Knee ligament lesions

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The knee is the largest joint in the body and is vital for movement. Side and cruciate ligaments provide knee stability.
The cruciate ligaments connect the thigh (femur) and shin (tibia) bones through the knee joint. These ligaments connect these two bones tightly together like a short rope, providing the necessary stability when the knee is bent and straight. The anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL).

The lateral ligaments fix the femur and tibia bones by connecting them internally and externally (the external lateral ligament attaches to the fibula bone located on the outer back of the tibia and indirectly fixes the tibia). It prevents the knee joint from opening to both sides. At the same time, it supports the cruciate ligaments in fixing the rotational movements of these bones.

Anterior Cruciate Ligament (ACL) Injuries

The ACL prevents the tibia from sliding forward relative to the femur. It also prevents the rotational movement of the tibia.
The anterior cruciate ligament can be injured in the following ways;
• Sudden change of direction, knee rotation
• Do not slow down while running, sliding
• When landing on the ground after jumping
• Direct blow to the string

Symptoms

When your anterior cruciate ligament is injured, you may not feel any pain immediately. However, a snapping sound or impaired knee control is often felt. Within 2-12 hours, the knee swells and there is pain when standing up. Ice application and raising the leg until the orthopedist can see it reduce the development of pain and swelling.
If walking with an anterior cruciate ligament tear, the knee cartilage may be damaged. Especially when the body is rotated while the foot is stationary, the thighbone (femur) rotates while the shinbone (tibia) remains stationary. This has a grinding-injury effect on the cartilage.

Diagnosis

The basic diagnosis and evaluation method of ACL tears is examination. There are various examination tests. In particular, stability tests that make the decision to operate are performed by examination.
In patients with this type of injury, direct x-rays to detect other bone pathologies and MRI for intra-articular pathologies may be requested. In rare cases, arthroscopic examination may be required.

Treatments

There are surgical and non-surgical treatment alternatives.

Non-Surgical Treatment;
• Incomplete (partial) tears
• Age or those with generally low physical activity
• In stability tests (such as the pivot shift test), the general stability is in good condition.
Surgical treatment may not be required in the knees. It is recommended that such patients do regular exercises to improve the anterior and posterior thigh muscles (quadriceps and hamstrings) and use special knee braces for risky activities.
Surgical treatment;

It is necessary for active patients who have an ACL tear and want to do sports. It is recommended for people with occasional knee rotation and less active activity to restore confidence in the knee and prevent cartilage damage.
In surgical treatment, a tendon (or a part of it) around the knee is generally used arthroscopically to provide a reconstruction suitable for the original anatomy of the anterior cruciate ligament. After ACL reconstruction surgery, a serious physical therapy and rehabilitation program is applied for about 3 months.
Posterior cruciate ligament (PCL) injuries

The posterior cruciate ligament (PCL) is not injured as often as the ACL. PCL injuries are usually caused by excessive strain and pull. The most common cause is caused by a bending motion towards the front of the knee. This type of movement can occur with a wrong step, but it occurs more frequently in sports such as snowboarding, motorcycle, football.

Knee stability is impaired in PCL injury. In particular, the tibia slides backward relative to the femur. This movement can cause injury or thinning of the soft knee joint cartilage. This wear may result in calcification in the future.
Symptoms in PCL injury are similar to ACL tears. However, instability findings such as knee rotation are rarer.
Most people with a PCL tear return to their normal activities without surgery after a good rehabilitation program. Athletes who have ruptured the PCL with a bone fragment from the tibia or who cannot return to their pre-accident performance despite rehabilitation may require surgery.

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