Rupture of cruciate ligaments of the knee joint - Causes, symptoms and treatment. MF.
Cross-shaped( cruciate) ligaments are located in the articular cavity of the knee. The anterior cruciate ligament is attached from one side to the back of the thigh bone projection, passes through the articular cavity and joins on the other side to the anterior part of the pit of the tibia. The anterior cruciate ligament fixes the joint, preventing a strong shift of the tibia anteriorly. The posterior cruciate ligament of the joint connects the lateral surface of the condyle with the posterioris muscle of the tibia and passes through the joint of the knee, fixing the joint and preventing the shin from moving in the "posterior" direction.
Damage to the anterior cruciate ligament occurs with the greatest frequency due to forces exerted toward the front of the knee joint with the bent and directed inward tibia. More often the ruptures of cruciate ligaments result from rapid sudden movements in the joint of the knee.
Rupture of cruciate ligament of knee
The main causes of rupture of knee ligaments are:
• force on the thigh or lower leg;
• sudden braking;
• landing from a height on the straightened legs;
Symptoms of knee ligament rupture
The ruptures of the cruciate ligaments of the knee joint are of three degrees:
• first degree: in the tissue of the cruciate ligament there were micro-ruptures. This causes pain in the knee, mobility is limited and there is a slight puffiness.
• second degree : the symptomatology is similar, as in the case of a small rupture, however, if such a trauma took place at least once, most often it repeats. The consequence of this is a decrease in the elasticity of the tissues, wear of the ligaments. Secondary trauma can occur with the usual turn of the foot.
• third degree: is the most dangerous, since it represents a complete rupture of cruciate ligaments, this is accompanied by soreness and limited movements. The joint becomes extremely unstable, the function of limb support is impaired.
There are often "combined" gaps. The most dangerous injury is the rupture of two cruciate ligaments, two lateral ligaments and the most articular bag. As a result of this, extreme joint instability arises and to complete loss of support for the injured limb.
Symptoms of rupture of cruciate ligaments of the knee joint include:
• painful sensations
• swelling,
• limited movements in the knee
• symptom of "balloting" of the knee cap
• instability, "looseness" of the joint.
• symptom of the "drawer".
Often the symptoms of rupture of the cruciate ligament of the knee joint are similar to the symptoms of other knee injuries, such as bruise, meniscus damage, sprains, dislocated knee cap. Therefore, with these symptoms it is important to consult a doctor for proper diagnosis and treatment.
First aid for rupturing the knee ligaments
The first help in rupturing the cruciate ligaments of the knee joint is that the victim is given pain medication, rest is provided, the ice is applied to the damaged joint, the knee is fixed and raised.
The victim must be taken to a medical facility. If there is no such possibility, in the first 24 hours after the injury, the victim must limit any movement of the injured leg to avoid further damage to the joint ligaments. In the first twenty-four hours, cryotherapy should be used - apply ice or cold compresses to the damaged area. This helps reduce the hemorrhage in the tissue.
A tire, bandage, or wrap around the limb should be applied with an elastic bandage. With severe pain, the patient should take non-steroid pain medications. In no case, the place of damage can not be heated, it is forbidden to "tilt" the knee.
Diagnosis of knee ligament rupture
There are following methods for diagnosing the rupture of cruciate ligaments of the knee joint:
• talk with the patient to find out the circumstances of the
injury • reception of the "drawer".In order to diagnose ruptures of cruciate ligaments, the doctor tries to shift the victim's shin anteriorly or backwards. In the case of rupture of the anterior cruciate ligament, the shin is strongly biased forward. In the case of rupture of the posterior cruciate ligament, the shin is effortlessly displaced posteriorly. If the rupture happened a long time ago, the symptom of the "drawer" becomes indistinct due to the development near the place of damage to the fatty subcutaneous tissue that stabilizes the knee.
• Arthroscopy-joint is inspected from the inside with the
probe • X-ray
• Computed tomography and mrt( rarely used due to high cost)
X-ray: rupture of the cruciate ligament of the knee
Treatment methods for the cruciate ligament rupture of the knee joint
Treatment begins with a puncture of the injuredjoint in order to eliminate blood fluid from the joint bag. The doctor leads the place of damage to novocaine. Then, making sure that the motor functions of the joint are not violated, and the meniscus is not damaged, the limb, slightly bent at the knee, is mobilized with a plaster bandage for up to one month.
Inpatient monitoring is not required. After the gypsum is removed, the doctor prescribes LPC, massage and physiotherapy procedures. Immediately after the injury, surgery is not performed because of the risk of complications. In the case of fracture of the bone fragment and its displacement, surgical operation is urgently performed.
Thus, conservative methods for treating knee ligament rupture include:
•
anesthesia •
edema removal •
mobilization Surgical treatment of cruciate ligaments of the knee joint
The indications for a surgical operation on the cruciform ligaments are the "looseness" of the joint and the impossibility of painless movement with the supporton the damaged limb. The operation is performed 5-6 weeks after the injury. Bunches do not stitch, because it does not lead to a positive sustainable result. A plastic restoration is performed using a part of the patella ligament. In some cases, endoprosthetics of ligaments with artificial materials are performed.
For optimal outcome of surgical intervention for restoration of ligaments, it is necessary to choose: a graft of suitable strength and rigidity, correctly locate and fix the transplant. As a transplant the surgeon uses:
• autografts from the nasolabial ligament
• grafts from the hamstring
• allografts( donor)
The lifespan of artificial ligaments is limited.
In the case of the appointment of surgical treatment, the patient is placed in a hospital, most often for a period of two weeks.
Post-operative rehabilitation period
The cruciate ligament transplant has the greatest strength during the transplant process. Consequently, the primary task of the surgeon is to ensure the speedy mobilization of the joint and prevent joint "weakness."This goal is achieved through the optimal fixation of transplanted tissue.
It is necessary within a week to limit any physical effect on the knee, for this it is necessary to use crutches. The load should be increased gradually, this should occur in conjunction with physiotherapy procedures. For the first three to five days, the injured leg should always be in a raised position. Physiotherapy should be combined with regular lymphatic drainage.
Due to clinical trials, it is known that moderate knee stress contributes to the best healing of the graft, as this produces new collagen fibers that provide elasticity and strength of the tissues. Thus, for today, doctors prefer an active rehabilitation period, involving a special set of physical exercises that are specifically designed to restore the functioning of the knee joint after rupturing of the cruciate ligament.
The postoperative period involves gymnastics, which positively affects the strengthening of the transplant. It is recommended to practice:
• semi-squats with a slope of the
• a variety of gentle foot exercises
• moderate walking
Forecast after rupture of knee ligaments
The period of incapacity for cruciate ligament rupture is approximately 2 weeks. Patients engaged in manual labor can return to work 4-6 weeks later.
In the case of swallowing, after six to eight weeks after surgery, the patient can begin to perform physical exercises such as swimming, walking, cycling, etc.
Patients are strongly advised not to actively engage in sports for six months after surgery. Sports are recommended only after a year.
Rev.doctor of traumatologist-orthopedist Savchenko V.R.