Ligament injuries of the knee

The knee joint needs soft tissue support in order to remain in balance and perform its functions due to its anatomical structure and multitude of functions. The soft tissue supports of the knee joint are examined in 2 groups as intra-articular and extra-articular.

1-Intra-articular structures:
Anterior cruciate ligament
posterior cruciate ligament
inner meniscus
external meniscus

2-Extra-articular structures:
inner lateral ligament
outer lateral ligament
Muscles

Injury to one or more of these structures may impair the functions of the knee joint as well as disrupt the anatomical integrity of the joint. Knee injuries are usually in the form of sports injuries, but also in the form of traffic accidents, falling from a height, direct impact and knee sprain. The severity of the injury is usually directly proportional to the damage to the joint. It is necessary to look at the treatment as 2 stages: First of all, emergency treatment; What to do immediately after injury. In the second stage, the treatment that will ensure the structural and functional integrity of the knee.

Emergency Treatment: In the first stage, it should be checked whether there is a dislocation or fracture in the joint, and if there is, emergency treatment should be performed. Vascular and nerve injuries are frequently seen in knee injuries, especially in dislocations. These should be evaluated and treated immediately. If there is no vascular and nerve injury, the damaged joint should be taken to rest (with plaster, bandage or knee brace) and the joint should be expected to settle with ice application and drug treatment. During this period, the patient should avoid stepping on his leg and use crutches if necessary. After the joint has subsided, the knee should be re-evaluated by the orthopedist and the degree of ligament injury in the joint should be determined.

Stage I: There is an incomplete tear in the ligament. There is continuity of the ligament and the findings are usually mild. In the first stage, rest, ice and medication are sufficient.
Stage II: The ligament is not completely torn, but there is elongation and stretching in the neck. They can usually be treated with joint fixation for 3-4 weeks, but surgical treatment may be required if there is no complete healing.
Stage III: The bond is completely broken. There is a feeling of emptiness in the joint. Non-surgical treatments can be applied in such injuries, but if there is not sufficient healing, a permanent feeling of space and subluxation (semi-dislocation) may develop in the joint. In this case, the ligament will need to be repaired or restructured.

The most frequently injured ligaments of the knee joint are the medial cruciate ligament, the anterior cruciate ligament, and the lateral lateral ligament. The posterior cruciate ligament is rarely torn and usually occurs as a result of direct blows to the knee. Ligament injuries can be single or multiple ligament injuries. This condition often results in knee dislocation and is a serious injury. Surgical treatment is often required after emergency treatment.

Injury of lateral ligaments: Since the inner lateral ligament prevents the opening of the inner part of the knee, it can be injured due to excessive stretching in the side impacts of the knee while standing. In this case, the inner part of the knee opens, while the outer part narrows. This injury can occur alone or in combination with other ligament injuries. The most frequently injured structures with the medial lateral ligament are the anterior cruciate ligament and the meniscus. It is important in the treatment whether there is additional injury or not. While non-surgical treatments are usually sufficient in isolated injuries, surgical treatment may be required in case of accompanying cruciate ligament and meniscus injury.

Injury of the lateral ligament: In the lateral ligament, it works exactly the opposite of the mechanism. With the impact on the inner side of the knee, while the outer side is opened, the inner side is closed and the increased tension in the outer lateral ligament may cause injury. Healing is slower and more difficult than the lateral ligament. For this reason, the fixation period of the knee should be longer than the inner lateral ligament. The treatment is like the internal lateral ligament in stage I and II injuries. Stage III injuries require surgery.

Anterior cruciate ligament injuries: It is mostly in the form of sports injuries. The ligament is torn as a result of the foot remaining fixed on the ground during reverse movements and the thigh turning outward, especially in sports played on the carpet field, due to the fact that the field does not slide. Treatment of anterior cruciate ligament injuries is usually determined by the patient’s needs, instability of the knee, and whether there is additional injury. If the patient does active sports and wants to continue, if he is a young patient, if the feeling of space in the knee negatively affects his daily life or professional life, and if there is an additional meniscus or ligament injury, surgical treatment should be applied. Reconstruction of the ligament is preferred because the repair of the ligament in surgical treatment fails due to insufficient healing potential of the cruciate ligaments. Usually, the kneecap beam or back muscle beam taken from the person is used. Cadaver beams can also be used.

Whether the treatment is surgical or non-surgical in knee ligament injury, physical therapy is essential. Maintaining the range of motion of the joint and strengthening the muscles during and after the treatment affect the success of the treatment.

Meniscus injury: The meniscus has very important functions in the knee joint. These are load transmission, ensuring the harmony of the thigh and tibia during movements, and ensuring the stability of the joint (keeping the joint in place). The injury mechanism usually occurs when the thigh is forced outward while the foot is stationary on the ground. In older patients, if there is wear on the meniscus, simpler strains (such as kneeling, stepping down the stairs, etc.) occur. In the diagnosis of meniscus tears, injury history and examination are usually sufficient. If additional injury is suspected and the clinic is unclear, the diagnosis can be made by MRI. In the treatment, the patient’s complaints and the degree of the tear are important in deciding. Generally, the preferred treatment is to clean the torn parts of the meniscus with the closed method by imaging the joint with a camera. Meniscus repair can be performed in suitable patients and tears.

Muscle injury: Injury to the muscles around the knee joint occurs when the muscles are exposed to excessive stretching as a result of not doing enough warm-up exercise before sports. Serious injuries are rare and usually occur in the form of small muscle tears. The treatment is mostly rest, ice and physical therapy after drug therapy. Rarely, there may be complete rupture of the muscles from their attachment to the bone. In this case, depending on the function of the muscle, surgical suturing may be required.

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