Breaking of the patellar ligament: causes, symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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ICD-10 code
S83.6. Stretching and rupture of other and unspecified elements of the knee joint.
What causes a patellar ligament rupture?
The most common rupture of the patellar ligament occurs with a direct mechanism of injury.
Closed ligament injuries in most cases are the result of indirect violence - a movement that exceeds the functionality of the joint. Distinguish strains and ligament ruptures. Since the extensions have been considered, we will dwell on the discontinuities.
Isolated closed ligament ruptures occur most often in the knee, ankle and first metacarpophalangeal joints. Damage to ligaments of other joints, as a rule, accompany fractures and dislocations of bones.
With the rupture of one or more ligaments of the knee joint, its support function is broken - there is instability, podvikhivanie, which is termed "instability of the joint."
Symptoms of rupture of patellar tendon
Patients complain of pain and instability in the knee joint.
Classification of patellar ligament rupture
The patellar ligament ruptures can be partial and complete.
On the basis of the degree of morphofunctional disorders of all anatomical formations of the functional system of the knee joint, GP Kotelnikov identified three forms of its instability: compensated, subcompensated and decompensated.
- In patients with a compensated form of post-traumatic instability of the knee, most qualitative indicators are usually close to normal. Clinically, almost no muscle atrophy is detected, their strength is estimated at 5 points. Only the use of the device to detect instability in the joint allows us to establish a pathology. Arthroscopy helps to detect damage to specific anatomical structures. Biopsy and the study of indicators of functional and biomechanical examination (electromyography, rheovasography, subgraphy, etc.) indicate that the existing changes are only slightly inconsistent with the norm.
- In patients with a subcompensated form of joint instability, qualitative indicators have been changed. Periodically there is pain and a crunch in the joint, there is atrophy of the muscles of the thigh. The difference in the circumference of the hips reaches 3-4 cm. Instability manifests itself with considerable loads and running. At half of patients instability is revealed clinically, almost at all - with the help of special devices for diagnosing rupture of ligaments. Strength of the flexor and extensor of the lower leg to 4 points. On the roentgenograms, the changes corresponding to gonarthrosis of stages I - II are found. Additional methods of research confirm the presence of pathology in the joint.
- In the decompensated form of instability, the rates of clinical and morphofunctional examination are significantly deviated from the norm. Patients complain of constant pain, instability in the knee joint even when walking, sensation of crunching, clicks, the appearance of lameness. Some patients use a cane. When examined, a sharp atrophy of muscles is detected with a decrease in strength of less than 4 points. Pathological mobility in the knee joint is clinically noted by all patients, so the need for additional devices to determine the instability disappears. X-ray and microscopic studies reveal changes in the joint, characteristic of arthrosis of II-III degree.
The proposed classification allows to solve tactical tasks in the choice of the necessary method of treatment.
[Diagnosis of patellar ligament rupture
Anamnesis
In the history - an indication of an appropriate injury.
Examination and physical examination
On examination, the swelling and bruising below the patella are revealed. With the tension of the quadriceps muscle of the thigh there is no tonus of the patellar ligament. The patella is located above the usual place. Movement in the knee joint is moderately limited due to pain, except active flexion, which is absent - a positive symptom of the "stitched heel".
Laboratory and instrumental research
On the radiographs of the knee joint, high standing of the patella is revealed, sometimes tearing fractures of tuberosity of the tibia.
Treatment of rupture of patellar ligaments
Conservative treatment of patellar ligament rupture
With an incomplete rupture, conservative treatment of a patellar ligament rupture is possible
Surgical treatment of patellar ligament rupture
With complete ruptures, the ligaments are reconstructed surgically, using classical sutures or their combinations used to sew the tendons.
After the intervention, a circular gypsum bandage is applied from the inguinal fold to the ends of the fingers for 6-8 weeks. With old ruptures, patellar ligaments resort to her auto- or alloplasty.
A cut is made 8-10 cm long in the projection of the patellar patch. Stupid scar tissue is stupidly and sharply divided and forms a bed for the transplant. Shilom form the transverse canals in the middle of the patella and tuberosity of the tibia. Take a graft from the wide fascia of the thigh on the "feeding leg". Conduct it consistently: from the outside to the inside through the patellar canal, then down through the canal in the tuberosity from the inside to the outside, then upwards. Stretch the graft after the maximum patella reduction and stitch with the beginning of the graft at the entrance to the first canal. In the middle part, both portions of the transplant are stitched together, immersed in the scar and into the remaining remains of the ligament, and sewed over the transplant.