The most common clinical symptom of a cruciate ligament rupture is a sign of a “drawer” characterized by excessive mobility of the lower leg in the forward and backward directions. During diagnosis, the specialist bends the patient’s relaxed limb at an angle of 90 degrees, supports the thigh with one hand, and shins the shin forward and back with the other. If it moves forward, this indicates, first of all, a violation of the integrity of the anterior cruciate ligament. If the tibia moves back, it means that there was a rupture of the cruciate posterior ligament. With a partial rupture of the cruciate ligaments, the described symptom may be absent. For the most complete study of the combined diagnostic joint arthroscopy is performed.
Cruciate ligament injuries. Therapy
With partial rupture of the knee ligaments, the treatment is conservative: joint puncture, as well as the application of a gypsum splint. Full is considered an indication for surgical intervention. The integrity of ligamentous fibers can be restored in the traditional way (through open access) or endoscopically (using an arthroscope). Arthroscopic operations are considered the least traumatic. What else can be the treatment for rupture of the knee ligaments?
For chronic injuries, lavsanoplasty is performed. Either replacement of the ligamentous apparatus with an autograft from the ligament of the patella of the same patient, with fresh injuries of the knee ligaments, the end of the ligament is sewn to the bone. The operation in this case should be performed no later than 5-6 weeks from the moment of rupture. Surgery is not performed at an earlier date because it can cause the development of contracture (limitation of mobility). In general, the treatment of ruptures of the cruciate ligament of the knee joint is not an easy process.
Meniscus tear
The meniscus is a specific cartilage that is located inside the joint cavity in the area of the junction of the bones. Their main function is to increase the area of contact of the surfaces of the joint and the most even distribution of loads. Meniscus functions also include reducing friction and cushioning in the area of cartilage surfaces.
Menisci, and there are only two of them - internal and external, are injured very often. They are covered with cartilage and are attached by ligaments to the tibia. When bending the knee, menisci account for about 80% of the load, so their integrity is extremely important for normal movement.
Meniscus damage is of two types:
- traumatic, as a result of blows to the knee, falls and further;
- degenerative due to metabolic and age-related disorders.
What is most often associated with a rupture of the ligaments of the meniscus of the knee joint? The doctor will be able to answer this question in more detail. But basically it is combined with damage to the anterior cruciate ligaments and with a fracture of the condyle of the tibia (the inner meniscus is often affected).
Meniscus tears usually occur due to heavy loads or sports injuries. In this case, the following symptoms occur:
- joint pain, swelling;
- accumulation of fluid inside the joint;
- a feeling of friction or clicks in the knee;
- blockade of the joint, accompanied by the movement of the meniscus inward, as well as the inability to extend the limb.
If you suspect a similar injury, a detailed examination of the knee by an orthopedic surgeon is necessary. If a fluid is found in the cavity of the knee joint that interferes with diagnosis, the specialist makes a joint puncture and anesthetizes the injury zone. In addition, in order to conduct a more accurate diagnosis, it is necessary to remove the swelling of the damaged area.
Radiography in several projections is also required. This helps to eliminate the presence of bone fractures, subluxation of the patella, damage to the articular surface. If necessary, an MRI is prescribed to obtain an image of the meniscus area and the level of damage, as well as the condition of the tendons, ligaments and cartilage.
Arthroscopy is considered necessary - a technique for examining the knee joint from the inside by introducing a special tool into it with lighting and a camera.
To select a method for treating meniscus rupture, the area of injury, the age of the patient, the period of time from the moment of injury, and other factors are taken into account.
When the meniscus is torn, as well as when the ligaments are torn, two methods of treatment are used - surgical and conservative. The conservative method involves unloading the joint. Namely, the application of fixing bandages, cooling, elevated position of the legs and physiotherapeutic procedures. Surgery for rupture of the knee ligament involves various manipulations in which doctors try to achieve maximum matching of the torn parts of the meniscus.
First aid
It is important for the victim to provide the necessary assistance. In this case, the following algorithm of actions should be observed:
- After rupture of the ligaments of the knee joint, the immobilization of the injured limb is important. Initially, it is necessary to immobilize the injured area - fix it using a special tire, an elastic tight bandage or a tire from improvised means, an orthosis (knee pad), and a plaster cast.
- Cooling the damaged area. To do this, apply ice or compresses with cold water, which help to reduce pain and swelling.
- Taking pain medication. : «», «», «», «», «», «» .
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Diagnostic measures
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- CT, MRI;
- radiography;
- Ultrasound
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