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Tears of the lateral ligaments of the knee joint: causes, symptoms, diagnosis, treatment
Last reviewed: 23.04.2024
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ICD-10 code
S83.4. Stretching and tearing (internal / external) of the lateral ligament of the knee joint.
What causes ruptures of the lateral ligaments of the knee joint?
Lacerations of the lateral ligaments of the knee joint occur with an indirect mechanism of injury - excessive deviation of the shin to the inside or outside, with a lateral ligament torn opposite to the side of the deflection.
Symptoms of ruptures of the lateral ligaments of the knee joint
Patients are concerned about pain and instability in the knee joint, with local pain at the site of the rupture.
Diagnosis of ruptures of the lateral ligaments of the knee joint
Anamnesis
A characteristic trauma in the anamnesis.
Examination and physical examination
The joint is swollen, its contours are smoothened. On the 2nd-3rd day after the injury, there is a bruise, sometimes extensive, descending to the shin. Determine the presence of free fluid (hemarthrosis): a positive symptom of swelling and ballotation of the patella. Palpation reveals local soreness in the projection of the damaged ligament.
When the lateral ligament ruptures, the excessive deviation of the tibia is noted in the direction opposite to the damaged ligament. For example, if there is a suspicion of the rupture of the inner lateral ligament, the doctor with one hand fixes the outer surface of the patient's knee joint, and the second deflects the shin outwards. The ability to deflect the shin outward is much greater than on the healthy leg, indicating the rupture of the inner lateral ligament. The patient's leg should be unbent at the knee joint during the examination. In acute trauma, these studies are performed after the introduction of procaine into the cavity of the knee joint and its anesthesia.
After the acute period has subsided, the patients have instability of the knee joint ("podhikhivanie"), which causes the injured to strengthen the joint by bandaging or wearing a special knee. Gradually develops muscle atrophy of the limb, there are signs of deforming gonarthrosis.
Laboratory and instrumental research
If the development of deforming gonarthrosis begins, the clinical diagnosis can be confirmed by X-ray examination using the device proposed in the clinic. The roentgenogram clearly shows the expansion of the joint gap on the side of the injury.
[Treatment of ruptures of lateral ligaments of the knee joint
Indications for hospitalization
Treatment of an acute period of trauma is performed in a hospital.
Conservative treatment of ruptures of lateral ligaments of the knee joint
With an isolated rupture of one lateral ligament, conservative treatment is used. The puncture of the knee joint is performed, hemarthrosis is eliminated, 25-30 ml of 0.5% procaine solution is injected into the joint cavity. For 5-7 days (before the edema disappears) a gypsum linget is applied, and then a circular gypsum dressing from the inguinal fold to the ends of the fingers in a functionally advantageous position and with an excessive tibial deflection (hypercorrection) towards the lesion. UHF and static gymnastics are appointed from the 3rd day. Immobilization lasts 6-8 weeks. After its elimination, a restorative treatment is prescribed.
Surgical treatment of ruptures of lateral ligaments of the knee joint
There are several ways of operating recovery of the collateral ligaments of the knee joint.
Plastic collateral tibial ligament. Discontinuities of the collateral tibial ligament are more common than tears of the collateral fibular. Often they are combined with injuries of the inner meniscus and anterior cruciate ligament (Tourner's triad).
To restore the stability of the knee joint with the tearing of the collateral tibial ligament, Campbell's operation was used most often before. The material for plastics is a strip from the wide fascia of the thigh.
In the subsequent, a lot of ways of operative restoration of the collateral tibial ligament were suggested: corrugation, plastic ligament, lavender, canned tendon.
In 1985, A.F. Krasnov and G.P. Kotelnikov developed a new method of autoplasty of this bundle.
Make an incision of soft tissues in the projection of the lower third of the tender muscle and isolate its tendon.
In the region of the internal epicondyle of the thigh, a bone-periosteal valve is formed, the tendon is moved under it. Then sew it to the periosteum at the entrance and exit. The valve is strengthened by the transossal sutures. Sew the wound.
Apply a circular gypsum dressing from the fingertips to the upper third of the thigh for 4 weeks. The angle of flexion in the knee joint is 170 °.
This operation compares favorably with previously used traumatic and uncomplicated techniques of execution. The transplant under the bone-periosteal fold is fixed reliably due to tenodesa, which is proved by the clinical and experimental works of A.F. Krasnov (1967). The second fixation point in the tibia remains natural.
Plastic collateral fibula ligament. In old cases, the stability of the knee joint with tears of the collateral peroneal ligament is restored with the help of its plastics with auto- or xeno materials. As a rule, preference is given to autoplastic interventions. An example is the Edwards operation, where the ligament is formed from a flap of the broad fascia of the thigh.
Along with the known plastic techniques for tearing the collateral peroneal ligament, the method of its autoplasty, proposed by GP Kotel'nikov (1987), is also used. It is used for tears of the collateral fibular ligament in patients with compensated and subcompensated forms of instability of the knee joint. In the case of a decompensated form of instability, taking a graft from the wide fascia is not desirable because of the sharp atrophy of the hip muscles.
A graft of size 3x10 cm with a base at the external condyle is cut from the wide fascia of the thigh. In the region of the epicondyle of the thigh, a bone-periosteal sash is formed by the base behind the width of the transplant.
The second longitudinal incision is 3-4 cm long over the fibula head. It forms a channel in the anteroposterior direction, remembering the danger of damage to the common peroneal nerve. Lay the transplant under the sash, pull and pass it through the canal. Stitch at the entrance and exit. The bone-periosteal suture is fixed with transosseous sutures. The free end of the fascia is sutured to the transplant in the form of a duplicate. Wounds are sutured tightly. Apply a gypsum circular dressing from the fingertips to the upper third of the thigh at an angle in the knee joint of 165-170 ° for 4 weeks.