Torn anterior cruciate ligament in a child
Synonyms
Anterior cruciate ligament rupture, ACL rupture, anterior cruciate ligament lesion
definition
Under a anterior cruciate ligament tear in the child, as in the adult, one understands a complete, or in the case of a tear, an incomplete, interruption of the continuity of the front Cruciate ligament (ligamentum cruciatum anterius) in the Knee joint.
introduction
The ligaments of the human body consist of taut, tight fibers connective tissue. By nature, these tapes are great stable and suitable for withstanding large loads.
If one compares the anatomical structures of the knee joint in children with those of adults, there are no differences in structure apart from the size. Children are therefore almost as often affected by injuries to the knee joint as, for example, anterior cruciate ligament tears.
The anterior cruciate ligament is part of the band apparatus of that Knee joint secures. It is located within the Joint capsule and together with the posterior cruciate ligament (ligamentum cruciatum posterius) and the posterior meniscus ligament (ligamentum meniscofemorale posterius) the inner ligaments (Internal bands) of the joint.
The tape also connects the Thigh bone (Femur) with the Shin (Tibia).
In addition to the Inner bands there are still those Outer bands (Collateral ligaments), namely the outer and inner collateral ligament. As the name suggests, these fiber structures are externally on the joint and outside the joint capsule.
While the outer collateral ligament Thigh (Femur) and Fibula (Fibula) connects with each other, stand over the inner collateral ligament Thigh (Femur) and Shin (Tibia) in connection with each other.
Above all, the inner ligaments are functional, including the cruciate ligaments Cohesion and stability of the joint body is responsible, as the thighbone would otherwise slip out of the flat socket of the tibia. In addition, the cruciate ligaments restrict mobility in the knee joint and thus ensure even more stability.
When the joint is moved, the ligaments wrap around each other when turned inwards and apart when turned outwards.
In addition to mechanical functions, the inner bands also contribute to Sensory function (Proprioception) by using specialized nerve endings to detect the position of the joint in space and using the Spinal cord to the brain conduct.
Due to their position, the cruciate ligaments, especially the anterior cruciate ligament, are right prone to injury such as overstretching or cracks (Ruptures). Torn ligaments in the knee joint are among the most common injuries, but can usually be treat well. However, treatment in children is often more difficult than treatment in adults.
frequency
In around 40% of the cases, ligaments are injured most common knee injury Next Lesions of the menisci (small discs of cartilage inside the knee joint) or one popped kneecap. In 50% of the cases tear that anterior cruciate ligament, the rear is much better protected from cracks due to its anatomical position.
73% of the cruciate ligament tears occur Sports accidents, only 27% have other causes, such as accidents at work or at home. When the sports are most common skier (28%) or Soccer player (23%) those who suffer.
Children tend to be not quite as often affected like adults, because their ligaments are a little more flexible, but they suffer more often ligament tears Bone involvement. The even softer bones of the little ones are responsible for this.
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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".
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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.
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causes
Cause of one Torn anterior cruciate ligament in the child, as in adults, is primarily one Exceeding the extensibility of the tape. If a ligament is overstretched to such an extent, the causal rotation usually came from the X-leg (Valgus) -Position out. Cruciate ligament tears therefore often occur as Sports injuries on. Especially Soccer player, Tennis player or ski-and Snowboarders are often affected here. But also squash, hockey or basketball, so all sports with them frequent, quick changes of direction can cause knee injuries.
Children who play soccer or are learning to ski also suffer such injuries. But also in everyday life, for example during Romp around or on the playground can it through for example sudden twisting or twisting happen that the child suffers such an injury. However, not only extreme inward or outward turning movements can be the cause of a cruciate ligament tear, but also excessive extension or flexion movements when tense Thigh muscles.
Cause for one Rupture of the posterior cruciate ligament are rather rare trauma, such as a car accident. If the anterior cruciate ligament tears, this is often due to the movement pattern and the spatial proximity to each other inner meniscus (small, crescent-shaped cartilage disc in the knee joint) and the Inner band affected. The meniscus can tear completely or partially, as can the inner ligament.
This pattern of injuries, also known as,classic skier injury"Is known, is called the" unhappy triad "(unfortunate trio).
Forms of the cruciate ligament tear in children
In general, if an anterior cruciate ligament ruptures, between three forms can be distinguished. Dem complete crack, the Crack or partial crack with overstretching of the outer band structures and the Crack with bone involvement.
Complete crack (complete rupture):
In this case the cruciate ligament is completely torn, the continuity completely interrupted. There is also no longer any band connection between Thigh and Shin, the stability of the Knee joint can no longer be sustained. The lower part of the torn band no longer grows together with the upper part by itself, as it sinks downwards due to the force of gravity.
Crack (Partial rupture):
With this type of injury only those inner parts of the band affected, the "shell" remains intact, but is often overstretched due to the injury pattern. Even so, the stability of the joint cannot be properly maintained. If the inner part of the ligament remains connected, then there is also the Chance of self-healing.
Tear of the bony connection:
If the anterior cruciate ligament ruptures in children, it is not uncommon for part of the bony structure to be torn out with it, as the bones of children are still proportionate soft are. The affected bone is often that Shin (Tibia) as the Thigh bone (Femur) is much thicker.
Then the shin is missing at the upper end a piece of bone, the ligament itself is still there intact or torn. If bony structures are involved, a Self-healing also excludedAs with a complete crack, since the pieces of bone are no longer connected to one another and can no longer grow together.
Symptoms
A ligament tear is produced different symptoms. The first signs of a rupture of the anterior cruciate ligament can often be noticed while the injury is developing. Loud cracking, tearing, or even popping, as well sudden severe pain during awkward movement of the child suggest ligament involvement. Immediately afterwards you can quickly make one swelling and pulling pains in the joint noticeable.
The joint changes color blue or reddish, this indicates a spreading bruise in the joint. This is created by Blood vessels in the vicinity of the belt, which were also damaged due to the injury. But the bruise can also first after some time (Minutes to hours) occur.
Does it come to the storage of blood in the joint, is the skin Tightly stretched over the knee and shiny, the knee feels hot.
Since the cruciate ligaments, especially the anterior cruciate ligament, normally stabilize the knee joint and limit mobility, a cruciate ligament rupture can instability or abnormal mobility to be watched. The shin bone can be unnaturally wide when the leg is bent forward against the thigh move.
If the inner ligament is also involved in addition to the anterior cruciate ligament, a lateral shift watch the two bones against each other. When the little patients try to step on or to walk, they often bend in again hobbling gait to relieve the damaged knee is typical.
The children also complain of pain Movement or touch. It is also typical for the pain symptoms of a torn ligament that the pain subsides after a short time at rest, under pressure but occur again increasingly. The pain at rest is characterized as dull and throbbing, when loaded as stabbing or pulling.
diagnosis
If an anterior cruciate ligament rupture is suspected, the diagnosis usually begins with a survey by the doctor to the accident. For children who are still too young, the parents may have to answer the doctor's questions.
On the Anamnesis interview that follows Palpation of the joint by the examiner. This procedure is quite uncomfortable for the little patients, because that knee due to the torn ligament pressure sensitive is. In order to avoid causing pain to the children and to relieve them of the fear of further examinations, this should be done extremely careful be proceeded. It often helps if parents or trusted people are present during the examination to calm the little ones down.
In addition to palpating the injured area, there are Movement tests, which can quickly confirm the suspicion of a torn cruciate ligament. On the one hand there is always the Drawer test carried out. An attempt is made to do this with the knee bent Lower leg forward against the Thigh to move.If the joint were not injured or the ligaments were intact, it would be no shift to observe.
However, if there is a torn anterior cruciate ligament, the abnormal mobility causes a forward shift, a so-called ,,front drawer"Or a positive drawer test (also Lachmann test).
Similarly, you can also use the drawer test for the posterior cruciate ligament carry out. If the lower leg can be moved backwards, this is a sure sign of a defective posterior cruciate ligament.
Another movement test is thePivot Shift Test". The lower leg is used for this turned inwards under pressure. Does it come to Displacement of the tibia at the articular surface, this indicates a torn cruciate ligament. The pivot shift test is positive.
Once the history and movement tests have been completed, the imaging procedures the diagnosis of anterior cruciate ligament rupture can be definitively verified. Means roentgen it is primarily examined whether bony structures are involved in the crack. If there is such an involvement, the x-ray quickly shows that a piece of the bone is missing that was torn out with the tape.
Isolated torn ligaments without harm to cooking can best be done using a Magnetic resonance imaging (MRI) can be diagnosed. A radiologist can work on one MRI image of the knee joint Either determine the damage to the ligament directly or determine the degree of injury from the backward deviation of the thighbone.
Magnetic resonance imaging is also most suitable for children because the small patients no radiation exposure (like x-rays) because the imaging is based on a magnetic field generated for the body harmless is.
The disadvantages of x-rays and magnetic resonance imaging, however, are that the children very quiet have to behave, but this is very difficult for them, especially in exceptional situations caused by injury. Here, too, it can be helpful if the parents are present at least before and after the examination. With a few exceptions, parents can during the actual examination not be present, especially since you shouldn't unnecessarily expose yourself to x-rays.
If X-rays and MRIs cannot provide a clear diagnosis, the doctor will resort to them in rare cases diagnostic jointoscopy (Arthroscopy) back. The main disadvantage of this procedure is the fact that it involves an intervention general anesthetic acts. Although the operation is only minimally invasive, the risks compared to magnetic resonance imaging or X-ray diagnostics increase. However, if the diagnosis turns out to be an advantage,anterior cruciate ligament tear“Can confirm, directly after the arthroscopy, still under the same anesthesia Restoration of the cruciate ligament respectively.
therapy
Therapeutic measures for a cruciate ligament injury are usually based on the Extent of injury. Exists a Joint effusion, the joint may need to be punctured. A joint puncture, i.e. piercing the swollen joint with a needle to drain the fluid that has flowed into it Blood, is especially necessary if the effusion prevents healing or further treatment. After removing the effusion, subsequent therapy can either conservative or surgical to be addressed.
Conservative:
Is the tape only overstretched or torn and are not bone Affected, the injury can be conservative, that is not operational be treated. Likewise will be Tears in the posterior cruciate ligament often treated conservatively.
Immediately after the accident, it can be helpful to close your knee cool and to burden as little as possible to prevent symptoms from getting worse. During the closed season, the leg can use Forearm crutches be relieved.
Medication with Painkillers (Analgesics) may or may not be useful depending on the intensity of the pain Consultation with the doctor respectively.
If the injury was a long time ago, after the pain has subsided, it is mainly on Lymphatic drainage to eliminate swelling and systematic muscle building in the Thigh set to stabilize the knee.
Physiotherapy and physiotherapy are also sensible therapy options after the acute phase. Children are common bad conservative because, depending on their age, they don't even understand that they shouldn't put weight on the leg, for example. Furthermore, children should as few drugs as possible take, therefore pain medication is also a critical point during conservative treatment.
Operational:
Is it a complete crack, an operation of the joint should be considered, as the lack of stability in the joint can lead to the rubbing of bones and the formation of a arthrosis can come.
Nowadays torn ligaments are no longer sewn, but with a graft fitted. As a graft either a piece of the Hamstring (Patellar tendon) between Kneecap and Shin or the Semitendinosus tendon (Thigh muscle tendon) is used. The operation will minimally invasive under general anesthetic carried out and lasts about an hour.
By two very small cuts (about 5mm) on the knee, the instruments and a camera are inserted into the joint. Then the graft tendon is fitted exactly into the knee joint and self-releasing (bioresorbable) Screws fastened in the bone.
Due to the minimally invasive procedure, the duration of the inpatient Hospital stay to a minimum reduced become. After about 1-3 days the patient can leave the clinic after a successful operation.
For treating children, surgery is that Means of choice. After the anesthesia, the young patients do not notice any more of the treatment and will be in the period after the operation thanks to minimally invasive intervention not long tormented by pain. To only two nights the children can then return home to their familiar surroundings.
Follow-up treatment:
Whether it is surgery or conservative therapy, it should definitely be one Cruciate ligament tear S.rail be worn to the leg to stabilize and avoid consequential injuries caused by careless movements. Physiotherapy and physiotherapy are the most important points in the follow-up treatment of an anterior cruciate ligament tear.
There is for children as well as for adults various physiotherapy exercises to strengthen the muscles and improve stability in the Knee joint. Children can do many exercises, for example exercises with one trampoline Bring it closer in a playful way, which makes follow-up treatment extremely easy and sometimes even fun.
Lymphatic drainage as part of physiotherapy is useful, but can be used in children difficult have to be carried out, since they have to remain calm here too.
Forearm crutches to relieve the leg are also difficult to use in children, as the little ones either cannot handle the crutches at all or are much too impatient to use them consistently, depending on their age. Parents should be at this time much patience with their children have around them difficult recovery period to facilitate.
Duration
Depending on the type of therapy, either conservative or surgical, it takes the cruciate ligament tear to completely heal 3 weeks to 2 months. In exceptional cases, the healing process can take several months.
Becomes conservative must be treated complete decongestion wait, which can take up to two months.
After surgery, the foot should 2-3 weeks just partially burdened become (up to 20 kg). It is helpful here to place the affected leg on the scales and increase the load until it shows around 20 kg. If necessary, the procedure can be repeated more often in order to get a feeling when a load of 20 kg has been reached.
Until approx 6 weeks after the operation should be a Knee brace be worn to ensure good stability.
Light training or intensive physiotherapy should be approximately after taking off the motion rail 6-8 weeks respectively. Sports that require sudden movements and changes of direction should still be 6-8 months after the ligament tear not be exercised as it gets here quickly Consequential injuries or even one new cruciate ligament tear can come.
This time can seem infinitely long for children because they may not be able to practice their hobby and do not have sufficient exercise. Despite possible whining and imbalance of the little ones, the medically prescribed rest breaks should must be strictly observed to ensure healing without consequences.
forecast
If conservative therapy was used, the healing process takes longer significantly longer and the risk that the affected ligament will not grow together properly and thus tear again more quickly increases. In conservative therapy, if too early stress or careless movements lead to rubbing Thighbones and tibia can be a long-term consequence of a arthrosis form. This is often necessary lengthy treatment and can very painful be.
In contrast, surgical therapies have the advantage of healing more quickly and consequential damage is rather minor. The majority of patients tolerate the tendon implant well. Just Rare it comes to Tear of the implant or to permanent instability.
In the past, people were often reluctant to operate on children for a ruptured cruciate ligament. Today, however, it is believed that just kids should be operated on. This statement is justified, among other things, with the activity of the little ones. Children are more impatient, more active than adults and have a bigger one Urge to move. After surgical treatment, you can usually deal with this earlier and without risk than after conservative treatment.
prophylaxis
It is difficult to really prevent a cruciate ligament tear. When exercising, it helps to do enough before training to warm up and to stretch. Children should be taught as early as possible how to warm up properly so that there are no injuries.
There is also a lot here to keep the sport fun factor Games or playful exerciseswith which to do this. For example, instead of running laps to warm up, you can play catch.
Will winter sports like Snowboarding or skiing If you have learned and practiced sufficient warm-up training, it is of course necessary here as well. You can come home with you before your skiing holiday Ski gymnastics kick off. These are special exercises that target precisely those muscle groups that are particularly stressed when skiing.
The most important factor in winter sports is that concentration. Especially on the last day's descent, carelessness or fatigue lead to falls and injuries. So if you notice beforehand that the children are getting tired or unable to concentrate or are starting to overestimate themselves, it is advisable to do one additional break to insert.
Cruciate ligament ruptures in children can hardly be prevented in everyday life, but here they only occur sporadically.
A rupture of the anterior cruciate ligament in children is not uncommon, but can usually good and without permanent damage be treated.
