Symptoms of a torn ligament
The classic leading symptom of a torn ligament is pain. The intensity of the pain 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. Therefore it is difficult for the patient to judge only from the pain sensation what kind of ligament injury it is. Depending on the extent of the torn ligament, an effusion may occur, which is accompanied by externally visible swelling and blue coloration of the affected region.
In addition, the torn ligament is often described as an audible event. Instability is regarded as an indication of a torn ligament. Due to the loss of functional stability as a result of the rupture of the ligament, patients exhibit an uncertain behavior. If ligament structures of the knee or ankle joint are affected, the gait pattern may be altered, since, for example, the still healthy side is preferred to bear weight.
Diagnosis
For the affected person himself it is not possible to distinguish between ligament stretching and torn ligaments of the outer ligaments. The doctor will ask questions about the course of the accident, examine the foot and take an X-ray to rule out the possibility of a bone injury. In addition, the stability of the joint will be checked, which is sometimes painful when the injury is fresh.
If there are still doubts afterwards, 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 stretched so that the stability can be assessed in the X-ray image. Nowadays, held x-rays no longer play a significant role in initial diagnostics (acute diagnostics).
On the one hand, many patients do not tolerate this procedure and on the other hand, the severity of 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 differently in each individual, the doctor usually makes a control x-ray of the healthy mutual ankle joint to determine the healthy norm and then to be able to distinguish better between healthy and sick.
The extent of ligament damage can be accurately assessed by means of a magnetic resonance imaging (MRI). Since there are no immediate consequences for further treatment and MRI is expensive and poorly available, it is usually not used in diagnostics. .
Treatment
As with most injuries, a decision must be made as to whether the torn ligament should be treated conservatively or surgically. In both cases, a first measure should be the application of the so-called PECH rule in the context of emergency measures. Behind the term “PECH” are the respective treatment steps: The PECH-principle provides that the affected person should pause immediately with the activity or load of the ligamentous apparatus in order to relieve the corresponding torn structure on the one hand and on the other hand to avoid further irritation in case of a tear, which could possibly provoke a complete ligament rupture.
The region of the torn ligament should then be cooled well. The cold causes a reduced bleeding and a reduction of the swelling via the vasoconstrictive effect. In addition, the cold therapy has a pain-relieving effect.
Regardless of what is used for cooling, be it ice, an ice pack or simple cold compresses, one should always make sure that the cold does not come into direct contact with the skin, but that a cloth or compress is placed between the skin and the cold source. The main aim of compression (C = Compression) is, as with cold therapy, to reduce swelling. By compressing the affected area, the blood circulation is reduced.
It is important to compress in a targeted manner in order to adequately contain any possible swelling. The last step of the PECH scheme is elevation, which promotes blood reflux so that there is less swelling. It is recommended that the region of the torn ligament be elevated for approximately 48 hours.
. – P = Pause
- E = ice
- C = Compression and
- H = Raise. 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, the type of ligament rupture, the affected joint, the degree of activity and lifestyle. It is also important to know whether the joint is a ligament- or muscle-locked joint. If this is the case, the highest priority is to heal the joint without defects in order to regain full stabilizing function.
As a matter of principle, one tries to treat the torn ligament with a conservative therapy, no matter where first. In addition to the PECH scheme, a torn ligament should always be kept still and, if necessary, a splint or bandage should be worn to compensate for the acquired instability. However, if after a certain period of time there is no improvement in the form of pain relief, swelling and regaining stability, surgery should be considered.
The surgical treatment includes the implantation of plastic ligaments or the body’s own plastics. Depending on where the torn ligament is located, implantation may not be considered immediately. It is also possible to reattach a torn ligament to its bone attachment.
Physiotherapy to reconstruct 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 conservative or surgical treatment is involved, the primary goal is to regain the functionality and stability of the ruptured ligament.
This can be achieved by immobilising and sparing the affected ligament structure, including the surrounding structures which could have a mechanical influence on the ruptured ligament. Tapering is an established treatment method for conservative treatment of torn ligaments. Here, the “Kineso Tape” fulfils the function of a functional bandage.
It supports the muscles, but above all the baths in their stabilising function without restricting movement. It also protects against extreme movements and counteracts swelling through slight compression. In order to strengthen or support the ligament structures, the tape must always be applied individually, depending on the course of the ruptured ligament and the location or posture where complaints occur.
The different colours of the tapes imply the strength of the tape so that it is possible to choose the right tape for the severity of the problem. In addition, the “Kineso Tape” fulfils one measure of the PECH scheme, namely compression (C=Compression). Despite its elasticity, the tape can be applied to the skin so tightly that it acts like a compression bandage.
In general, taping can be used both as a preventive measure and after an acute torn ligament. If, in addition to the torn ligament, there are also injuries to the bone and cartilage or conservative treatment has been unsuccessful, the ligaments can be sutured. However, surgery is only recommended in exceptional cases, such as for competitive athletes, as it does not always lead to a faster or more complete healing.
In rare cases, complications occur during the operation. As with any operation, infections, bleeding or injuries to nerves or blood vessels in the area of the ankle joint can occur. In very rare cases, mobility in the joint is then permanently restricted after an operation.
Following the operation, the ankle is immobilised for six weeks with a lower leg plaster cast. Regardless of the type of treatment, there is a risk of developing venous thrombosis whenever the leg is immobilised. This complication can be avoided as far as possible by administering anticoagulant medication containing, for example, the active substance heparin.
All suitable medication is administered in the form of injections. A thrombosis can lead to damage to the veins themselves on the one hand and to life-threatening pulmonary embolism on the other. After a complete rupture of the outer ligaments with involvement of all three outer ligaments), sport may only be practised again after twelve weeks at the earliest, competitive sport even after six months.
The risk of a renewed rupture (torn ligament) is very high if the strain is exerted too early and the treatment is incorrect. However, this information must be seen in relative terms and depends on the extent of the injury and type of sport. Physiotherapeutic therapy also plays a decisive role after the surgical treatment.
Strong muscles stabilize the joint during the course of movement, so that the ligaments are less stressed. In case of permanent instability, special orthopaedic shoes and special insoles or bandages may be suitable to stabilise the joint. After the end of immobilization and rest, the joint can be gradually reloaded.
Initially, however, only a small load is applied, which is then increased depending on any pain. During the first four to six months, suitable joint protection – for example a tape bandage – should be worn, especially during sports. Before taking up sports activities, the muscles should be rebuilt to such an extent that the surrounding musculature ensures sufficient stability of the joint. Further functional treatment:
- Early functional further treatment with orthosis (e.g. Aircast, Malleoloc, etc., see picture above) under full axial load
- Physiotherapeutic exercise treatment (physiotherapy) in function- and activity-oriented intensity
- Electrotherapy, ultrasound
- Exercises for sensomotoric (proprioceptive) training (special physiotherapy, PNF)
- Incapacity to work 1-6 weeks (depending on profession)
- Sport specific training after 2-12 weeks
- Competitive sports after 12 weeks at the earliest
- Orthetic protection during sports for at least 3-6 months (orthosis or tape)
