ligament damage

Glazkov Yuri Konstantinovich chief doctor

Tear of the collateral ligament in the knee joint

Collateral ligament rupture is one of the most common knee injuries, occurring more frequently in young, active people due to sports or household chores. A collateral ligament tear can be caused by short-term but increased stress on the knee joint, e.g. B. from jumps, sudden turns, falls, severe bruises, unnatural bending of the limb.

Depending on the extent and location of the damage, a distinction is made between complete and partial tears of the inner and outer collateral ligaments of the knee joint. A complete tear is characterized by a separation of the ligament into two parts or a separation of the tissue from the attachment site. With a partial tear, the fibers are torn, which is often confused with a sprain.

Depending on the cause, ligament tears can occur

• Traumatic, caused by increased stress on the joint;
• Degenerative, when the damage has occurred due to changes in joint structures due to degenerative changes, disease or age-related factors.

symptoms

Injury to the collateral ligaments of the knee joint is accompanied by characteristic symptoms:

• severe, stabbing pain that occurs when the knee is at rest;
• swelling of the soft tissues around the knee, spreading to neighboring areas;
• localized subcutaneous effusions;
• tenderness when touched;
• Difficulty moving the joint.

In some cases, the fibula tear is accompanied by an external deformation of the knee contour, and sometimes a characteristic crunching, popping sound is heard when trying to move.

causes

Ligament damage is most often caused by degenerative changes in the joint or trauma. In people with systemic connective tissue diseases, such as rheumatoid arthritis, the joint wears out more quickly. The joint system is affected by inflammatory processes in the surrounding tissues. A ligament tear, in which the individual fibers are no longer connected to each other, occurs when the elasticity and strength of the ligament weakens (more common in older people).

Damage to the ligaments of the knee joint is manifested by the following symptoms: Pain syndrome. Injury to the medial collateral ligament (inside) is accompanied by pain on the inside; the tear of the lateral collateral ligament (outside) causes pain on the outside. Swelling of the tissue with redness of the injured area. Possible formation of a hematoma. Joint instability is a feeling of instability or subluxation of the joint. This symptom is most pronounced when the leg is straightened. The severity of clinical symptoms depends on the extent of the injury. They can be associated with a bone fracture, patellar or meniscus injury.

How is it diagnosed?

By assessing the nature of the injury and examining the extremity, an experienced trauma surgeon can make the correct diagnosis. Additional examination methods to confirm the initial diagnosis:

• X-ray image – provides general information, allows the exclusion of fractures of bony structures
• MRI - the 'gold standard' for intra-articular injuries and ligament damage, slice-by-slice images of the desired area provide the doctor with maximum information
• Ultrasound – computed tomography
• Computed tomography is a radial diagnostic method and is informative about damage to bone structures. MRI allows you to visualize soft tissues that may be damaged in the event of an injury.

The specialists of our center carry out MRI scans for trauma, and after the scan you can contact a specialist in this field for a diagnosis and an up-to-date treatment plan.

How to diagnose

During the consultation, the doctor asks the patient about his complaints and collects anamnestic information. Other underlying diseases and risk factors are pointed out. The circumstances of a possible traumatic impact are explained. If there is suspicion of damage to the ligaments of the shoulder joint, the mobility of the shoulder is assessed.

Ultrasound examination. Ultrasound examination allows real-time assessment of the condition of the soft tissues.

X-ray. This method is used when the lesion of the ligamentous apparatus is accompanied by a bone fracture.

Magnetic resonance imaging (MRI). This is a more precise method of imaging soft tissues and bones and can detect even small lesions.

MRI is the preferred method for diagnosis. Specialists in MRI clinics can get a precise picture of the disease based on the examination results.

Diagnosis of lesions of the shoulder ligament

To properly diagnose the injury, the doctor must know the symptoms, timing, and circumstances of the injury. For a thorough examination, it is important to determine the type of pain to determine the extent of ligament damage. The specialist may also ask about previous injuries and how they were treated.

By examining the patient, the specialist will determine:

An x-ray examination of the patient may be ordered to rule out sprains, fractures, breaks, and other mechanical injuries. This is done if the doctor suspects that the shoulder ligaments are damaged.

Other diagnostic methods are usually:

• Arthroscopy – minimal surgical manipulation using special equipment;
• Ultrasound – examination using ultrasound waves;
• MRI – representation of the joint using a magnetic field.

Only a specialist can correctly assess the type and extent of ligament damage in the shoulder. Additionally, the symptoms of dislocations are similar to other possible shoulder injuries, so it is sometimes difficult to determine which injury the victim has suffered.

Treatment of shoulder ligament injuries

The first treatment is to eliminate all movement of the shoulder. It is advisable to immobilize the shoulder, tendons and ligaments for some time.

The doctor usually prescribes painkillers to reduce pain and swelling, as well as vitamins. The diet must be balanced - including hyaluronic acid, chondroitin and glucosamine in the diet accelerates the healing process.

In more severe cases, treatments include:

• cold compresses on the injured area;
• fixation of limbs;
• electroresection with anti-inflammatory drugs;
• Magnetotherapy – treatment with a magnetic field;
• Balneotherapy – treatment with mineral water;
• Paraffin therapy is a method of heat treatment with paraffin.

If the shoulder is dislocated or ligament is torn, no surgery is usually performed. Surgery is only indicated in rare cases where injuries result in complications.

Massage is necessary as the final form of treatment to allow the patient to fully recover from the injury. Exercise therapy with moderate movement control is also recommended.

To prevent shoulder ligament injuries, regular exercise, a balanced diet and weight control, correct training technique, etc. are essential.

classification

– Indirect mechanism (non-contact mechanism – not landing after a jump, twisting the leg when braking suddenly).

II. DIAGNOSIS AND TREATMENT METHODS, APPROACHES AND PROCEDURES

– Blood chemistry: (determination of glucose, total bilirubin, alanine aminotransferase, aspartate aminotransferase, urea, creatinine, total protein);

Minimum list of tests to be performed upon referral for elective hospitalization:

– Magnetic resonance imaging of the knee joint (indications: torn, dislocated and damaged knee ligaments)

– Blood chemistry: (determination of glucose, total bilirubin, alanine aminotransferase, aspartate aminotransferase, urea, creatinine, total protein)

– Collection of complaints and anamnesis, physical examination.

Complaints: Severe pain with accompanying swelling, feeling of slackness and instability of the knee joint, limitation of range of motion.

anamneseOccurs more often with an indirect mechanism of injury (unsuccessful landing after a jump, twisting of the leg during an emergency stop). More rarely, a direct blow to the knee joint.

X-ray of the knee joint in 2 projections: The abnormal congruence of the articular surfaces is noticeable.

Treatment

Antibiotic therapy.
Antibiotics are used for postoperative wound inflammation and to prevent postoperative inflammation. These include cefazolin or gentamicin if allergy to B-lactams is present, or vancomycin if methicillin-resistant Staphylococcus aureus is detected/at high risk. The Scottish Intercollegiate Guidelines and others strongly recommend antibiotic prophylaxis for this type of surgery (3,4,5). Changes in the antibiotic list for perioperative prophylaxis should be based on microbiological monitoring in the hospital.

Administration of NSAIDs for postoperative pain relief should be started intravenously 30-60 minutes before the expected end of surgery. Intramuscular administration of NSAIDs is not indicated for postoperative pain relief due to variability in serum concentration and pain caused by injection (7), with the exception of ketorolac (intramuscular administration possible).

NSAIDs are contraindicated in patients with a history of gastrointestinal ulcers and bleeding. Paracetamol, which has no effect on the gastrointestinal mucosa, is the drug of choice in this situation.

Table 1.. Medications used for shoulder joint dislocation (without anesthesia support)

Cruciate ligament injuries, symptoms and consequences.

The following cruciate ligament injuries can occur: sprain and complete or incomplete tear.

The main symptom of a cruciate ligament tear is the 'drawer sign'. This is characterized by the fact that the shinbone can move freely forwards or backwards. If the anterior cruciate ligament is torn, the shinbone may move forward slightly - this is known as 'anterior drawer symptom'. If the posterior cruciate ligament is torn, the shinbone may slip backwards slightly - this is known as the 'posterior drawer' symptom. Compared to the posterior cruciate ligament, the anterior cruciate ligament is more frequently damaged.

In older ligament tears, the symptoms of a drawer condition are not as pronounced because the fatty tissue at the site of the tear allows the knee joint to be partially stabilized.

causes of injury

Acute new and chronic injuries are treated conservatively by applying a cast and protecting the joint.

Chronic injuries require surgical treatment using arthroscopy. Arthroscopy is a minimally invasive surgical procedure that is inserted deep into the joint cavity through a small incision (approx. 4 mm). This method does not require an excessively large incision, which shortens the rehabilitation time after arthroscopy (up to 6 weeks) and significantly reduces pain. During rehabilitation, physiotherapy treatments and therapeutic massages, physiotherapy treatments and gradual limitation of physical activity are required.

The in. NI Pirogov Clinic of High Medical Technology, Department of Traumatology and Surgery No. 2

Conservative treatment

After diagnosing a torn knee ligament, the doctor recommends non-surgical treatment if there is partial damage to the connective tissue bundle fibers. This usually includes:

• Adhering to nutritional recommendations to ensure that the body receives the correct amount of vitamins, minerals and protein compounds it needs for recovery.
• The use of drugs from various pharmacological groups, including anti-inflammatory drugs, cartilage protective agents, calcium preparations and vitamins.
• Physical therapy. Magnetic therapy, mud baths and medicinal electrophoresis are used to accelerate healing of damaged structures and reduce the severity of inflammatory reactions.

Conservative therapy can be carried out on an outpatient basis. It does not require hospitalization as long as the patient follows medical advice in a disciplined manner.

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Surgical treatment is aimed at restoring the anatomical structure of the damaged structures. It includes several surgical techniques:

• Open approach surgery – the skin, subcutaneous tissue and capsule are cut to gain access to the damaged structures, followed by plication.
• Arthroscopy is a modern, minimally invasive technique in which an arthroscope with microtools is inserted through small incisions into the joint cavity to repair damaged ligaments.

Arthroscopy is now the procedure of choice because it minimizes trauma and shortens rehabilitation time.

Treatment of meniscus and cruciate ligaments

The severity of the injury determines the best course of treatment. The question of how to treat the injury can only be answered by a doctor. In NCC2, it is better if an orthopedic surgeon is available. In each case, an individual decision must be made as to whether surgical, conservative or physiotherapeutic treatment or a combination thereof is required.

Conservative treatment. It aims to eliminate the blockage of the joint. To do this, a puncture is made, the joint is cleared of exudate and blood, Novocaine is injected and then the blockage is removed. This is a step-by-step manipulation. If the result is favorable, immobilization is carried out. Conservative treatment is carried out:

If conservative treatment fails or the disease becomes chronic, the patient is recommended surgery. Surgery is recommended.. Which method is chosen depends on the complexity of the case, the patient's age and the presence of complications:

• Partial or complete removal of the meniscus (meniscectomy);
• If the injured person is young, physiotherapy rehabilitation can be carried out, which is the mildest method;
• The safest and preferred method is arthroscopy, in which the damaged segment is sutured;
• A relatively new method, intra-articular meniscal fusion, is characterized by low trauma and the use of special fixators;
• Meniscus transplantation is an expensive procedure and is used when other techniques have failed. There are contraindications to the operation.

Reconstructive period

Conservative treatment is recommended, which includes the following. physical therapy. The exercises are selected individually and the massage therapy has proven itself. This period lasts 2-3 months and its effectiveness depends on many factors.

Rehabilitation – the period after surgery is a long process. Its duration depends on the severity of the injury. A cast or stitches are necessary and freedom of movement is restricted. To make this time go by faster, you should follow the recommendations of the rehabilitation doctor at the CDC.

Operated knee meniscus injuries can be accompanied by complications:

• thrombosis of the great saphenous vein;
• entrapment of nerves;
• impairment of blood flow;
• infections;
• Sensitization to anesthetics.

The success of healing also depends on regular exercise. The course of physical therapy is determined by the doctor. If the patient turns to the specialists of NCC No. 2 (Central Clinical Hospital of the Russian Academy of Sciences), he will receive high-quality treatment for meniscus or ligament diseases, as well as effective rehabilitation treatment. For more information, call the clinic at (499) 400-47-33.

Treatment

Injuries to the meniscus and ligaments of the knee joint must be treated immediately. Partial damage to the cruciate ligaments leads to instability of the knee joint over time. If the patient performs a sedentary activity and the instability is not too great, immobilizing the joint with metal inserts is sufficient to keep the joint stable in the longitudinal plane.

In all other cases, or if the leg can no longer be supported at all, surgical treatment is required. There are various surgical and plastic procedures to strengthen the joint's capsular and ligamentous system. In cases where these are not effective, knee replacement surgery is performed. In the event of a torn meniscus, surgery is the only way to preserve the function of the joint. In addition to open surgery, small incisions can also be made through an arthroscope.

complications

Impairment of the function of the knee joint (loss of mobility), osteoarthritis, muscle loss of the hip.

prophylaxis

The following measures should be taken to prevent injuries to the meniscus and ligaments in the knee joint. Avoiding knee injuries at home and during sports. The extent of physical stress must correspond to the training level and age of the person affected. Wearing protective equipment during sporting activities. Always wear comfortable shoes.

What questions should you ask your doctor?

How does damage to the meniscus and ligaments of the knee joint occur?

Is surgery always necessary?

Advice for the patient

If you suspect that there is damage to the meniscus and ligaments of the knee joint, you should consult a traumatologist. To prevent such injuries, you should avoid hard work, direct blows, and falls on the knee.

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