Lateral Ligament Injury

GENERAL FEATURES

The lateral ligament plays an important role in keeping the knee joint Do not slide to the side during movement. The knee joint has internal and external ligaments, these ligaments are very strong and close to the sides of the joint capsule, keeping the knee flexion and extension always on a horizontal axis passing through the attachment of these two ligaments.

The medial ligament is a thick, strong, 15 mm wide fibrous band that deviates from the medial condylar tubercle inferiorly and anteriorly to attach to the medial surface of the tibia. This ligament is firmly attached to the joint capsule, making it difficult to separate.

The internal ligaments are more often injured than the external ligaments. When the ligament ruptures, the knee joint is dislocated to the side, and the internal examination shows signs of opening. The external ligament is a thin, round cord that deviates from the lateral condylar tubercle of the femur downward and posteriorly to attach to the tip of the fibula. When the external ligament is torn, it is usually torn low, near the place where it attaches to the tip of the fibula.

The lateral ligament is one of the important ligaments of the knee joint, so it is necessary to diagnose and treat it promptly to avoid complications. osteoarthritis pillow.

CAUSE AND Mechanism of Injury

• Direct mechanism: The traumatic force exerts strong impact on the lateral aspect of the knee joint causing knee dislocation or supratibial head fracture, femoral condylar fracture and damage to the lateral ligament.
• Indirect mechanism: when falling from a sitting position, creating a rotational force or a strong impact when flexing the knee, causing the shin to flex, rotate outward and the lower head of the femur rotates inward, at this time the lateral ligament is stretched and torn and broken. .

Histopathology

• Location: rupture of the medial ligament usually in the upper or middle half or pop in the attachment point at the medial condyle of the femur. The external ligament is often torn low, near the attachment point to the fibula cap.
• Damage level:
  • Minor injury: stretch breaks part of ligament
  • Severe injury: rupture of the entire ligament.

CLINICAL SYMPTOMS AND X-ray images

Clinical symptoms

Subjective:

• After the injury, the patient finds that the knee joint is swollen and sometimes there are bruises on the inside or outside of the knee
• Severe pain, sharp pain when the patient rotates the knee joint
• Loss of muscle mass: the patient limps or is impotent.

Objective:

• Pressing is the most painful where the ligament is broken, pressing the attachment and the path of the ligament is also very painful
• Examination revealed obvious signs of joint dislocation (internal ligament rupture with internal spondylolisthesis, rupture of external ligament with lateral dissection) and abnormal lateral movement.

X-ray symptoms

Take a shot X-ray Knee joint in two upright and inclined positions and photographed when opening the joint to compare and find associated bone lesions.

DEFINITION AND DIFFERENT DIAGNOSIS

• Definitive diagnosis: Based on clinical symptoms, it is enough to help diagnose lateral ligament rupture.
• Differential diagnosis:
  • Break cruciate ligament: check with drawer sign
  • Torn meniscus: There is a phenomenon of joint jamming, pain in the corresponding joint space.

PROGRESS AND COMPLAINTS

• Normal progression:
  • For sprains mild: the patient only has pain in the first few days, the knee joint after a few days motionless then return to normal movement
  • For severe sprains: early diagnosis and timely treatment are necessary to avoid complications affecting the operation of the knee joint later.
• Complications: When the lateral ligament is injured, if not treated well, complications and sequelae may occur.
  • Swollen, painful knee joints persist for many months, affecting work and living
  • Limiting the range of motion of the knee joint, ossifying the ligament surrounding the knee joint
  • Decreased stability of the knee joint, leading to long-term arthritis chronic, degenerative joint
  • Quadriceps muscle atrophy makes walking difficult and painful.

TREATMENT

• Conservative treatment:
  • Với các trường hợp dây chằng bên bị đứt một phần hoặc chỉ bị bong điểm bám cần điều trị ngay bằng cách chọc hút hết dịch trong khớp nếu có, sau đó cast đùi – cổ chân trong tư thế gối gấp 10^o
  • The time to leave the powder is from 5 to 6 weeks, after removing the cast, let the patient practice bending and stretching the knee combined with physical therapy
• Surgery:
  • If the complete rupture of the lateral ligament comes early, surgery is performed to reattach the ligament. After surgery, the thigh-ankle cast is from 5 to 6 weeks
  • If the ruptured lateral ligament is old, surgery to reconstruct the ligament is required. Many methods of reconstructing damaged lateral ligaments have been applied.

For example:

• Slocum-Larson (1968) method of reconstructing the ruptured internal ligament uses semi-tendon tendons to strengthen the medial capsule.
• Andrew's lateral ligament reconstruction (using the iliotibial band) by Ellison (1979) (using the biceps tendon,...).

All these methods after surgery must be immobilized with thigh-ankle casts for 6-8 weeks.