Treatment
The choice of treatment in the case of a torn ligament depends on the extent of the injured ligaments, whether the ligaments are completely or only partially ruptured and whether other structures have been affected. An initial measure should be the application of the PECH scheme, regardless of the decision to use conservative or surgical therapy. The letters contain the respective treatment steps: First of all, the load on the knee should be stopped (P = pause) and then the affected region should be cooled (E = ice).
Furthermore, it is important to bandage the knee or to compress it with cool compresses (C = Compression) and then to put it up (H = Raise). All 4 steps are aimed at reducing swelling and relieving pain. The decision to treat a torn ligament conservatively is usually made if it is an isolated torn ligament or a partial tear.
The conservative choice of therapy is also supported by the assumption that the slight instability due to the torn ligament can be compensated by the surrounding, well-developed musculature. Furthermore, it is not unusual for patients to see a doctor long after the rupture event due to growing discomfort. In such cases, old torn ligaments are no longer treated surgically but conservatively.
This conservative treatment takes the form of support splints, so-called orthoses or a plaster cast. These aids ensure relief, stabilization and immobilization of the knee joint, so that the structures can regenerate without stress. The splint holds the knee joint in the correct position and keeps the structures in place during movement.
An isolated tear of the inner or outer ligament can be immobilised, for example, by a 6-week plaster cast. Once the complaints, i.e. the pain and swelling, have subsided, it is advisable to begin physiotherapeutic treatment in order to strengthen the ligaments and surrounding muscles again. The strength training and also the coordinative movement school should stabilize the knee joint in itself again, to make a new injury less likely and to regain the former stress tolerance.
The instability is thus compensated for by targeted muscle building training to such an extent that those affected can fully load their knee joint again even with purely conservative care. If the stability cannot be regained by conservative treatment, surgical treatment is indicated. Other criteria that speak in favour of surgery are the involvement of cartilage-bone damage, fresh and complicated torn ligaments (e.g. “Unhappy Triad”) or failure to respond to conservative therapy.
The latter aspect is often the case despite the patient’s compliance with conservative treatment in the form of rest, rest and physiotherapy. Depending on which ligament structure is torn, the appropriate surgical technique is chosen. Generally, capsular ligament plastics are indicated when muscular stability is not possible and the patients are still very young.
As a rule, parts of the ligamentum patellae or the semitendinosus muscle are removed and used as a replacement ligament. The indication for surgery, especially in the case of a torn cruciate ligament, is particularly advantageous for young, athletic patients, as studies have shown that this group can benefit enormously from a restoration through ligamentoplasty and regain full stability and load capacity. As a rule, the procedure is performed in the form of a joint endoscopy, the so-called joint arthroscopy.
This is a minimally invasive procedure, in which the required instruments are only inserted through small skin incisions and no major surgical scars are left behind. The duration of arthroscopy of the knee is significantly reduced compared to open surgery.