Introduction
The therapy of a torn inner ligament in the knee can be performed conservatively or surgically, depending on the severity of the injury. The choice of therapy depends primarily on the extent to which the tear in the inner ligament is caused by the rupture and the extent of instability.
Operation
The indication for surgery as therapy for a torn inner ligament in the knee is much rarer than conservative treatment in the form of immobilization, rest and physiotherapy. Nevertheless, there are reasons that make surgical treatment of a torn inner ligament necessary. An important indication for the operation is a pronounced unfolding.
This is checked by bending the knee 30° and subjecting it to valgus stress (lateral bending movement of the lower leg to the thigh). If at the same time an enormous instability is present, surgery is unavoidable. Other criteria that speak in favor of surgery are the fact of a complete rupture of the inner ligament, the involvement of other structures and age.
If the inner ligament is completely torn, it is a more serious lesion than if it is only partially ruptured or torn. In addition, the injury requires surgery if there is osseous involvement. In this case, reconstruction of the bony parts of the fracture must be performed intraoperatively to restore the anatomically correct position.
Various osteosynthesis procedures are available for this purpose, such as the use of screws to refix a chipped bone fragment. The age aspect is important because younger patients are operated on more frequently than older patients. Although there is no limit to the age at which surgery should no longer be performed, patients over 50 years of age are operated on less frequently than younger patients.
In general, however, an individual clarification is advisable, as it depends on the extent to which the joint is/was currently stressed and how long it will be exposed to stress. Younger patients put more strain on their knee joints and thus the collateral ligaments due to sports activities than older patients. In addition, young patients have a higher life expectancy, which is associated with a longer period of stress on the inner ligaments.
Once the decision for surgery has been made, the inner ligament is treated by a minimally invasive procedure. The prerequisite for being able to perform the arthroscopic procedure (arthroscopy = joint endoscopy) is that the region near the rupture of the inner ligament is swollen and there are no longer any significant restrictions on movement. This means that surgery cannot always be performed immediately after a rupture of the inner ligament.
In the meantime, the torn ligament should be treated by immobilization and gentle treatment with physiotherapy that may promote healing. In the case of fresh torn ligaments, the ligament is repaired or refixed intraoperatively. Either the two ends of the inner ligament are sutured together again or the torn out attachment – or the original site of the ligament – is reattached to the bone.
Older torn inner ligaments, on the other hand, are treated with a replacement ligament. There are two options here, either the transplant can be made from the patient’s own body or from a foreign material. In the past, the former has proven to be a better option in terms of healing and prognosis.
A last typical indication for the surgical treatment of an inner ligament rupture is the so-called “Unhappy Triad” clinical picture. This involves simultaneous injury to the three structures: inner ligament, inner meniscus and anterior cruciate ligament. In this case, the other two structures must of course be treated surgically in addition to the ruptured inner ligament.
A rupture of the inner ligament is only operated on if the damage to the ligament is complex and, for example, a piece of bone has been torn away. In this case, conservative (i.e. non-surgical) therapy is not possible and surgery is the only way to achieve healing or sufficient stabilization of the knee. An advantage of an operation on the knee joint is, of course, that a direct refixation of the ligament on the knee can be carried out, thus correcting the injury.
This is more likely to restore stability to the knee. In addition, pain should be less likely to become chronic (permanent) after an operation. Every operation carries the risk of complications.This includes, for example, the possibility of injury to structures such as nerves or blood vessels during surgery.
Another complication is an inflammation of the knee joint, which would then require a longer period of treatment. Also, the time until the knee joint is fully loaded is not necessarily shorter than with conservative therapy. For this reason, surgery for a torn ligament should only be performed if the prospects of recovery using conservative therapy are not promising.
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