Rupture of the anterior cruciate ligament of the knee (PX): treatment and rehabilitation
Treatment and rehabilitation after anterior cruciate ligament rupture of knee
The most common problem with knee injuries is a rupture of the anterior cruciate ligament (ACL).
In order to understand the formation mechanism of injury and its causes, it is necessary to deal with the anatomical features of the knee, which is one of the most complex structures of the musculoskeletal system.
The knee is three bones:
And in order for the knee to function properly, connect the three bones of the whole five ligaments: the ligament of the patella, internal and external collateral ligament, anterior and posterior cruciate ligaments.
Ligament – it is a strong connective tissue that provides a knee in a certain range. If you go beyond it, at least, you can earn a sprain or tear of the ligament.
Anterior cruciate ligament (ACL) is located in the middle of the knee joint and connects two bones: the tibia and femur. Supporting the knee joint, the ligament does not allow much to advance the tibia forward.
With regard to the posterior cruciate ligament, it is located slightly behind the front and, if you look in the front, they form a cross (hence the name of the ligament).
Bundle equipped with a large number of nerve fibers, receptors, but has virtually no blood vessels.
The cause of trauma
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To get a rupture of the cruciate ligament of the knee at risk athletes and this is connected with sports injuries. In addition, the reason for the gap may be other factors:
- a blow to the knee;
- dorozhno-transport incident;
- sudden movements in the knee: a quick run, followed by a sudden stop, jumping, squatting, flexion-extension;
- the stumbling;
- degenerative and inflammatory processes in the respective ligaments;
- landing on straight legs;
- the sharp turns.
There are also risk factors that increase the likelihood of this injury:
- weak thigh;
- weak hamstrings, quadriceps;
- wrong tactics exercise;
- playing sports that require sudden stops, turns, moves: basketball, football, skiing.
The mechanism of the development gap
To know the mechanism of development of the injuries is important not only to medical professionals, but athletes, in order to avoid reasons for the gap.
Knowledge will help and is far from sports people to avoid injury to the PCB:
- deviation of the tibia (valgus) and its simultaneous rotation to the outside;
- rotation of the tibia on the outer side, and the hip inward (most often seen in football, basketball, where you need to jump);
- contact injury: direct blow to the knee;
- the injury of skiers, called «phantom foot»: in the time of the fall of one ski off the ground, touching it only the rear part, thus, there is rotation of the tibia relative to the femur;
- a kick in the knee, in the thigh or calf.
Varieties of trauma
Rupture of the anterior cruciate ligament of the knee is:
- Partial. In this situation may not occur conditions of instability of the tibia, as the surviving part would be to stabilize motion of the joint. In this situation, there are painful, broken to 50% of the fibers. Also used complex treatment. In the case of athletes operative intervention is necessary.
- Micronutri is characterized by minor injuries for which treatment will apply conservative methods. Surgical intervention is not required. Specific complications remains.
- Complete rupture provides only surgical intervention, in view of the complete rupture of a ligament and loss of supporting function of feet.
As will manifest itself torn ligaments?
Understand that the person had a rupture of the anterior ligament of the knee is possible, knowing its symptoms:
- severe pain in the knee region at the time of injury;
- dislocations of the tibia, having a periodic character;
- swelling in the knee region;
- constant knee pain in all movements;
- redness at the site of injury, bruises and scratches;
- the temperature in the region of injury;
- bleeding in the cavity of the knee joint;
- distinctive sound (crackling) at the time of injury.
Whether the human ACL rupture or not can say a trauma surgeon, relying on symptoms and mechanism of injury. After anesthetizing locations travmatizatsii he will proceed to the examination and then will answer: is there a gap and what is its degree.
After inspection the specialist will likely be assigned other special methods of diagnosis:
- Arthroscopy. Minor surgery, which resulted in the break region introduced a special device to examine the condition of the joint. Also, this method can serve as a correction.
- Fluoroscopy – a method that cannot directly educate and show the pair itself and its condition, but may exclude other options of pain, such as arthritis, fracture of the patella, etc.
- MRI is the most accurate method not only to study the state of the anterior cruciate ligament, but also other possible issues. Accurately shows the place of the gap.
- Ultrasound will show the presence of the joint cavity fluid, will be able to visualize the damage.
Measures first aid in case of suspected rupture of the anterior cruciate ligament are common to any damage to the joint or ligaments:
- it is necessary to immobilize the leg and put on the hill;
- in any case, to prevent reliance on an injured leg: lay the victim;
- the joint should be fixed with elastic bandage;
- 15-20 minutes should be imposed for cold, repeat the procedure should be in an hour;
- be sure to give pain medication (tablet, injection) and immediately seek medical help;
- when hemarthrosis doctor will prescribe the procedure for the pumping of blood from the region of the joint;
- in most cases, may be imposed plaster Longuet to eliminate the mobility of the knee.
Further actions in a medical institution
The main goal of treatment in rupture of the anterior cruciate ligament is the removal of inflammation, elimination of pain and restoration of function of the ligaments and knee joint.
For treatment, different methods are used and conservative – the first of them. This is the first medical assistance that you need urgently to provide a victim, once you rest, pain relief and the elimination of mobility of the knee.
If all these rules were observed, but in the joint cavity of gathered blood, the doctor prescribes a special procedure to remove it.
If the injury does not require operative intervention specialist shall appoint a special physical education.
Performing these exercises the patient can strengthen muscles and, accordingly, to pump them, giving develop atrophy, which often happens after long-term treatment of ligaments and neglect physical activity.
Performing exercises return strength to the muscles, and in addition, will strengthen the joints themselves, so they do not stop moving in all directions.
Integral therapy is massage, application of orthopedic devices, knee support, treatment in sanatoriums.
If you installed a complete tear of the ligament without surgery can not do, and it is a reconstruction of the anterior cruciate ligament, which is performed using a special grafts that mimic certain human tissue (in this case bale).
Used the use of autograft from the patellar tendon, which is cut from the tibia, the patella, together with the enzymes and is fixed in the bone canal, thus it completely replaces the ligament after rupture.
Otherwise, cut the graft from the hamstrings muscles of the thigh, which after receiving stitches in half and have, as in the previous case.
If the treatment was not applied injury surgery, rehabilitation will take about 6-8 weeks and it will consist in the application of cold to the injured area, massage, physiotherapy, physical therapy to strengthen muscles, joints and ligaments, to prevent their atrophy.
In case of presence of surgery the rehabilitation time will increase to 6 months:
- So in the first month the main task – to remove puffiness, pain, to allow passive movement in the joint. The program maximum – to walk without crutches.
- The second stage – up to 10 weeks: to improve the performance of the previous stage and to achieve the walk without any particular control.
- The third stage is the achievement of muscle endurance and strength using exercises (pay particular attention to squats, lunges).
- The fourth stage is the maximum range of motion, and endurance, activity.
- The fifth stage is the consolidation result.
Complications and prevention
The main complications after the injury and incorrect treatment can be:
- limitation of range of motion;
- after surgery the irregularity and rehabilitation can lead to detachment of the graft and migration of the bone channels;
- patellofemoral osteoarthritis.
On average, after treatment suffering from the trauma of the people in 90% of cases continue to exercise with a break for rehab for about six months.
With regard to prevention of ACL rupture is a strict observance of the rules on training, avoid jerks, sudden stops after running and knee injuries, thigh, drumstick.