Posterior cruciate ligament tear symptoms
introduction
Of the posterior cruciate ligament tear as an injury to the posterior cruciate ligament of the knee is sometimes already noticeable at the time of the tear. The affected person feels symptoms, in this case the rupture of the Knee joint, possibly a noise (Crack) can be heard when tearing.
This is followed by swelling and Pain in the knee joint area. The swelling of a posterior cruciate ligament tear is the result of a bloody one Joint effusioncaused by the rupture of blood vessels supplying the knee joint.
This then leads to bleeding into the joint space, from which the effusion results. This bloody joint effusion is known as Hemarthrosis (arthron = joint, hamm = blood).
The symptoms / pain of the knee affected by the posterior cruciate ligament tear are caused by the stretching of the joint capsule, which occurs as a result of the knee joint effusion.
The irritation of nearby nerves conveys the pain sensation in a posterior cruciate ligament tear.
Another consequence of the posterior cruciate ligament tear, including the effusion, is the restriction of the mobility of the knee.
An additional symptom of a posterior cruciate ligament tear is increased instability of the affected leg.
The posterior cruciate ligament acts as a stabilizer for the knee joint, especially when the knee is flexed. It prevents the lower leg from sliding back in relation to the thigh.
In the case of a posterior cruciate ligament tear, this stabilization is consequently lost, so that instability occurs as a typical symptom of a posterior cruciate ligament tear.
You might also be interested in this topic: Cruciate ligament overstretched
How is the posterior cruciate ligament tear diagnosed?
The physical examination reveals typical signs of a posterior cruciate ligament tear. This includes positive results at the rear Drawer test as well as with Lachmann test. For this test procedure, the examiner bends the injured leg of the affected person in the knee by 90 degrees for the drawer test or by 30 degrees for the Lachmann test.
The next step is to move the lower leg back towards the thigh. In the case of a posterior cruciate ligament tear, there is a positive result with mobility backwards, but if the knee is not injured, no movement backwards can be triggered.
A posterior cruciate ligament tear is very often accompanied by other symptoms and injuries to the knee on the affected side of the body.
Often there is a combination with Damage to the collateral ligaments (Collateral ligaments, ligamentum collaterale mediale and ligamentum collaterale laterale) of the knee joint.
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Other accompanying injuries
Also bony avulsion injuries of the posterior cruciate ligament at its anchoring point on Tibia (Tibia) represent possible accompanying injuries in a posterior cruciate ligament tear.
Becomes a posterior cruciate ligament tear not treated, for example because the affected person does not notice the crack due to the lack of or very mild symptoms, the symptom of instability comes to the fore and a chronic loss of stability develops.
Those affected complain of symptoms such as giving in or slipping away the injured knee, which is known as "giving way"-Symptomatic (give way = engl. give in). In addition to the instability described above, if the posterior cruciate ligament tear is untreated, signs of wear and tear of the joint, especially the joint, develop over time Cartilage as well as the menisci.
A posterior capsular contracture is particularly typical. Since the lower leg regularly sinks backwards due to the torn posterior cruciate ligament, the joint capsule adapts itself by shortening this movement, so that called Contracture (Shortening) occurs. Osteoarthritis are further signs of wear and tear that are typical of an untreated posterior cruciate ligament tear. On the one hand, these arise on the knee joint itself as Osteoarthritis of the knee or osteoarthritis of the knee. On the other hand, after a posterior cruciate ligament tear, what is known as retropatellar arthrosis (retro = behind, patella = Kneecap) develop. This means signs of wear and tear of the joint space between the rear kneecap (patella) and Thigh bone (Humerus). Such arthroses make themselves noticeable as pain. Retropatellar osteoarthritis as a result of a posterior cruciate ligament tear is characterized by pain, which occurs mainly when walking downhill or downstairs. Even after sitting and getting up, the affected person feels increased pain, which is localized in the retropatellar region, i.e. behind the kneecap.
Pain after an accident
In most cases, a cruciate ligament tear occurs in connection with an accident.
The direct symptoms after an accident that results in a posterior cruciate ligament tear are mainly dominated by severe pain.
The pain that occurs after the accident can be explained on the basis of the processes in the knee that follow the tear of the posterior cruciate ligament. The accident causes a bloody effusion in the joint capsule and creates a certain pressure on the capsule. The capsule is supplied with nerves that register the stretch and cause the pain. Reducing the effusion after the accident can therefore help reduce pain.
The operation
Which therapeutic measure is taken depends on various factors:
- The age of the patient
- The patient's activity, including in particular sporting activities
- The burden in the context of the profession
- The possible presence of accompanying injuries (Meniscal tear)
Occurs in a young, competitive athletic patient who is also exposed to high physical strain as part of his job posterior cruciate ligament tear without any accompanying injuries, surgical therapy is most likely. However, the individual injury must always be in harmony with the various therapeutic measures.
As part of the operative therapy measures, the Cruciate ligament surgery first of all. Such an operation is usually not performed directly. The risk is too high that joint scarring will occur during the operation due to the insertion of an endogenous tendon, which under certain circumstances would lead to restricted mobility. A body's own tendon is characterized by the fact that it can almost restore the lost hold of the joint. The "old" properties and their functions should imitate the ideal state almost true to life. The body's tendons therefore offer the possibility of anatomical reconstruction in a special way.
These “ideal properties are not fulfilled by every endogenous tendon. As part of the cruciate ligament surgery, the Patellar tendon (= kneecap tendon), as well as the tendons of the Semitendinosus muscle and Gracilis muscle (= hamstring) proven.
- The patellar tendon:
Many should Patellar tendon reflex be a term. This is the reflex that can be triggered by lightly striking a reflex hammer and evoking a reflex response.
If you now have the Patellar tendon If you want to use a cruciate ligament surgery, you do not remove the entire patella tendon. For a cruciate ligament surgery, it is sufficient to remove a piece about 1 cm wide from this tendon. However, it is important that a bone block is attached to both ends. These bone blocks are fixed in the drill canals by means of so-called interference screws, which consist of either titanium or sugar (= carbon compounds). The transplant is installed arthroscopically, in the form of a Knee arthroscopy.
The bone blocks of the patellar tendon usually grow in within 4-6 weeks.
- The semitendinosus or gracilis tendon
This is a tendon of the thigh. To use it as a cruciate ligament plastic, it is removed as close to the knee as possible through a small incision on the inner thigh (on the inner tibial head). After removal, a quadruple graft, also known as a quadruple hamstring graft, is made from it by doubling it. The doubling is necessary to produce a corresponding tear strength.
This transplant can also be made from another thigh tendon, the gracilis tendon.
In some cases, the gracilis tendon can be removed in addition to the semitendinosus tendon. In such cases the graft will then be taken eight times.
The advantages of the semitendinosus and gracilis transplants are the lower rate of complications, lower pain after removal of the tendons and only a small, cosmetically favorable skin scar.
The slower healing behavior of the tendons in the bone canals compared to the patellar tendon has a disadvantageous effect. In contrast to the patellar tendon with its bone blocks, the semitendinosus and gracilis tendons only grow in after about 10-12 weeks.
Symptoms after surgery
After the operation of a posterior cruciate ligament tear, symptoms may initially persist, even if the operation is successful.
Especially post-operative pain are normal after cruciate ligament surgery and can be treated by taking certain pain relievers. Swelling of the knee is also common after the operation and usually disappears completely as it heals.
A certain instability of the joint can also persist after the operation, but it should completely disappear during the healing process through targeted physiotherapy.
If new symptoms occur or symptoms persist for a long time after the operation, it is advisable to consult a doctor about the symptoms.
