Torn ligament on the knee

definition

One speaks of one Torn ligament on the knee, it can mean different bands. Both the Sidebands as well as the Cruciate ligaments be cunning. In both cases, a ligament tear (synonym: ligament rupture), as the name suggests, is a tear or tear off of the respective ligament structure.
In principle, a torn ligament on the knee does not necessarily mean the complete tear, it can also be just one Crack act of band structures.
The knee is also considered to be a joint that is predisposed to a ligament injury because it has a long lever arm.

to form

On the one hand, there are important band structures that can tear Lateral ligaments (outer ligament tear, inner ligament tear)namely the inner and outer band, and the two Cruciate ligaments (anterior cruciate ligament tear, posterior cruciate ligament tear), anterior cruciate ligament and posterior cruciate ligament. Theoretically, these ligaments can all rupture in isolation, but a combination of ligament ruptures is far more common and likely.
Worth mentioning is the knee injury called "Unhappy Triad". Here it comes to a simultaneous rupture of 3 structures: the Inner band, the anterior cruciate ligament and the Indoor mensicus.

In addition to the classification according to the affected ligament structure, a torn ligament on the knee can also be classified as a recent or chronic injury.

root cause

As common cause a ligament rupture is the Rotational movement in the knee joint with the lower leg bone fixed. This puts the ligaments under so much stress that at a certain point they can no longer withstand this and then tear off. That particular point in time is called Point of elasticity. If it is exceeded, the result is a torn ligament, before that it can already Strains or strains the tapes are coming.

Such rotational traumas are for sports like soccer games, squash or handball typical as it is often too quick changes of direction comes and twisted the knee. In addition to the frequent sports injuries, traffic accidents can also rupture the ligaments of the knee.
The posterior cruciate ligament is particularly vulnerable. When seated, our knee joint is bent to about 90 °. At this point, the collateral ligaments are somewhat loosened and not tense as in the extended or standing position. This eliminates a major factor that secures and stabilizes the knee joint from rotation, so that external forces such as a rear-end collision affect the cruciate ligaments.
As with the Triple injury "Unhappy Triad" it is not uncommon for other structures of the knee joint, such as the menisci or bony areas, to be affected in addition to the ligaments.

There is also some debate nowadays that some people might have a certain predisposition for a torn ligament on the knee. It is currently assumed that a woman's anterior cruciate ligaments tear more often than a man's. Why that is so cannot be explained.

Appointment with a knee specialist?

I would be happy to advise you!

Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
Various television programs and print media report regularly about my work. On HR television you can see me every 6 weeks live on "Hallo Hessen".
But now enough is indicated ;-)

The knee joint is one of the joints with the greatest stress.

Therefore, the treatment of the knee joint (e.g. meniscus tear, cartilage damage, cruciate ligament damage, runner's knee, etc.) requires a lot of experience.
I treat a wide variety of knee diseases in a conservative way.
The aim of any treatment is treatment without surgery.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

You can find me in:

• Lumedis - your orthopedic surgeon
  Kaiserstrasse 14
  60311 Frankfurt am Main

Directly to the online appointment arrangement
Unfortunately, it is currently only possible to make an appointment with private health insurers. I hope for your understanding!
Further information about myself can be found at Dr. Nicolas Gumpert

Symptoms

A torn ligament on the knee is a very painful injury. The sharp and sharp pain sets in immediately after the rupture event, which is sometimes audible as a "popping" or popping noise. The source of the pain depends on which ligament on the knee is torn. In addition to the main symptom of pain, a torn ligament is usually always accompanied by swelling of the knee joint. The swelling can be traced back to a joint effusion, which is mostly bloody and therefore also bears the name hemarthrosis. Those two symptoms are very characteristic of a torn knee ligament.

Which structure is ultimately affected can be narrowed down by the instability that occurs. Those affected, whose inner or outer ligaments are affected, increasingly bend away inward or outward. If the cruciate ligament ruptures, some patients feel that the lower leg is slipping forward under the knee joint. In general, an unsteady gait can be seen due to the loss of stability.

A torn ligament is usually accompanied by restricted mobility.The degree of movement is limited by the joint effusion and the associated swelling. Your own perception of pain also limits further mobility and resilience.

Read more on the subject below Pain knee

diagnosis

The diagnostic spectrum for a ligament rupture in the knee is relatively broad. Before diagnostic tools such as X-rays or magnetic resonance imaging are used, the clinical examination many possibilities based on Stability tests to check whether there is a torn ligament and if so, which ligament is affected.

As with any examination, however, the first thing is the Inspection and palpation of the knee joint. The first important indications of a torn ligament can already be identified here: Is there any fresh ligament rupture occurs frequently Accompanying symptom of the bloody joint effusion, the so-called hemarthrosis. Acute hemarthrosis shows up as a swollen, slightly discolored skin change on the knee joint.
You can do this by palpation Sign of the "dancing patella" check for joint effusion. To do this, the doctor with one hand strokes the suprapatellar recess, a bursa, of the lying patient with an outstretched leg. At the same time he presses on the kneecap with the other hand (patella) and pay attention to a resilient resistance, which is indicative of a knee joint effusion.

With the different Stability studies There are specific tests for each group of ligaments of the knee joint that can be used to demonstrate increased mobility due to a ligament rupture and can be carried out following inspection and palpation.
The first will be Inner and outer band tested. You put your knee under it Valgus and varus stress. This refers to the stress on the knee including the ligament structures from forces that cause the joint to bend laterally (= valgus stress) and a second time medially (= varus stress).
When performing the valgus stress, the lateral ligaments are compressed and the medial inner ligaments are stretched and tested for stability. With the help of the varus stress you can control the functionality of the outer ligament. Increased "foldability" when kinking hardens the suspicion of a torn ligament. In addition, the pain provoked by the two tests can indicate a meniscus lesion.

To Control of the cruciate ligaments can the Drawer phenomenon and the Pivot Shift Test be performed.
With the drawer phenomenon, instability is tested in terms of increased mobility, in that the doctor bends the patient's knee, sits on the tip of the foot and grasps the lower leg. Now he pulls the lower leg forward once and then pushes it backwards. An anterior instability indicates a rupture of the anterior cruciate ligament, a posterior instability suggests that of the posterior cruciate ligament.
Another test that is positive for an anterior cruciate ligament rupture is the pivot-shift test, also known as the subluxation test. Here you press the lower leg against the knee and then simultaneously perform an internal rotation under valgus stress. The pivot shift test is then to be assessed as positive if there is a painful subluxation, an incomplete joint dislocation of the tibial plateau to the front and outside.

If a torn ligament is suspected, in the vast majority of cases one will be Imaging of the knee joint. Here is a MRI of the knee best, as this is where the band structures are best assessed.

Another test, which is similar to the drawer phenomenon in its implementation and how the pivot shift tests the anterior cruciate ligament, is the Lachmann test. In contrast to the drawer phenomenon, the knee joint is not angled at 90 ° but only 30 °. In this slightly flexed position, the mobility can then also be checked.

All of these clinical stability tests are used to diagnose a fresh ligament lesion. If there is a chronic ligament injury, a reduction in the size of the thigh muscles can be seen.

As Ensuring the suspected diagnosis A torn ligament will almost always be one MRI of the knee prescribed. In comparison to X-rays, magnetic resonance tomography does not use X-rays, but rather the magnetic field and radio waves. Ligament tears can be identified with this imaging method detected very well become. X-rays tend to capture bony structures, so often one X-ray to rule out an accompanying fracture is arranged.

treatment

The Choice of treatment in the event of a torn ligament based on the Extent of the injured ligamentswhether the ligaments are completely or only partially torn and whether other structures have been affected.

A First measure should, regardless of the decision to use conservative or surgical therapy, use the PECH schemes be. The letters contain the respective treatment steps: So you should start with the Stop straining the knee (P = pause) and then the cool affected region (E = ice). It is also important to bandage or with the knee compress cool wraps (C = Compression) and after put up (H = elevation). All 4 steps are aimed at reducing swelling and relieving pain.

The decision was a torn ligament conservative treat is usually taken when it comes to one isolated or partial torn ligament acts. The conservative choice of therapy is also supported by the assumption that the slight instability due to the torn ligament can be compensated for by the surrounding, well-developed muscles. In addition, it is not uncommon for those affected to consult a doctor long after the rupture, due to increasing symptoms. Old torn ligaments in such cases are no longer operative but conservatively cared for.

This conservative treatment takes the form of Support rails, so-called orthoses or a plaster cast. These aids ensure relief, stabilization and immobilization of the knee joint so that the structures can regenerate stress-free. The splint holds the knee joint in the correct position and keeps the structures in motion during movement. A isolated inner or outer ligament tear can for example by a 6 week plaster cast be immobilized.

To Decrease in complaints, so the pain and swelling, it makes sense with one physiotherapy treatment to begin to strengthen the ligaments and surrounding muscles again. The Strength training and also the coordinative movement school should stabilize the knee joint again in order to make another injury less likely and to regain the former load tolerance. The instability is compensated for by targeted muscle building training to such an extent that those affected can fully load their knee joint again even with purely conservative care.

If the stability cannot be regained through conservative treatment, the Indication for surgical treatment posed. Further criteria that speak for an operation are the Involvement of cartilage-bone damage, fresh and complicated ligament tears (e.g. "Unhappy Triad") or that Not responding to conservative therapy. The latter aspect is often the case despite the patient's compliance with regard to conservative treatment in the form of rest, gentle treatment and physiotherapy.

Depending on which band structure is torn, appropriate surgical technique elected. Generally are Capsular ligament plastics indicated when muscular stability is not possible and the patients are still very young. As a rule, parts of the patellar ligament or the semitendinosus muscle are removed and used as a ligament replacement. The indication for surgery, especially in the case of a cruciate ligament rupture, is particularly advantageous for young, athletic patients, as studies have shown that this group can benefit enormously from restoration through ligament surgery and regain full stability and resilience.

Usually the Surgery in the form of a joint reflection, the so-called joint arthroscopy. This is a minimally invasive procedure in which the necessary instruments are only introduced through small skin incisions and no major surgical scars remain. The Duration of arthroscopy on the knee is significantly reduced compared to an open operation.