Introduction
A ligament (Latin: ligamentum) is a structure that connects bones together. Ligaments often connect bones at joints and serve here mainly to stabilize the joint. They also limit the extent of movement in its physiological function. The ligaments, which consist of connective tissue, are only stretchable to a very limited extent and can be stretched or even torn in the event of injury or excessive strain, which is then called a torn ligament (rupture). With an approximate share of 20% of all sports injuries, torn ligaments are very important and make it a common clinical picture.
Cause
A frequent cause of torn ligaments is unphysiological movement beyond the normal range of motion, for example when falling or even when the foot is bent. Excessive strain on the joint and the ligamentous apparatus causes damage to the joint and can even lead to torn ligaments. A torn ligament often occurs in the foot, especially in the upper ankle joint or even in the knee.
There are also typical underlying accident mechanisms for certain torn ligaments. For example, the frequent bending of the foot, also called supination trauma, typically leads to a rupture of the outer ligament of the foot. However, a torn ligament can not only be caused by unnatural movement patterns, but also by external force acting on a joint, such as a foul in football.
Typical signs of a torn ligament are very severe pain directly after the trauma. These are particularly strong when there is movement or pressure on the affected area, but they are usually present without movement or stress on the structure. Shortly after the tear, usually within a few minutes, there is a severe swelling of the joint.
During the next few hours, bruising often appears due to blood vessels torn in the injury, which additionally causes the swollen area to appear bluish in colour. Since the ligaments can no longer fulfil their stabilising function due to the tear, the passive movement of the joint results in abnormal mobility, i.e. movement patterns that would not be possible in a joint with an intact ligamentous apparatus, such as the so-called folding of a joint. During the active movement of the affected joint, which is still possible in contrast to the fracture, the joint feels unstable and unsafe.
Diagnosis
A torn ligament is diagnosed by the doctor, who will first ask about the symptoms and the accident mechanism causing the injury through an anamnesis interview, as this is often very specific to the injury of a particular ligament. This is followed by an examination of the injured area, whereby the doctor pays particular attention to any bruising, swelling or pressure pain of the affected structures. Furthermore, it is tested whether the joint can be moved unusually and to an unphysiological extent.
Then an X-ray is taken to check whether there are any injuries to the adjacent bones. In the case of complicated injuries or for planning operations, an MRI (magnetic resonance imaging) is often also performed. This procedure allows a good assessment of soft tissue structures such as the ligaments or even cartilage tissue.
It is important to know whether cartilage tissue or bones were also injured, as this often results in a different therapy. Torn ligaments used to be quickly advised to undergo surgery, but today this is only carried out in exceptional cases such as torn cruciate ligaments, in professional athletes who have to put a lot of strain on their ligaments again quickly and severely, and in the case of multiple injuries to the ligaments, it is the treatment of choice. Today, attempts are being made to treat the torn ligament conservatively and to promote natural healing, which is achieved by immobilising the injured ligaments.
This is achieved by immobilising the injured ligaments. Splints (orthoses) or corresponding tapes, i.e. tapes stuck to the skin, are used for this purpose, which are intended to take over the stabilising function of the torn ligament, thus relieving it and also maintaining the mobility of the joint as far as possible. The acute pain is treated with painkillers.
The healing of a torn ligament by the merging of the injured structures often takes a long time. The actual healing process, which consists of cell division and regeneration mechanisms, cannot be accelerated. However, a lot can be contributed to the healing process, on the one hand, by providing fast and effective initial treatment of the torn ligament and, on the other hand, by not standing in the way of the healing process and thus prolonging it.
A basic principle for the initial treatment of a torn ligament is the so-called PECH rule. Here, the individual letters stand for the measure to be carried out: P=pause, E=ice, C=compression, H=high support. The most important thing here is to protect and avoid stress on the affected joint (P: pause).
Furthermore, cooling the joint helps to reduce the pain and to bring the swelling under control as far as possible (E=ice). The cooling should be done with ice cubes, which, however, do not have direct contact with the skin because of possible frostbite, but should be wrapped in a towel, for example. A carefully applied stabilizing bandage can also be useful until a visit to the doctor, as it compresses the blood vessels in the injured area and thus counteracts enormous swelling by limiting the space available for the spread of bleeding (C=compression).
In order to accelerate the regression of swelling and haematoma, it is also advisable to elevate the affected joint (H = elevation). In addition, a quick presentation to the physician accelerates the healing process, as optimal therapeutic approaches can be made after the diagnosis has been made, such as wearing a stabilizing splint. Here, too, the healing process of the ligaments can be supported by wearing the prescribed splint consistently day and night, thus relieving the ligament structures so that they can grow together and thus heal without additional stress. Depending on the type of torn ligament and the recommendation of the doctor treating the patient, additional physiotherapy can also accelerate the healing process of the torn ligament by strengthening the muscle apparatus in such a way that the lack of ligament stabilisation of the joint is reduced and thus muscular joint security is achieved. By consistently carrying out the prescribed exercises, one can also contribute a lot to the healing process of the torn ligament.
