Knee ligament injury

Definition

Knee ligament injury is a common injury that is more common in active young people and usually occurs at home or during sports. Knee ligament damage is caused by excessive joint movement (overextension, twisting of the limb on the axis, tibial extension, or retraction). Sometimes, the damage occurs due to impact or pressure on the lower leg. Patients with damage to the ligaments of the knee joint complain of pain, limited mobility, and swelling in the area of the joint. Diagnosis is established based on anamnesis and clinical examination; to exclude a fracture, radiography may be performed. MRI of the knee joint, diagnostic puncture, or arthroscopy are additionally prescribed.

General information

Knee ligament injury is a common injury, especially in active young people. It usually occurs at home or during sports. Knee ligament damage is caused by excessive joint movement (overextension, twisting of the limb on the axis, tibial extension, or retraction). Sometimes, damage occurs as a result of impact or pressure on the shin.

Classification

The following degrees of damage to the ligaments of the knee joint are distinguished:

• Grade I. Partial rupture of the knee joint ligaments (individual fibers are torn). Such damage is often called stretching of the knee joint ligaments, although the ligaments are not elastic and cannot be stretched;
• Grade II. Incomplete rupture of knee joint ligaments;
• Grade III. Complete rupture of the ligaments of the knee joint. Usually combined with damage to other elements of the joint (capsule, menisci, cartilage, etc.).

Considering the localization of trauma in traumatology, injuries of the lateral (external and internal) and cruciate (anterior and posterior) ligaments are distinguished.

Lateral ligament injury

Anatomy

Two collateral ligaments are located on the lateral surfaces of the knee joint. The collateral peroneal ligament at the top strengthens the joint from the outside. It attaches to the femur’s outer condyle above and the fibula’s head below. The collateral tibial (medial collateral) ligament, respectively, is located on the inner surface of the joint. Above, it is attached to the inner femoral condyle, below – to the tibia. In addition, some of its fibers are attached to the joint capsule and the internal meniscus, so injuries to the internal collateral ligament are often combined with an injury to the internal meniscus.

Damage to the external collateral ligament of the knee joint

The outer lateral ligament is less often damaged than the inner ligament. Damage to the ligaments of the knee joint occurs when the tibia is excessively tilted to the inside (e.g., tucking the leg). The rupture is often complete and may be combined with a detached fracture of part of the fibula head.

Symptoms

The patient complains of pain in the area of the lesion, which increases when the tibia is tilted to the inside. Movement is limited. The joint is swollen, and hemarthrosis is determined. The severity of symptoms depends on the degree of damage to the ligaments of the knee joint. In the case of a complete rupture, there is looseness (excessive mobility) in the joint.

Damage to the inner lateral ligament of the knee joint

The internal collateral ligament is more commonly injured but is usually incomplete. The injury occurs when the tibia is excessively tilted to the outside. This knee ligament injury is often combined with a tear of the inner meniscus and damage to the joint capsule, which can be diagnosed by MRI of the knee joint.

Symptoms

The joint is edematous. Pain is determined when probing, movement, or tibia deviation to the outside. Hemarthrosis is revealed. Movement is limited. Complete rupture is accompanied by excessive mobility in the joint.

Treatment of injuries to the lateral ligaments of the knee joint

Stretching and tearing of knee joint ligaments are treated conservatively by traumatologists. The site of injury is anesthetized with analgesics. The puncture is performed if there is a large amount of blood in the joint. A plaster splint is applied to the leg from the ankles to the upper third of the thigh.

A complete tear of the inner collateral ligament is also treated conservatively. A complete tear of the external collateral ligament requires surgical intervention, as the ends of the ligament are usually distant from each other and cannot heal on their own. The ligament is sutured during surgery with a lavsan suture or tendon autoplasty. Grafts are used in case of ligament separation. In the case of a detached fracture of the head, the bone fragment is fixed to the fibula with a screw.

When the ligament fuses, its length is often increased due to scar tissue. As a result, the strengthening function of the ligament is reduced, and the knee joint becomes unstable. If other joint structures (capsule, cruciate ligaments) do not compensate for this instability, reconstructive surgery (ligament reattachment or tendinoplasty) is performed.

Cruciate ligament injury

Anatomy

The cruciate ligaments are located inside the knee joint and connect the articular surfaces of the tibia and femur. The anterior cruciate ligament attaches at the top to the posterior-upper surface of the external condyle of the femur, passes through the joint anteriorly and internally, and then attaches to the articular surface of the tibia in its anterointernal part.

The posterior cruciate ligament attaches to the anterosuperior surface of the inner condyle of the femur, runs posteriorly and externally in the joint cavity, and then attaches to the articular surface of the tibia at the posterior external aspect of the tibia. The anterior cruciate ligament prevents the tibia from sliding to the front, and the posterior cruciate ligament keeps the tibia from sliding to the back.

The anterior cruciate ligament is damaged by a blow or pressure on the back of the bent tibia. The posterior cruciate ligament is damaged by overextending the tibia or by a blow to the front of the tibia. Damage to the anterior cruciate ligament is more common. Turner’s triad (“unhappy triad”) is not uncommon: a combination of an anterior cruciate ligament tear with damage to the external collateral ligament and a tear of the internal meniscus.

Symptoms

The knee joint is swollen and painful, and fluid is detected in the joint cavity. The main clinical sign of cruciate ligament rupture is the drawer symptom (excessive mobility of the tibia in the anteroposterior direction). The doctor bends the patient’s relaxed leg at an angle of 90 degrees, then holds the thigh with one hand and moves the tibia to the back and front with the other.

If the tibia is displaced to the front, there is a failure of the anterior cruciate ligament. The posterior cruciate ligament is not intact if the tibia is displaced to the rear. This symptom may be negative in the case of a partial tear (sprain) of the cruciate ligaments. Diagnostic arthroscopy of the knee joint is performed for a more complete examination of the associated injuries in case of knee ligament damage.

 

Treatment

In case of partial tears, conservative treatment is performed: puncture of the joint and plaster splint for up to 5 weeks. Complete ligament rupture is an indication for surgery. Ligament integrity can be restored using the classical method (through open access) or endoscopically (using an arthroscope). Arthroscopic operations are less traumatic. In case of fresh injuries of knee joint ligaments, the end of the ligament is sutured to the bone; in case of old tears, repair or replacement of the ligament with an autograft from the patellar ligament is performed. Surgery is performed 5-6 weeks after the injury. Surgical intervention should not be performed earlier, as it may lead to the development of contracture (limitation of movement) in the joint.

All these treatment options are available in more than 900 hospitals worldwide (https://doctor.global/results/diseases/knee-ligament-injury). For example, Arthroscopic reconstruction of the knee ligament can be performed in these countries for following prices:

Turkey $5.2 K – in 26 clinics

China $8.7 K – 14.5 K in 8 clinics

Germany $12.9 K in 43 clinics

Israel $26.6 K in 16 clinics

United States $27.0 K in 17 clinics.