Ligament ruptures and sprains. Rupture of the cruciate ligaments of the knee joint

Damage to the capsular ligamentous apparatus of the knee (CLA) is a fairly common injury among athletes and active young people. It is just as often diagnosed in victims of road accidents or other emergency situations. In addition, sprains are quite often recorded during unsuccessful falls during icy conditions. In this case, twisting of the lower limb occurs along the longitudinal axis, hyperextension in the knee joint, which leads to injury and long-term treatment.

The lateral ligaments can be damaged either alone or in combination with a sprain or rupture of the posterior cruciate tendon bundles. Most often during an injury, the medial ligament is damaged, much less often - the lateral ligament.

Collateral cords are located on the sides knee joint and limit the displacement of the tibia relative to the thigh. The following main ligaments of the knee are distinguished:

Medial or tibial ligament (MCL). It connects the inner sides of the femur and tibia and prevents the lower leg from moving outward.
Lateral or peroneal ligament (LCL). This connective tissue band secures the femur and fibula with outside joint and does not allow the tibia to deviate inward.

Guiding collateral cords are antagonists. They play a significant role not only in the dynamics of the knee joint, but also in the statics. When ligaments rupture, instability of the entire skeleton develops.

General information about capsular ligamentous injuries

The strength and reliability of joints depends on the condition of the ligaments and muscles surrounding the joint.
Injury to the fibers of the tendon bundle in medicine is called “stretching” and is grouped by type depending on the severity of the injury:

Thus, it is customary to distinguish between complete and partial rupture of the cord. In the second case, the connection between the tissues of the tendon bundle is maintained. With a complete rupture of the ligaments, damage to the fibers may be observed in one section of the bundle, or its complete separation from the attachment site may be noted, sometimes together with a bone fragment.

The ISS is more susceptible to stretching. However, damage to the UCL is usually combined with injury to all ligamentous components of the posterolateral region of the knee, so treatment and recovery of a combined rupture is more severe and lengthy.

Injury to the internal collateral ligament

ISS ruptures are most often diagnosed among people involved in potentially traumatic sports: snowboarding, football, basketball, alpine skiing. Often the cause of a sprained medial ligament is fitness, namely jumping rope. In addition, damage to the ISS is often observed among breaststroke swimmers. The cause is constant overstrain of the muscles of the lower extremities.

The injury is characterized by excessive displacement of the tibia towards the outside of the articular joint.

Signs of stretching

Damage to the ISS usually occurs as a result of direct impact on the knee joint as a result of a blow or bruise. The following symptoms are observed:

swelling of the affected area;
hematoma with inside hips;
hemarthrosis;
instability of the leg while walking.

With a complete rupture of the medial ligament, abnormal mobility of the joint and the inability to move independently are noted.

When stretched, flexion and extension of the knee joint are possible, but extremely painful.

Damage to the external collateral ligament

Ruptures of the UCL are recorded much less frequently than lesions of the ISS. The most common reason injuries - lateral blow to the inner surface of the knee. In this case, the tibia moves in the lateral direction, the ligament is stretched or torn.

In addition, stretching can be caused severe bruise the inside of the knee against a hard object or by twisting the leg outward during a fall. At the time of injury, the victim experiences sharp pain on the outside of the knee, and a cracking or clicking sound is heard.

Signs of damage

The following symptoms are characteristic of a UCL injury:

After a few hours, the pain is accompanied by extensive swelling of the outer area of the knee joint, and a hematoma is formed.

Due to special anatomical structure When the lateral ligament is damaged, hemarthrosis does not occur. If the LCL injury is combined with other lesions of the knee apparatus (rupture of the meniscus or cruciate bands, posterior capsule), then hemarthrosis will occur.

Treatment of collateral ligament injuries

First aid should be provided immediately after injury. The injured limb must be immobilized and placed in an elevated position, and a cold compress or ice. For fixation of the capsular-ligamentous apparatus in normal position You can also use an elastic bandage. Any load on the leg is eliminated.

The first stage of treatment begins with collecting an anamnesis about the mechanism of injury. The doctor examines the damaged joint, compares the level of deviation of the tibia compared to the healthy leg and prescribes an x-ray in two projections. The favorable outcome of the disease largely depends on the speed of contacting a doctor.

Based on the severity and nature of the damage to the tendon-ligamentous apparatus, further treatment tactics are determined.

If only a sprain of the collateral ligament of the knee is diagnosed, then conservative treatment is acceptable. In case of combined lesions or the presence of a complete rupture, surgical intervention is indicated.

The choice of one or another method of therapy can only be made by an experienced orthopedic doctor. Self-medication is unacceptable.

Conservative treatment

Stretching and tearing of the lateral ligaments of the 1st and 2nd degrees allows the use of non-surgical methods of therapy. The damaged area is anesthetized when large cluster A puncture is performed in the articular cavity. The leg is immobilized, sometimes with a plaster cast from the ankle to the middle of the thigh. In case of minor damage, you can get by elastic bandage.

The length of time the limb remains in a fixed position is determined individually for each patient. On average they are 30–45 days. After rehabilitation therapy, the affected person can gradually return to daily activities while continuing to support and protect the knee with an orthosis.

Complete rupture of the ISS is also treated conservatively. When the lateral ligament ruptures, surgery is required, since its ends diverge significantly from each other and independent fusion is difficult.

Medicines, physiatry

Further therapy includes taking anti-inflammatory, painkillers and antiplatelet agents, chondroprotectors, vitamins and mineral supplements. During the period of tissue healing, it is recommended to wear compression hosiery and limit the load on the affected limb. These actions are aimed at speeding up rehabilitation and reducing the risk of possible deep vein thrombosis.

A few days after receiving the injury, code inflammatory process And pain syndrome begin to decrease, specialists prescribe physiotherapeutic procedures. The most commonly used treatments are ozokerite applications, mud therapy, and magnetic therapy.

Often, after fusion of damaged fibers, the length of the tendon cord increases due to scar tissue. As a result, it ceases to perform a fixing and guiding function, and the knee joint becomes unstable. In this case, reconstructive plastic surgery is indicated.

If during injury the ligament is torn from its attachment point with bone fragment, the choice of treatment tactics depends on the size of the fragment and the angle of its displacement.

Surgical therapy

Depending on the location and characteristics of the damage, use different methods surgical treatment. In the case of a fresh injury or uncomplicated rupture, simple tissue suturing may be prescribed. For more complex injuries, plastic surgery of the collateral ligaments is used.

Reconstruction

The procedure involves suturing broken fibers, removing areas of necrosis, and attaching the damaged bundle to the articular fragment. When tissue is completely torn off, including together with a bone fragment, titanium fastening elements are used: staples, bolts, anchors.

In the case of a simple rupture in half, the ligament is sutured and the limb is fixed with a plaster or orthosis. This promotes faster tissue fusion.

Autotransplantation method

If, as a result of an old injury, chronic instability of the joint has developed over time, suturing is ineffective. In this case, complete replacement of the ligament is necessary. Autoplasty required. The material used is part of the semitendinosus tendon.

Before prosthetics, a section is taken from the inner area of the lower leg connective tissue, from which the graft is created. During the operation, channels are drilled into the bones, through which the fibers of the removed tendon are passed and fixed with titanium screws.

It is very important that the location of the graft completely replicates the anatomy of the original ligament. This is necessary to fully restore the functionality of the joint and reduce the risk of postoperative complications.

Often an artificial prosthesis is used as a substitute. This method is more effective and significantly speeds up recovery after surgery. The big advantage of this method is that the procedure is less traumatic. Modern materials take root well in the body and are completely safe.

Allotransplantation

This method is based on the use of natural tissue taken from a donor as a graft. Plastic surgery of this type is rarely used, since there is a risk of rejection of foreign material.

Today, the vast majority of operations to restore the integrity of ligaments are performed using arthroscopy, which significantly reduces the rehabilitation period and does not leave rough postoperative scars.

Recovery after surgery

The rehabilitation period can last from several weeks to 6 months. It all depends on the type of surgical treatment and the severity of the damage:

A minor grade 1 sprain will require the joint to be secured with an elastic bandage for at least 7 days.
Wearing the retainer during conservative treatment lasts no more than 4 weeks. During this time, the tissues have time to recover sufficiently.
It takes at least 45 days for the graft to engraft.
With a combined rupture, the rehabilitation period can take from 6 to 12 months.

Such recovery periods are quite realistic, provided that all doctor’s recommendations are carefully followed.

After 2–3 months, the affected person can return to active image life and sports activities. However, from now on you will have to be extremely careful, trying not to injure the AC joint again.

Particular attention is paid during the rehabilitation period, the purpose of which is to strengthen the muscles of the lower extremities. In addition to exercise therapy, great benefit During the rehabilitation period, physiotherapy and massage bring benefits. The procedures help reduce pain and swelling after surgery and improve blood circulation in the periarticular areas.

In addition, there are a number preventive measures, capable of strengthening ligaments and protecting them from sprains and tears in the future. These are the following events:

regular execution special exercises, strengthening the KSA;
cycling or exercising on an exercise bike or treadmill;
consumption of foods containing sufficient quantity vitamins and minerals;
selection of appropriate sports equipment and shoes;
getting rid of excess weight.

Conclusion

It is better to prevent damage to the ligaments of the knee joint than to treat it for a long time and persistently. However, it is not always possible to avoid traumatic situations. If problems arise, you must immediately visit a doctor, undergo the prescribed examination and carefully follow all recommendations. In this case, the prognosis of the disease will be favorable, and the recovery time will be as short as possible.

– partial or complete disruption of the integrity of the ligaments as a result of traumatic exposure. Widespread, may be complete or partial. The cause is usually a domestic or sports injury. The ligaments of the ankle and knee joints are most often affected. Damage to the ligaments is manifested by pain, increasing swelling, and limited support and movement. Often, a pronounced hematoma appears in the injured area on days 2-3. The diagnosis is made based on examination; if necessary, radiography, ultrasound and MRI are prescribed. Treatment is often conservative.

Ligament injury is an injury in which a ligament or its individual fibers are torn. Along with bruises, it is one of the most widespread traumatic injuries. Usually occurs as a result of a household or sports injury, and can occur in people of any age. Lower limbs suffer more often than the upper ones. There is a certain seasonality, for example, the number of injuries to the ankle ligaments increases sharply in winter time, especially during the icy season.

The immediate cause of injury is excessive pressure or range of motion that exceeds the elasticity of the ligament tissue. The most common mechanisms are twisting of the leg, less often twisting of the arm (for example, in case of an unsuccessful fall or playing contact sports). The degree of ligament damage can vary significantly - from a minor sprain, all symptoms of which disappear within 2-3 weeks, to a complete rupture, which requires surgical treatment.

Ligament damage: classification, diagnosis, treatment

Regardless of the location of the injury, in traumatology there are three degrees of ligament damage:

1st degree (stretching)– rupture of part of the fibers of the ligament while maintaining its continuity and mechanical integrity. In everyday life, such an injury is usually called a sprain, although in fact the ligaments are not elastic and cannot stretch. Accompanied by moderate pain. There is no bleeding, swelling is minor. There is a slight limitation of support and movements.
2nd degree (tear)– rupture of most of the fibers of the ligament. Accompanied by swelling and bruising. Movements are painful and limited. Minor instability of the joint may be detected.
3rd degree – ligament rupture. There is severe pain, large bruising, severe swelling and instability of the joint.

The diagnosis of ligament damage is made taking into account the mechanism of injury and examination data. In general, the more pronounced Clinical signs, the more fibers of the ligament must be torn. At the same time, it should be taken into account that swelling and hemorrhage increase over time, therefore, with very fresh complete ruptures, the symptoms may be less pronounced than with tears 2-3 days old. To assess the extent of ligament damage, an ultrasound or MRI of the joint is prescribed.

Ligament damage is differentiated from fractures and dislocations. When a dislocation occurs, there is a pronounced displacement of the bones relative to each other, the joint is severely deformed, normal anatomical relationships are disrupted, movements are impossible, and when passive movements are attempted, spring resistance is detected. In case of ligament damage appearance the joint is changed only due to swelling, the anatomical relationships are not disturbed, movements are possible, but limited due to pain, there is no spring resistance.

When a fracture occurs, deformity, crepitus, and pathological mobility. However, these are optional signs of a violation of the integrity of the bones; in some cases (for example, in a non-displaced fracture of the lateral malleolus) they may be absent. Other symptoms of a fracture (swelling, limitation of movement, pain and loss of support) are similar clinical manifestations ligament damage, so X-ray examination is necessary to make a final diagnosis. If necessary, MRI or ultrasound is also prescribed.

Treatment of incomplete ligament injuries is carried out in the emergency room. Patients are prescribed rest, physiotherapy and exalted position limbs. On the first day, it is recommended to apply cold (for example, a heating pad with ice) to the damaged area, then - dry heat. When walking, a tight bandage is applied to “hold” the joint and protect the ligaments from further injury. At rest, the bandage is removed. In no case should you leave an elastic bandage on overnight - this can cause a disruption in blood supply and cause increased swelling of the limb. For severe pain, patients are advised to take painkillers. Period active treatment usually 2-4 weeks, full recovery ligament occurs after approximately 10 weeks.

In case of complete ligament ruptures, patients are hospitalized in the trauma department. Immobilization is carried out, the limbs are placed in an elevated position, analgesics and physiotherapy are prescribed. In the future, depending on the location of the damage, both conservative therapy and surgical treatment may be indicated. As a rule, surgery to restore the integrity of the ligament is performed in in a planned manner. However, in some cases, surgery can be performed immediately upon admission. Subsequently in mandatory carry out rehabilitation measures.

Ankle ligament damage

It is the most common ligament injury. Usually occurs when the foot turns inward. The ligaments located between the fibular and talus or the fibular and calcaneal bones. In case of 1st degree injury (sprain), the patient complains of mild pain when walking, slight or moderate swelling of the joint, and walking function is not impaired. 2 degree of ligament damage (tear) is accompanied by severe swelling, spreading to the outer and front surface of the foot; there is a significant restriction of movement, walking is difficult, but usually possible. With grade 3 (complete rupture), intense pain occurs, swelling and hemorrhage spread throughout the entire foot, including its plantar surface, and walking is often impossible.

An MRI of the ankle joint reveals a partial or complete tear of the ligament. On radiographs of the ankle joint, with 1-2 degrees of ligament damage, there are no changes; with grade 3, a small fragment is sometimes visible bone tissue, torn from the bone in the area of attachment of the ligament.

Treatment for a sprain on the first day includes cold and tight bandaging. From 2-3 days, physiotherapy is prescribed: UHF, alternating magnetic fields, and subsequently paraffin or ozokerite. Recovery usually occurs within 2-3 weeks. If the ligament is torn, a plaster splint is applied to the limb for 10 or more days. The rest of the treatment is the same as for a sprain, the recovery period is several weeks. In case of complete ruptures, a splint is first applied to the joint; after the swelling subsides, the plaster is circulated and kept for at least 2 weeks. Subsequently, the bandage is modified so that it can be removed during exercise therapy, massage and physiotherapy. The cast is kept for up to 1 month, then for 2 months it is recommended to wear a special ankle support or elastic bandage to prevent re-damage to the ligaments. Surgery usually not required.

Damage to the lateral ligaments of the knee joint

Damage to the collateral ligaments occurs when there is forced lateral deviation of the tibia. If the shin deviates outward, damage to the internal ligament is possible; if it deviates inward, damage to the external ligament is possible. The internal ligament suffers more often, but usually does not rupture, but is only partially torn; in some cases, complete ruptures occur. The external ligament is less commonly affected, and, as a rule, complete ruptures, avulsions from the epicondyle of the femur, or avulsions from the head of the fibula along with a small bone fragment are observed.

The patient complains of pain, difficulty moving and walking. The joint is swollen, hemarthrosis may be detected. Palpation of the ligament area is painful, movement is limited. With significant tears and complete ruptures, excessive lateral mobility of the tibia is observed. In case of partial ruptures, a plaster splint is applied and UHF is prescribed. In case of complete ruptures of the internal ligament, conservative therapy, which includes immobilization, exercise therapy and physiotherapy.

Complete ruptures of the external ligament are accompanied by significant divergence of the ends, so such injuries require surgical intervention. During the operation, the damaged ends of the ligament are sutured or the ligament is repaired using the biceps femoris tendon. When a fragment of the fibula is torn off, the fragment is fixed with a screw. IN postoperative period carry out rehabilitation measures: massage, exercise therapy and physiotherapy.

Damage to the cruciate ligaments of the knee joint

The cruciate ligaments located in the cavity of the knee joint are damaged during extreme movements. The anterior cruciate ligament is usually torn when struck back surface bent knee joint, back – when hitting the front surface of the shin or sharp extension of the knee joint. Tears and tears cruciate ligaments, as a rule, occur when sports injury: while playing football, wrestling, skiing, etc.

When the ligaments of the knee joint are damaged, sharp pain. Movements become painful, the volume of the joint increases, and hemarthrosis forms in it. The hallmark of a torn cruciate ligament is the “drawer” sign. The doctor tries to move the patient's bent shin back or forward. With ruptures of the anterior cruciate ligament, there is an excessive forward displacement of the tibia, and with ruptures of the posterior cruciate ligament, there is an excessive posterior displacement of the tibia.

To exclude fractures, an x-ray of the knee joint is performed. To assess the extent of ligament rupture, MRI of the knee joint or arthroscopy is prescribed. Treatment includes puncture of the knee joint, immobilization for up to 1 month, exercise therapy, physiotherapy and massage. Surgeries are usually carried out 5-6 weeks after the injury, since early surgery can cause the development of joint contracture. The exception is ligament ruptures with a bone fragment and displacement of the fragment; in such cases, urgent surgery is indicated.

Indications for delayed ligament repair are gait disturbances and joint laxity. Simple stitching does not provide desired result Therefore, traumatologists perform plastic reconstruction of the ligaments using a graft from the patellar ligament. In some cases, damaged ligaments are replaced with artificial materials. In the postoperative period, antibiotics, analgesics, massage, physiotherapy and exercise therapy are prescribed. The patient is advised to avoid excessive stress on the knee joint.

TRAUMATOLOGY - EURODOCTOR.ru -2006

The external ones are most often damaged ligaments ankle joint . This occurs when moving awkwardly, when walking on an uneven surface, when the foot turns inward and bends towards the sole. In this case, the ligament between the talus and fibula or the ligament between the calcaneus and fibula may be damaged.

There are three degree of ankle ligament damage:

The first degree of damage is when individual fibers of the ligament are torn or torn. This injury is often and incorrectly called a sprained ligament, although in fact the ligaments cannot stretch.
The second degree is a partial rupture of the ligament. In this case, a significant part of the ligament is torn, but this does not lead to loss of function of the ligament.
The third degree is a complete rupture of the ligament or separation of the ligament from its attachment.

At first degree ankle ligament damage the patient complains of not severe pain when walking, palpating the ligament or ankle joint. Edema and swelling appear in the area where the ligament attaches. When walking, the patient feels pain, but the walking function itself is not impaired. The second degree of damage or partial rupture of the ligament is characterized by the spread of swelling to the anterior and outer surface feet. The pain when palpated is severe, especially at the site of the ligament tear. Walking may be difficult due to painful restriction of movement in the ankle joint, which is further aggravated by movement.

In case of first and second degree damage to the ankle ligaments, x-rays no deviations are detected.

In the third degree of damage to the ankle ligaments, the patient experiences severe pain when trying to step on the injured leg. Edema, swelling and hemorrhage are pronounced and spread over the entire surface of the foot, even affecting the plantar part. Walking is very difficult and very painful.

When a ligament is completely torn off, sometimes a piece of bone tissue to which the ligament is attached is torn off along with the ligament. This area of bone is visible on an x-ray.

As first aid for damaged ankle ligaments, a tight pressure bandage is applied and cold is applied over it. This helps stop bleeding at the tear site and reduce swelling and mobility of the ligament. For the first degree of damage, it is recommended to wear a pressure bandage for up to 2 weeks. Two to three days after the injury, physiotherapeutic treatment is prescribed (alternating magnetic field, baths, paraffin and ozokerite applications, massage). Recovery occurs within two weeks. With the second and third degrees of ligament damage, severe painful sensations which requires pain relief. The most effective is the injection of a 1% solution of novocaine or a solution of novocaine with alcohol into the area of the rupture.

With partial ligament rupture apply a plaster splint for a period of at least 10 days. Physiotherapeutic procedures are prescribed and physical therapy, during which the splint is removed. Recovery usually occurs within 3 weeks.

In case of third degree damage to the ankle ligaments When the ligament is completely torn from its attachment site, the patient must be hospitalized in the trauma department of the hospital. A closed plaster cast is applied to the joint for two weeks. Then the bandage is modified so that it can be removed during physiotherapeutic procedures and massage.

Treatment in this case lasts about one month. After ligament damage, the patient must wear an eight-piece gauze bandage or a special ankle joint support for two months to prevent re-rupture at the healing site of the ligament.

Description:

Closed mechanical injuries to ligaments, most often ruptures, sprains (distortion). The most commonly observed among ligament injuries is sprain of the ankle or knee joint, which consists of tearing of individual fibers of the ligaments with hemorrhage into their thickness or rupture of the meniscus (in the knee joint).

Symptoms:

Victims report pain in the joint when moving, swelling. The examination reveals local pain on palpation and bruising, which can occur 2-3 days after the injury. When ligaments are torn, more intense pain is detected, difficulty moving the affected limb, and often hemarthrosis. The phenomena of stretching subside after 5-10 days, and in case of rupture they continue for 3-4 weeks.
Main syndromes: pain, swelling, hemodynamic disorders (blood supply or circulatory disorders), functional disorders, hemorrhage (hematoma).

Causes:

A sprain occurs when one or more ligaments in the knee are overstressed, overstretched, or torn.
Damage to the lateral knee 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 outer collateral ligament of the knee joint is damaged.

Treatment:

For treatment the following is prescribed:

Treatment of ruptures can be conservative or surgical, depending on the nature of the damage. With any treatment option, painkillers and hemostatic measures are carried out, and the affected part of the body is provided with rest using immobilization. Also, depending on the location and nature of the injury, immobilization can be of different types ( soft bandages, removable splints, circular plaster casts) and by timing (1-6 weeks). Conservative treatment- tight bandaging of the joint, rest, cold for 2 days, then thermal procedures. During surgical treatment, after removing the plaster splint, therapeutic exercises, massage and physiotherapy.

Physical methods of treating ligament injuries are aimed at restoring the functions of the ligaments (fibromodulating methods), for which it is necessary to relieve (analgesic methods), restore impaired blood and lymph circulation of damaged tissues (vasodilator and lymphatic drainage methods), stimulate reparative and regenerative processes (reparative and regenerative methods) . Physiotherapy begins 1-2 days after injury, including after surgical treatment. If there is a removable splint, it can be removed during the procedures.

Ligaments in the human body perform a fastening function; they connect muscles to bones and bones to each other. Because of excessive load A sprain or even rupture occurs. It is worth noting that this injury one of the most common. Sometimes it is enough to just make one careless movement and a person will receive a similar injury; athletes especially often suffer from it.

Symptoms

To provide first aid to a person or, you need to know the symptoms and mechanisms of sprains. If you are involved in any kind of sport, then this information will be even more useful to you. Sprains typically occur due to overuse. Small tears form in the ligament tissue, causing pain to the person. If a person is seriously injured, it may rupture completely.

When sprained, the symptoms will be as follows:

Strong pain;
- swelling;
- bruise;
- redness;
- impossibility of movement.

However, only a doctor can more accurately determine the nature of the injury by conducting an X-ray examination of the joint. If during an injury a person feels some kind of click or crunch, and then it becomes simply impossible to move the foot, then there is a high probability that this is a fracture. It may be accompanied by sprain or rupture of ligaments.

How to give first aid

The more competent and timely the treatment is provided, the greater the chances for a quick and successful recovery. First aid consists of certain actions. First of all, shoes and socks are removed in order to completely eliminate any pressure on the sore leg. It is desirable that she be completely immobilized. The leg should be slightly elevated, for example, by placing a folded blanket or some kind of support under it, this way you can improve blood circulation.

It is necessary to apply ice to the sore spot, but this should be done correctly. Place the ice on a dry cloth for literally twenty minutes, then take a break for the same amount of time and put the ice on again. This procedure must be performed within the first two hours after injury. If ice is not applied in time, the recovery process will be longer. Next, you need to tightly bandage the damaged joint with an elastic bandage. If necessary, you can take some painkiller tablet.