Orthopedics-Online

Therapy of an inner ligament tear in the knee

introduction

Treatment of a torn inner ligament in the knee can be conservative or surgical, depending on the severity. The choice of therapy depends above all on the extent to which the inner ligament can be opened up due to the rupture and the extent to which there is instability.

surgery

The indication of an operation as therapy for an inner ligament tear in the knee is much rarer than the conservative treatment in the form of immobilization, rest and physiotherapy. Nevertheless, there are reasons that make surgical treatment of the torn inner ligament necessary.

An important indication for the operation is that it can be easily opened. This is checked by bending the knee 30 ° and subjecting it to a valgus stress (lateral bending movement of the lower leg to the thigh). If there is also enormous instability, an operation is inevitable.

Further criteria in favor of an operation are the fact that the inner ligament has completely ruptured, the involvement of other structures and the age. If the inner ligament is completely torn, the lesion is more severe than if it is only partially ruptured or torn.

The injury also requires surgery if there is bony involvement. In this case, the bony fracture parts must be reconstructed intraoperatively so that the anatomically correct position is restored. Various osteosynthesis methods are available for this purpose, for example the supply of screws to refix a broken bone fragment.

The age aspect is important because younger patients are operated on more often than older ones. Although there is no limit to the age at which an operation should no longer be performed, patients aged 50 and over are operated less often than younger people. In general, however, an individual clarification is useful, as it depends on the extent to which the joint is currently being used and how long it will be exposed to the stress. Younger patients put more stress on their knee joints and thus the collateral ligaments than older patients due to sporting activities. In addition, young patients have a longer life expectancy, which is associated with a longer exposure time to the inner ligaments.

Once the decision to have an operation has been made, the inner ligament is treated with a minimally invasive procedure. The prerequisite for being able to perform the arthroscopic procedure (arthroscopy = joint mirroring) is the fact that the region near the torn inner ligament has swollen and there are no longer any significant restrictions on movement. This means that immediately after an internal ligament rupture, it is not always possible to operate immediately. Until then, the rupture of the inner ligament should be treated by immobilization and rest with, if necessary, physiotherapy that promotes healing.

If the inner ligament is freshly torn, the ligament is restored or re-fixed intraoperatively. Either the two ends of the inner ligament are sewn back together or the torn attachment or point of origin of the ligament is fixed back to the bone.

Older tears in the inner ligament, however, are treated with a ligament replacement. There are two possibilities here, either using the body's own material as the transplant or material from outside the body. The former has proven to be a better option in terms of healing and prognosis in the past.

A final typical indication for the surgical treatment of the torn inner ligament is the so-called “unhappy triad” clinical picture. The three structures are injured at the same time: the inner ligament, the inner meniscus and the anterior cruciate ligament. In this case, of course, in addition to the ruptured inner ligament, the other two structures must also be treated surgically.

Benefits of surgery

An internal ligament rupture is only operated on if the damage to the ligament is complex and, for example, a piece of the bone has also been torn out. In this case, conservative (i.e. non-surgical) therapy is not possible and surgery is the only way to achieve healing or adequate stabilization of the knee.

One advantage of an operation on the knee joint is, of course, that the ligament can be directly refixed to the knee and the injury is corrected again. As a result, stability in the knee is more likely to be restored. In addition, pain should become chronic (permanently) less frequently after an operation.

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

Disadvantages of an operation

Any intervention carries the risk of complications. This includes, for example, the possibility of damage to structures such as nerves or blood vessels during the operation. Another complication is inflammation of the knee joint, which would result in a longer treatment period.

The time until the knee joint is fully loaded is not necessarily shorter than with conservative therapy. For this reason, surgery should only be performed for a ruptured inner ligament if the prospects for recovery with conservative therapy are not promising.

Illustration of the inner ligament tear

Inner band
(= inner sideband
of the knee joint) -
Ligamentum collaterale tibiale
Inner meniscus -
Meniscus medialis
Joint capsule -
Articular capsule
Femur - Femur
Kneecap - patella
Outer band
(= outer sideband
of the knee joint) -
Ligamentum collaterale fibulare
Outer meniscus -
Lateral meniscus
Anterior cruciate ligament -
Ligamentum cruciatum anterius
Fibula - Fibula
Shin - Tibia

You can find an overview of all Dr-Gumpert images at: medical illustrations

Conservative therapy

bandage

A bandage is used to stabilize and protect the knee as well as to relieve knee pain.

Since the stability can be limited after an inner ligament rupture or to prevent the tear from progressing, a bandage should be worn when the knee is stressed. Even after surgical therapy, a bandage is used to stabilize and immobilize the knee. The pressure exerted by the bandage on the knee joint promotes blood circulation in the knee, which also supports healing. It is important that the bandage sits well on the knee and fits, otherwise the stabilizing effect of the bandage is not given.

Orthosis

An orthosis is an aid that is used to stabilize, immobilize and relieve pressure in the event of knee joint injuries.

The orthosis can be used in conservative therapy to support the healing process or after an operation to prevent the knee joint from being excessively stressed after the operation. Orthoses can offer particularly active people an opportunity to move more easily during the healing phase. The orthosis is prescribed by a doctor and then made by an orthopedic technician. It is also important - as with a knee support - that the orthosis fits so that stability in the knee is guaranteed.

Taping the knee

Taping the knee with kinesio tapes in the event of an inner ligament tear can also be used to support conservative (non-surgical) or surgical therapy.

The tape, like bandages or orthoses, serves to stabilize the knee. Furthermore, the blood circulation in the knee can be stimulated, so that healing is promoted. It is important that the taping is carried out according to correct instructions and that these are followed.

physical therapy

Physiotherapy is considered a conservative therapy in the treatment of the torn inner ligament in the knee. Since this is not surgically treated in most cases, compared to the torn lateral ligament in the knee, physiotherapy is of great importance and can be regarded as standard therapy. However, if an internal ligament tear has to be operated on, postoperative rehabilitation is followed by physiotherapy, so that physiotherapy is not only used as a purely stand-alone therapeutic approach, but also in combination with operative care.

In both cases, the primary goal of physiotherapy is to stabilize the knee joint and to positively influence the healing process. The instability in the knee increases with the severity of the internal ligament injury. Therefore, depending on the severity of the inner ligament tear, particular attention must be paid to restoring stability.

Training the leg muscles is particularly suitable for this. By strengthening the muscles, the knee joint can be stabilized and ligament guidance can be supported. The aspect of muscle development is also important if an operation has previously been carried out and the surrounding leg muscles have atrophied, i.e. regressed, through prolonged immobilization of the knee joint. In order to be able to guarantee sufficient stability, the muscular system must first be rebuilt through training. Leg muscle training is also important from a preventive perspective.

Once the inner ligament has ruptured, the risk of renewed injury is increased. Therefore, the muscles should be strengthened in order to be able to absorb and compensate for loads or strong forces on the knee joint, more precisely on the inner ligament. In addition to muscle building training, exercises for movement sequences and coordination are part of the physiotherapy. In addition, the patients receive a kind of training to become aware of dangerous movements and to avoid unfavorable movement patterns.

Therapy of pain

Pain occurs immediately after the injury and is often accompanied by other symptoms.

Therefore, the so-called PECH scheme (break, ice, compression, elevation) should be used immediately after the injury. Cooling the knee helps reduce the pain. In addition, pain relievers, so-called NSAIDs (non-steroidal anti-inflammatory drugs), can be taken for a short period of time. These include drugs such as ibuprofen or diclofenac. These drugs also work against inflammation in the knee joint at the same time. In addition, ointments with pain relievers such as diclofenac that are applied to the knee are a way of counteracting pain.

Homeopathic remedies can also be taken to support the pain. Globules containing arnica, calendula, apis mellifica or ruta graveolens act against the pain. Physiotherapy treatment is important as well and can relieve pain. If the pain occurs during exercise, bandages can stabilize the knee joint and reduce pain. Taping the knee can also reduce pain.

Duration of therapy and healing

The duration of therapy naturally depends on how severe the tear in the inner ligament is and what treatment is then indicated. Another relevant aspect is whether other structures are affected. As soon as menisci, cruciate ligaments or even bony areas are damaged in addition to the inner ligament, the healing period is extended by several weeks.

In general, healing takes at least a few weeks, but should take a maximum of 12 months. Minor injuries in which the inner ligament is not completely torn are usually treated conservatively so that stress or light sporting activity is possible again after 2-8 weeks. A full recovery usually occurs after about 3-4 months.

Of course, the healing process is very individual, so that some patients can only put weight on the knee again after 6-9 months without symptoms. In any case, it is important that the follow-up care is under medical supervision. The rehabilitation should also be long enough so that the once injured inner ligament has enough time to heal, otherwise the risk of chronic ligament instability or a renewed ligament lesion is increased.

In general, however, the inner ligament rupture is an injury that heals without complications and has a good prognosis. In order to protect the knee for the period immediately after the injury, it is particularly useful, depending on the professional activity, to take sick leave for a certain period of time. The sick leave is usually issued by the family doctor. The length of sick leave depends on certain factors such as severity, choice of therapy and occupational stress on the inner ligaments.