Orthopedics-Online

Torn ligament

introduction

A torn ligament (synonym: Ligament rupture) is, as the name suggests, a tear or demolition of a certain band structure. The ligament can be completely or only partially ruptured. The localization is also variable, so that a ligament tear is just as likely as in the middle. A ligament tear is also classified according to whether the stability is maintained after the ligament injury or whether it is lost, since it is difficult to identify more precisely under the microscope.

Above all, those are predisposed to a torn ligament Outer ligament of the upper ankle, Ligaments of the knee joint as well as ligaments in the metatarsophalangeal joint and on the carpal bones.

Synonyms

Torn ligament in the ankle
Ligament rupture
External ligament rupture
Fibular capsular ligament rupture
Tear of the anterior / posterior fibulotalar ligament
Fibulocalcaneare ligament
Ankle distortion, supination trauma
Ligament stretch

Medical: Fibular ligament rupture, desmorrhexis

English: ruptured ligament in ankle joint

definition

Injury to the upper ankle joint (ankle joint) often occurs during sporting activities, but also in everyday life. Most events do not lead to serious structural damage, i.e. injury with permanent consequences. Nevertheless, it can lead to a torn ligament, especially in the area of the outer ankle (please refer: Torn ligament on the ankle). When the doctor examines the ankle, they can hardly be distinguished from stretched ligaments or partial ligament tears or complete ligament tears. The transition is fluid.

Please also read our page Ligament Stretching - An Overview

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Athletes (joggers, soccer players, etc.) are particularly often affected by diseases of the foot. In some cases, the cause of the foot discomfort cannot be identified at first.
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frequency

Damage to the Outer bands of the ankle are among the most common sports injuries and thus among the most common injuries.
In the trauma surgery outpatient department, the torn ligament is the most common reason why a patient visits the outpatient department.

Causes of a torn ligament

The most common cause of a torn ligament in the foot or knee is external force. The forces that are transferred to a belt structure are so great that the maximum expansion tolerance is exceeded and the belt can tear.
Unfortunate movements can also tear ligaments. Typical movements in which you twist your foot and torn ligaments are sudden changes in direction and turning movements on slippery ground. Here, too, the connective tissue, tight ligament cord cannot withstand the force.

In principle, the ligaments of our body have the task of ensuring stability and, especially in joint regions, preventing movements beyond a certain physiological level. If this level of mobility is exceeded, a ligament tear follows. In general, old, untrained and previously damaged ligament structures are particularly susceptible.

Etiology - development of a torn ligament

Joint injuries, which also include torn ligaments, tend to affect those joints that have a long lever arm, such as the knee joint. The reason for this is that forces acting through compression or kinking can develop more easily and more easily.
In principle, the force of force can affect muscular, bony and ligamentous structures.

Depending on whether it is a muscle, bone or ligament-secured joint, the forces have a preferred effect on the respective structure. Injuries to the capsule and ligament apparatus are primarily caused by sudden and severe overstretching. This incident is summarized under the term "capsular ligament injury".
As a result, in the worst case, the ligament can be completely torn off, but stretching or straining is also possible. It is also typical that a torn ligament is accompanied by a capsular tear.

Figure torn ligament

Front fibula -
Ankle ligament -
Lig. Fibulotalare anterius
Fibula-calcaneus
Tape -
Calcaneofibular ligament
Posterior fibula
Ankle ligament -
Posterior fibulotalar ligament
Heel bone - Calcaneus
Ankle bone - Talus
Outer ankle -
(= Fibula bone)
Lateral malleolus
Fibula - Fibula
Shin - Tibia
Cuboid bone -
Os cuboideum
Scaphoid (of the foot) -
Navicular bone
Inner ankle -
(= Shin bone) -
Medial malleolus

I - I - Upper ankle
(Hinge line blue) -
Articulatio talocruralis
II - II - Lower ankle
(Hinge line purple) -
Articulatiotalocalcaneonavicularis

You can find an overview of all Dr-Gumpert images at: medical illustrations

Symptoms of a torn ligament

The classic leading symptom of a torn ligament is pain. The pain intensity is very variable. So slight pain does not necessarily have to be dismissed with a strain. Sometimes pure ligament strains are more painful than an actual torn ligament. As a result, it is difficult for those affected to judge what kind of ligament injury it is based on the sensation of pain alone.

Depending on the extent of the torn ligament, effusion can occur, which is accompanied by externally recognizable swelling and blue discoloration of the affected region. The torn ligament is also often described as an audible event.

Instability is considered an indication of a torn ligament. Due to the loss of functional stability due to the ligament rupture, patients exhibit unsafe behavior.
If ligament structures of the knee or ankle are affected, the gait pattern may be changed, e.g. the still healthy side is preferred.

Read more on the topic: Symptoms of a torn ligament

diagnosis

For the person concerned it is not possible to differentiate between a stretched ligament and a torn ligament of the outer ligaments. The doctor will ask questions about how the accident happened, examine the foot, and take an X-ray to rule out any injury to a bone.

In addition, the stability of the joint is checked, which is sometimes painful with a fresh injury. If there are still doubts, a so-called held X-ray provides additional information about the severity of the injury. The ankle is clamped in a holder and the joint is expanded so that the stability can be assessed in the X-ray image. Nowadays, recordings no longer play an essential role in the initial diagnosis (Acute diagnostics). On the one hand, many patients do not tolerate this procedure; on the other hand, the severity of the injury is increased by the stretching.

In the case of chronic instability, the extent of the instability can be estimated. Since joints can be spread open differently in every person, the doctor usually takes a control x-ray of the healthy mutual ankle joint in order to determine the healthy norm and then better distinguish between healthy and sick.

A magnetic resonance scan (MRI) can accurately assess the extent of ligament damage. Since there are no immediate consequences for further treatment and MRI is expensive and poorly available, it is mostly not used in diagnostics.

Read more about this on our website MRI of the foot.

treatment

As with most injuries, a decision has to be made as to whether the ligament tear should be treated conservatively or surgically.

A first measure in both cases should be the application of the so-called PECH rule as part of the immediate measures.
The respective treatment steps are behind the term "PECH":

P = pause
E = ice
C = compression and
H = elevation.

The PECH principle stipulates that the person concerned should immediately pause the activity or strain on the ligamentous apparatus, on the one hand to relieve the corresponding torn structure and, on the other hand, not to exert any further irritation in the event of a tear, which could possibly provoke a complete ligament tear. After that, the region of the torn ligament should be well cooled. The cold has the effect of constricting the blood vessels and reduces the bleeding and swelling. In addition, the cold therapy has a pain-relieving effect. Regardless of what is used for cooling, be it with ice, an ice pack or simple cold compresses, you should always make sure that the cold does not come into direct contact with the skin, but that a cloth or compress lies between the skin and the cold source.
As with cold therapy, the main goal of compression (C = compression) is to reduce swelling. Pressing the affected area will reduce blood flow. It is important to compress precisely in order to be able to adequately contain a possible swelling. The final step of the PECH regimen is elevation, which will encourage blood flow back so that there is little swelling. The region of the torn ligament should be elevated for about 48 hours. .

Whether conservative therapy or surgical treatment is indicated in the further course of treatment depends on various factors.
It is important to consider the patient's age, type of ligament rupture, affected joint, level of activity, and lifestyle. It is also important whether the joint is a ligament or muscle-secured joint. If the first mentioned is the case, the defect-free healing has the highest priority in order to regain the complete stabilizing function. In principle, one tries to treat the torn ligament no matter where first with conservative therapy.
In addition to the PECH scheme, a torn ligament should always be stored calmly and, if necessary, a splint or bandage worn to compensate for the acquired instability. If, after a certain period of time, there is no improvement in the form of pain relief, swelling and regaining of stability, an operation should be considered.

Surgical care includes the implantation of plastic bands or the body's own plastic. Depending on where the ligament is torn, implantation does not have to be considered immediately. It is namely also possible to fix a torn ligament again at its bone attachment.

Physiotherapy to rebuild the muscles in the area of the torn ligament is essential after conservative or surgical treatment.
The aim is to regain full stability through muscle strengthening and coordination training. Regardless of whether the treatment is conservative or surgical, the primary goal is to regain the functionality and stability of the ruptured ligament.This is possible by immobilizing and protecting the affected ligament structure including the surrounding structures, which could have a mechanical influence on the torn ligament.

Read more on the topic: Treatment of a ruptured ligament

Taping a torn ligament

Taping is an established treatment method for conservative treatment of a torn ligament.
The "Kineso Tape" fulfills the task of a functional bandage. It supports the muscles, but especially the baths, in their stabilizing function without restricting movement.

It also protects against extreme movements and counteracts swelling with a slight compression. In order to gain reinforcement or support of the ligament structures, the tape must always be applied individually, depending on the course of the ruptured ligament and at which point or position complaints occur. The different colors of the tapes imply the strength so that, depending on the degree of severity, you can choose which tape is the right one. In addition, the "Kineso Tape" fulfills a measure of BAD LUCK-Schemas, namely the compression (C = Compression). Despite its elasticity, the tape can be applied so tightly to the skin that it acts like a compression bandage.

In general, taping can be used both as a preventive measure and after an acute ligament tear.

Operative therapy

If there are injuries to the bone and cartilage in addition to the torn ligament, or if conservative treatment was unsuccessful, the ligaments can be sutured. However, only in exceptional cases, such as B. in competitive athletes, urgently recommend surgery, as it does not generally lead to faster or more complete healing. In rare cases, complications arise from the procedure. As with any surgery, infection, bleeding, or injury to nerves or blood vessels around the ankle can occur. The mobility in the joint is very rarely permanently restricted after an operation. Following the procedure, the ankle is immobilized with a lower leg cast for six weeks.
Regardless of the type of treatment, any immobilization of the leg carries the risk of developing venous thrombosis. This complication can be largely avoided by administering anticoagulant medication, such as the active ingredient heparin. All appropriate drugs are given in the form of syringes. A thrombosis can damage the veins themselves on the one hand and life-threatening pulmonary embolism on the other.
After a complete rupture of the outer ligament with all three outer ligaments involved, sport may only be exercised again after twelve weeks at the earliest, and competitive sport after six months. The risk of a new rupture (torn ligament) is very high if the load is too early and if the treatment is incorrect. However, this information must be viewed in relative terms and depends on the extent of the injury and the type of sport.
Physiotherapy therapy also plays a crucial role after the surgical treatment. Strong muscles stabilize the joint during the movement so that the ligaments are less stressed. If the instability persists, special orthopedic shoes and special insoles or bandages may be suitable to stabilize the joint.

rehabilitation

After the end of immobilization and rest, the joint can gradually be loaded again. Initially, however, only with low stress, which is then increased depending on any pain. In the first four to six months, suitable joint protection, such as a tape bandage, should be worn, especially when doing sports. Before starting any sporting activity, the muscles should be built up again to such an extent that the surrounding muscles ensure adequate stability of the joint.

Functional further treatment:

Early functional further treatment with an orthosis (e.g. Aircast, Malleoloc, etc., see picture above) with full axial load
Physiotherapy exercise treatment (physiotherapy) in function and activity-oriented intensity
Electrotherapy, ultrasound
Exercises for sensorimotor (proprioceptive) training (special physiotherapy, PNF)
Inability to work, depending on the job, 1-6 weeks (depending on the job)
Sport-specific training after 2-12 weeks
Competitive sport after 12 weeks at the earliest
Orthotic protection during sports for at least 3-6 months (orthosis or tape)

Read more on the topic: Ligament tear duration

forecast

Simple ligament stretches usually heal within one to two weeks out. If the capsular ligaments are torn, conservative therapy leads to scarred defect healing of the ligaments. Most of the time the scarred ligaments are sufficient to be able to take over the original function again. If the stability is not sufficient, this results in joint instability. Surgery should be considered in these cases. Such injuries can be treated surgically, especially for athletes. If the course is uncomplicated, it is usually completely fit for sport after three months.

Duration of a torn ligament

The recovery time can vary depending on the severity, location and physiological conditions of the person affected. There is currently no fixed information on the duration of the healing process that can be 100% committed to.

A small and simple torn ligament can already appear one to two weeks be healed. Other torn ligaments take a much longer healing process. In principle, the region of the ligament tear should last for at least Immobilized for 6 weeks become.
After that, slow and careful exercise is possible again. It is important that the tape is used to its original function again and that it is not immediately subjected to extreme stress.

In the case of a cruciate ligament rupture, for example, the To go biking or Walking kick off. With the to jog however, it should not be started until 3 months after the operation. Absolutely risky sports that are predisposed to a new ligament rupture (E.g. football, handball, skiing, tennis etc.) should not be driven again until 6-10 months later.
It is estimated that it takes a total of six months for the torn ligament structure to be functionally restored and for normal stress to be restored.

Cure / prognosis

The prognosis is clearly dependent on the one hand on the extent of the ligament tear and on the other hand on how the ligament tear was treated.
The age of the person affected also plays an important role. If a torn ligament is treated immediately, the chances of recovery are very good. In contrast to fresh torn ligaments, older ones are more difficult to treat and take longer. This is because restoring the former physiological form is almost impossible. Since ligaments are essential for the proprioception of our body, it is important to start therapy immediately to enable good healing.
Under Proprioreception one understands the deep sensitivity, which is responsible for our brain receiving information about joint, muscle and ligament positions and their activity. Therapeutic means such as plastic straps cannot do justice to the function of complex sensory perception.

There is also the risk of remaining instability if not treated consistently or if there is a very complicated torn ligament including a capsule injury. This increases the likelihood of suffering another injury to that ligament structure.

A proper diagnosis and appropriate treatment are also important in order to counteract a "dangling joint" or dislocations. With a throat joint is meant an unstable joint that develops due to numerous past joint injuries or not properly healed ligament tears and is less stable than a healthy joint. Ligaments are also important in keeping bones that articulate together in position.

However, if the ligaments are weakened after a tear, the joint is more prone to dislocation. After a ligament rupture, you should therefore protect the affected area long enough to ultimately regain full functionality and stability.

If a torn ligament does not stop properly, the risk of post-traumatic dislocation is increased. This means another joint injury, which is also caused by external force.

So there are some things that have to be taken into account in order to make the prognosis after a ligament tear favorable and to positively influence the healing process.

Read more on the topic: Healing a torn ligament

prophylaxis

A good training condition and careful warming up before sporting activities minimize the risk of distortion / twisting and thus the risk of a Torn ligament significant, but cannot ultimately prevent twisting. Good footwear can prevent ligament rupture by providing sufficient stability. The higher the sports shoe, the more secure the protection against ligament injuries. However, it must be taken into account that the risk of a broken bone or knee joint injury increases. As a preventive measure, joints at risk can be used in appropriate sports (Finger joints volleyball) can also be bandaged or protected with a tape bandage.