Cruciate ligament of knee joint: trauma, treatment, rehabilitation

The knee joint is the largest in the human body. And it is clear that the mechanics of his movements and anatomy will be matched. For students of medical schools there is nothing more difficult than arthrosyndhesmology, that is, the science of joints. The knee joint is the knee joint. And before talking about his illnesses, it is necessary to first understand the structure.

Bones

At the base of the formation of the joint are two long bones - the femoral and tibial - and one small, patella. Contrary to popular belief, the fibula does not take part in the knee joint. She has an articulation with the tibia slightly lower. At the lower edge of the tibia there are two elevations, called the condyles. They represent the upper part of the joint, and are covered with cartilage. On the opposite side of the tibia there is a plateau that perfectly fits to the condyles. It is also covered with cartilage for better slip. The last flat bone - patella - is located between the condyles in a specially formed depression. All the bones participating in the joint are covered with hyaline cartilage, up to five millimeters thick. It is dense, shiny and very smooth. Its function is to soften the loads during the execution of movements and reduce friction between the bones. Above, the entire structure is covered with a connective tissue capsule.

Bundles

In order to combine the three bones together, one cartilage is not enough. A good fixing device is required, which will be both elastic, resilient and strong. This function is performed by the ligaments. They are formed from dense connective tissue and stretched between the bones.

Thus, on the lateral surfaces of the joint are collateral ligaments that strengthen the capsule. There are two of them: lateral and medial. The function of these strands is to limit the mobility of the joint to the sides. Inside the capsule there are also ligaments. They are located between the articular surfaces and are called cruciform. Their task is not to let the joint move excessively forward and backward. The anterior cruciate ligament of the knee joint begins on the tibia. It pre-empts its advance and slips out of the joint surface. The posterior cruciate ligament of the knee joint also begins on the tibia and slows its movement back to the femur.

Together they help to keep the joint in a state of balance, provide stability and smooth movements.

Menisci

Outwardly they are similar to ligaments, but they are more similar in structure to cartilage. Located in the middle between the tibia and the femur and are necessary for greater congruence of the joint. Their main functions: a uniform distribution of body weight on the joint and ensuring its stability during movement and in a static position.

This is extremely important, since if there were no meniscus, the entire weight of the body would concentrate on several points inside the joint, and this would lead to rapid trauma and disability.

Muscles

On the front surface of the knee joint are the extensor muscles. They are attached to the top of the femur on one side and to the tendon of the patella - on the other. When they contract, there is an extension of the leg in the joint, allowing the person to step forward. The main work takes on the quadriceps muscle.

A group of flexor muscles is located on the back of the thigh. The point of attachment is also on the head of the femur, but the point of movement is on the posterior surface of the tibia, fixed by a strong tendon. The contraction of these muscles flexes the knee.

Nerves

The most important in the knee joint is the popliteal nerve. It is part of a large sciatic nerve and, leaving the joint, gives up three branches. The first one goes to the tibia and is located near its posterior surface. The second circumscribes the fibular bones and innervates the anterior and lateral surfaces of the tibia. And the third one descends to the foot. It's a mixed nerve. They have both a motor and a sensitive component. With injuries in the knee joint, it is possible to damage both the common nerve and its branches.

Blood supply

If we talk only about the joint, then it is fed by the arterial blood network. It is formed:

• Medial and lateral anterior arteries of the knee;
• Posterior arteries;
• The middle knee artery;
• Descending and bypassing the knee arteries.

All of them are branches of the tibial artery, which originates from the external iliac artery. And she, in turn, comes out of the common ileum.

Venous outflow is carried out on the same veins, which accompany each artery. The collector is the lower hollow vein, which returns the blood back to the heart.

Causes of knee joint injury

One of the most unpleasant injuries that can be got on the knee is the damage to the cruciate ligament of the knee joint. Not only is the stability of the entire structure broken, the volume of voluntary and passive movements is reduced, so also the treatment process will be long enough.

The causes of such an injury can be as household damage, and blows, accidents, sharp turns. Most often it occurs in professional athletes - skiers, skaters, skaters, jumpers or wrestlers. In order to avoid this, it is necessary to observe safety measures, to avoid increased loads on the joint, and also to maintain a diet that will maintain a sufficient level of collagen retaining the elasticity of the ligaments.

Clinic

When a person with a similar trauma is asked what he is complaining about, they hear in response about the following: "The knee hurts when bending and unbending." But he is silent about other symptoms.

- at the time of injury, a click or a crack from the rupture was heard;
- there was instability in the knee, a feeling of "looseness";
- Edema in the knee area during the first hours after injury;
- accumulation of fluid in the joint cavity (a symptom of fluctuations);
- Restriction of movements due to pain or swelling.

Therefore, when the patient tells you that his knee is hurting when flexing and flexing, this can mean not only breaking the cruciate ligament. It is necessary to conduct a full inspection before making any decision.

Classification of damages

First degree: anterior cruciate ligament rupture of the knee joint is slightly expressed, there is pain, a small swelling. The movements in the joint are somewhat limited, but mainly because of edema, and not because of trauma. Stability is saved.

Second degree: there is a partial rupture of the cruciate ligament of the knee joint, supplemented by all signs of first degree injuries. A distinctive feature is that such damage is prone to recurrence. And repeated trauma can be caused after much less effort than the first time.

Third degree: complete rupture of the anterior cruciate ligament of the knee joint. Severe pain, reactive edema with a significant restriction of passive and active movements. The joint is loose, its support function is broken.

Of course, this classification can not accommodate all forms of knee ligament injuries, but it helps to structure them according to severity.

Diagnostics

After a survey, a history of life and health begins the examination phase. The doctor is trying to figure out how much the subjective feelings coincide with the real facts. First he explores a healthy leg, including, paying special attention to the knee. This is necessary so that you can compare the damaged and the whole joint.

In order to check how much the cruciate ligament of the knee joint is damaged, the doctor is trying to shift the shin up and anteriorly. If there is a trauma, then he will succeed. There are several specific samples used in these cases.

After a manual examination, an instrumental study is under way. Namely - radiography of the knee joint. It allows you to identify gross fractures and tears. The next stage is magnetic resonance imaging. It allows you to diagnose with stunning accuracy. But sometimes it can even hurt. As the overdiagnosis becomes the reason for completely unnecessary surgical interventions. The cruciate ligament of the knee joint can be damaged so that instability does not occur, and a huge gap is displayed on the monitor.

Conservative treatment

Traumatologists do not always incline their patients to surgery. In this case, the indications for intervention are not the fact of the rupture, but the imbalance in the joint. This is a decisive factor. For joints and ligaments, immobilization and rest are often used until the integrity is restored. You can divide the treatment process into several stages.

1. A sharp period. Injured cruciate ligaments of the knee joint. Treatment is aimed at reducing pain syndrome and joint swelling. It is better for the injured person not to try to reach the hospital on his own. Cold places are applied to the site of injury, they are given painkillers and provide complete rest to the injured limb. If there is a buildup of blood in the joint, then it is necessary to suck it off periodically with a syringe, not allowing it to collapse and settle on articular surfaces, causing inflammation.
2. A stale gap. After the pain has receded, it is possible to begin trainings on strengthening of muscles. For joints and ligaments, there is nothing better than a strong muscular skeleton that will keep them from overextension and rupture. Begin with small, but each time the training becomes more intense, the amplitude of movements increases. To limit movement, an orthosis is used (a langet with an adjustable hinge system).
3. Blank sheet. At this stage, the doctor examines the joint as if it were not injured. And if the results satisfy it, that is, returned mobility, there are no pain sensations, instability and pathological signs, then the treatment can be considered successful.

But do not think that this is all over and you can immediately run a sprint distance. For a long time after the end of therapy, the patient will need to take care of the damaged leg, perform special exercises, and train the thigh muscles.

Operative treatment

The plastic of the anterior cruciate ligament of the knee joint is performed if there is no stability of the joint or it does not correspond to the norm. Usually it is carried out after conservative treatment, when there are positive shifts relative to the muscular apparatus.

Typically, such operations are done six months after the injury. But if the gap was several years ago, and the symptoms appeared recently - this is not an excuse to refuse surgical intervention. As a rule, athletes who have an anterior cruciate ligament of the knee joint undergo this type of treatment. The operation is a prosthetic sinew. For him, use both his own human ligaments and synthetic prostheses. Simple stitching of the ends of the torn ligament does not give positive results, and sometimes it is impossible purely technically, because of an uncomfortable place. The new cruciate ligament of the knee joint should fully correspond to the old, perform its functions and be correctly located.