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Hamstring Strain (for Teens) – Nemours Kidshealth

Frank was trying to beat an opposing player to a loose ball during a soccer game when he felt a sharp pain at the back of his left leg. He dropped to the ground, but when he tried to get up and walk, he fell down again and had to be helped off the field.

The next day, Frank went to see a doctor. The doctor asked him a few questions, examined his leg, and told him he had a grade 2 strain — a partial tear — of one of the muscles in his hamstring.

What Is a Hamstring Strain?

Three muscles run down the back of your leg, from your thigh to your knee — the biceps femoris, semitendinosus, and semimembranosus — and help you bend your knee and extend your hip. As a group, they are known as the hamstring. A hamstring strain, sometimes called a pulled hamstring, happens when one or more of these muscles gets stretched too far and starts to tear.

Hamstring strains can be mild, with little pain and a short recovery time. Or, they can be severe and need surgery and crutches for weeks.

What Are the Symptoms of a Hamstring Strain?

Chances are that if you strain your hamstring while running, you’ll know it immediately. You’ll feel a sharp pain and possibly a popping sensation at the back of your leg. You won’t be able to keep running and you may fall.

Other symptoms of a hamstring strain include:

  • pain in the back of your thigh when you bend or straighten your leg
  • tenderness, swelling, and bruising in the back of the thigh
  • weakness in your leg that lasts for a long time after the injury
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How Is a Hamstring Strain Diagnosed?

A hamstring strain might be diagnosed on the sidelines by a trainer or when you see a physical therapist. Often, you’ll also see the doctor for a hamstring strain. The doctor will examine your leg and ask you questions about how the injury happened and how much pain you have.

The examination will help figure out what grade of strain you have:

  • Grade 1; this is a mild strain. You may experience some pain when you use your leg, but it will be minor and there will be minimal swelling.
  • Grade 2; this is a partial tear of one or more of the hamstring muscles. This may cause you to limp when you walk and feel some pain during activity. You might see some swelling and bruising, and you might not be able to straighten your leg all the way.
  • Grade 3; this is a complete tear of one or more of the hamstring muscles. You’ll feel pain and not be able to straighten your leg all the way, and you’ll notice swelling right away. Walking will be very difficult and may require crutches.

What Causes a Hamstring Strain?

A hamstring strain generally occurs as a result of muscle overload, such as when you are running and your leg is fully stretched out just before your foot strikes the ground. When your foot strikes the ground and all your weight is on it, the muscles can get stretched too far and they may start to tear.

People who take part in certain activities that involve sprinting or jumping (like track and field, soccer, football, lacrosse, basketball, and dance) are more at risk of getting hamstring strains. These kinds of injuries are also more common in teens who are going through growth spurts. That’s because the leg bones may grow faster than a person’s muscles, pulling the muscles tight and leaving them more susceptible to getting stretched too far.

Some of the more common things that can contribute to a hamstring strain include:

  • Not warming up properly before exercising. Tight muscles are much more likely to strain than muscles that are kept strong and flexible.
  • Being out of shape or overdoing it. Weak muscles are less able to handle the stress of exercise, and muscles that are tired lose some of their ability to absorb energy, making them more likely to get injured.
  • An imbalance in the size of your leg muscles. The quadriceps, the muscles at the front of your legs, is often larger and more powerful than your hamstring muscles. When you do an activity that involves running, the hamstring muscles can get tired more quickly than the quadriceps, putting them at greater risk of a strain.
  • Poor technique. If you don’t have a good running technique, it can increase the stress on your hamstring muscles.
  • Returning to activities too quickly after an injury. Hamstring strains need plenty of time and rest to heal completely. Trying to come back from a strain too soon will make you more likely to injure your hamstring again.
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How Can You Prevent a Hamstring Strain?

Keeping your muscles in good shape is the best way to prevent hamstring injuries. Here are some ways to help protect yourself against them (and other sports injuries!):

  • Warm up properly before exercise or intense physical activity. Jog in place for a minute or two, or do some jumping jacks to get your muscles going. Then do some
    dynamic stretching— ask your coach or an athletic trainer to show you how. After you play, do some static stretches where you gently stretch your muscles, holding each stretch for 30 seconds or more. 
  • Keep your muscles strong and flexible year-round. Get regular exercise and adopt a good stretching program so your muscles don’t get a shock when you do an intense workout.
  • Increase the duration and intensity of your exercise slowly. A good rule of thumb is to make sure you add no more than 10% each week to the miles you run or the time you spend playing a sport.
  • If you feel pain in your thigh, stop your activity immediately. If you’re worried that you might have strained your hamstring, give it time to rest and don’t go back to your activity until your leg feels strong, you have no pain, and you can move your injured leg as freely as the other one.

What’s the Treatment for a Hamstring Strain?

The good news is that only the most severe muscle tears require surgery. Most hamstring strains will heal on their own or with some physical therapy.

To treat a hamstring strain, follow these tips:

  • Use the RICE formula as soon as possible after the injury:
    • Rest. Limit the amount of walking you do, and try to avoid putting weight on your leg if your doctor recommends this.
    • Ice. Use a bag of ice or a cold compress to help reduce swelling for the first 48 hours after the injury. This should begin as soon as possible after the injury and then every 3 to 4 hours for 20 to 30 minutes at a time until the swelling is gone. Wrap the ice or ice pack in a towel. Don’t put ice or ice packs directly on the skin because it can cause tissue damage.
    • Compress. Use elastic bandages or sports wraps to help support your leg and keep the swelling down if your doctor recommends doing so. Doctors recommend using elastic compression bandages instead of compression shorts because you can adjust the bandages as needed.
    • Elevate. When you are sitting or lying down, keep your leg elevated.
  • Take pain medicine. Ibuprofen and other non-steroidal anti-inflammatory drugs (NSAIDs) can help relieve pain and reduce swelling in the leg. Some doctors prefer other medicines like acetaminophen. Talk with your doctor about what you should take.
  • Do stretching and strengthening exercises. Slowly adding some exercises can help to improve your leg’s strength and flexibility (and, perhaps, prevent the injury from happening again). A doctor, athletic trainer, or physical therapist can help determine when your hamstring is ready for these exercises.

If you have a complete tear of one of your hamstring muscles or tendons, your doctor might want you to have surgery to reattach the tendon to the bone or fix the tendon.

Not overdoing things is key when it comes to this type of injury. Many people have a hamstring strain come back because they returned to play too quickly. So follow your doctor’s advice and don’t push yourself or feel pressure to get back into sports or other activities too soon.

Hamstring Tear or Strain | Orthopedics

Types of a hamstring tear or strain

  • Grade 1 — mild injury that heals within a couple weeks.
  • Grade 2 — moderate injury that is typically a partial tear in the muscle; patients are likely to limp when walking and will have occasional twinges of pain during activity.
  • Grade 3 — severe injury where the muscle is completely torn or a lump of muscle tissue is torn, and can take months to heal.

Causes of a hamstring tear or strain

Hamstring tears or strains are typically caused by stretching the soft tissues and muscle beyond their limits. In many cases, the patient will suffer from a hamstring tear or strain when running. Other causes of hamstring tears or strains:

  • Limited or lack of warm-up before exercising
  • Poor muscle strength or muscle fatigue
  • Tight hip flexors or weak glutes
  • Differences in leg length
  • Poor flexibility

Risk factors for a hamstring tear or strain

Risk factors of a hamstring tear or strain are similar to the causes. People who have poor flexibility, poor strength, muscle fatigue and those who do not warm up properly are at greatest risk for developing a hamstring tear or strain.

Other risk factors of a hamstring tear or strain include:

  • Age — as you get older, you are at higher risk of a pulled hamstring.
  • Previous injury — patients with previous hamstring injuries are at higher risk for a future hamstring injury.
  • Certain sports — sports that require sprinting or sudden change in direction put patients at a higher risk for suffering a hamstring tear or strain.

Symptoms of a hamstring tear or strain

The immediate symptom of a hamstring tear or strain is a sudden, sharp pain in the back of the upper leg. The pain may be so severe it stops you from continuing your activity.

Symptoms depend on the grade of the tear:

  • Grade 1 — tightness in the muscle while stretching, inability to fully move your leg from bending to straightened, and inability to bear weight on the leg affected.
  • Grade 2 — reduced muscular strength, limping when walking, and pain when bending the knee.
  • Grade 3 — a severe, sudden, sharp pain in the back of the thigh, inability to extend the knee more than 30 to 40 degrees, inability to walk without pain, and severe bruising around the impacted area.

Diagnosis of a hamstring tear or strain

A hamstring injury is diagnosed in a visit with your primary care or orthopedic provider. The doctor will take a full medical history and physical exam.

During the physical exam, the doctor will evaluate the swelling, tenderness and range of motion in the leg. In moderate tears or strains, the physician may be able to feel a divot in the muscle.

Your provider may also order diagnostic testing, like an MRI or x-ray, if he or she thinks you have sustained other, more serious injuries that need a different treatment regimen.

Treatments for a hamstring tear or strain

Mild to moderate strains can often be treated at home with rest, ice, compression and elevation in combination with anti-inflammatory medications. Crutches also may be recommended to help the patient get around.

  • Braces — braces can help keep the area stable during the recovery process.
  • Physical therapy and rehabilitation — although most hamstring tears will heal on their own, they need special exercises and therapy to return to full function.
  • Platelet rich plasma (PRP) injection — a PRP injection can help expedite the healing process by injecting growth factor platelets from the patient’s own blood back into the injured area.

Recovery from a hamstring tear or strain

The first phase of recovery is working to decrease the inflammation in the pulled muscle. The second phase of recovery works to build the normal supply of blood to the affected area. The final stage in the recovery process from a hamstring tear or strain works to repair the muscle that will allow the person to resume day-to-day activities.

Mild to moderate (grade 1 or 2) tears or strains can heal within three to eight weeks with diligent home therapy. For a grade 3 hamstring tear or strain, recovery may be as long as three months.

Returning to sports before the injury is fully healed can cause more severe injuries.

Hamstring Injury & Strain | Muscle tear Grades, Causes and Treatment

What are the hamstrings?

The hamstrings are the three muscles at the back of the thigh. At the top they are attached to the ‘sit bone’ of the pelvis. The lower ends cross the back of the knee joint and are then attached to the bones of the lower leg:

  • Semitendinosus – attaches to the back of the shin bone (tibia) on the inside of the back of the knee.
  • Semimembranous – also attaches to the back of the shin bone (tibia) on the inside of the back of the knee.
  • Biceps femoris – attaches to the top of the smaller bone of the lower leg (fibula) on the outside of the back of the knee.

They are involved in:

  • Bending the knee.
  • Tipping the pelvis back when you lean backwards.
  • Twisting the knee when the knee is bent.

What is a hamstring injury?

A hamstring injury is a strain (muscle tear). They most often occur at the middle of the back of the thigh where the muscle joins its tendon or at the base of the buttocks.

The three grades of hamstring injury are:

  • Grade I: a mild muscle strain – likely to recover in a few days.
  • Grade II: a partial muscle tear.
  • Grade III: a complete muscle tear or tear of an attachment – may take weeks or months to heal.

What causes hamstring injuries?

Hamstring injuries are common in all sports that involve short bursts of sprinting, suddenly stopping and changing direction and also jumping. So they are particularly common in football, rugby, baseball and track running.

Hamstring injuries happen most often at the end of the swing phase of running, just before the outstretched leg is put to the ground. At this point, the hamstring muscles have to suddenly shorten (contract) to bend the knee.

What makes a hamstring injury more likely?

There are many factors that are thought to make a hamstring injury more likely. Some are factors that you can do something about, such as:

  • Muscle strength – mainly weak hamstrings (see below).
  • Warming up – muscles work best and are less likely to be injured when they are warm. Doing some warming up exercises and keeping the legs warm with suitable clothing while warming up, are both essential.
  • Tiredness – a footballer is more likely to injure their hamstring in the second half of a match than the first. Overall fitness is important.
  • Core stability.
  • Flexibility, although there is some debate about how important this is.

Other factors may not be as easy to change, such as:

  • Previous hamstring injury – If you have already had a hamstring injury you are much more likely to have another one. Between 12 and 33 people out of 100 who have had one hamstring injury go on to have a second.
  • Older age – a hamstring injury appears to be more common as you become older.

Neither weight nor BMI is thought to be a risk factor for a hamstring injury.

Importance of hamstring strength

Hamstring strength is probably the most important factor in hamstring injury. There is disagreement in the research as to whether it is an imbalance between the strength of the quadriceps muscles at the front of the thigh compared to the hamstrings that matters most or just the strength of the hamstrings themselves. Either way, it is essential to spend time working on your hamstring strength in order to avoid injury. A highly trained sportsperson will tend to do this as part of their training but recreational footballers or runners, for example, may not realise that they need to as well.

A specific exercise has been devised to increase the strength of the hamstring muscles at the point in running when they are at most risk of injury. It is called the Nordic hamstring exercise (see below – ‘How to prevent a hamstring injury’).

Symptoms of a hamstring injury

You may feel or hear a pop, followed immediately by severe pain in the affected leg after sudden lunging, jumping or sprinting. The muscle will often feel tight and tender, and go into cramp or spasm. In severe cases, there can be swelling and bruising. Walking may be painful. You may be unable to stand.

The back of the leg will feel tight, tender and possibly bruised. With more severe injury, swelling and a black and blue or bruised appearance will follow. In some cases there may be a gap in the muscle that you can actually feel by touching it.

Mild hamstring strains may not hurt too much. But severe ones can be very painful, making it impossible to walk or even stand.

Complications

Grade I injuries tend to be mild in that they tend to heal fully with only minor aggravation to the injured person, particularly in those whose sport doesn’t put them at increased risk of further injury.

Grade II and III injuries take longer. Severely torn muscle can be debilitating for a long time and can be career-threatening to the professional athlete.

Hamstring injury treatment

Grade I-II minor to moderate hamstring injuries usually heal on their own. For the first 48-72 hours think of:

  • Paying the PRICE – Protect, Rest, Ice, Compression, Elevation; and
  • Do no HARM – no Heat, Alcohol, Running or Massage.

Paying the PRICE:

  • Protect your leg from further injury.
  • Rest your affected leg for 48-72 hours.
  • Ice can be applied as soon as possible after your injury – for 15-20 minutes at a time. The cold is thought to reduce the flow of blood to the injured area and may reduce bleeding as well as reducing the pain and inflammation:
  • Compression with a bandage can help to reduce pain and swelling. A tubular compression bandage will do the job well. You should only need this for a day or two.
  • Elevation – keep your leg slightly raised while sitting to help reduce swelling.
  • R is sometimes added to this list to make PRICER. R stands for Rehabilitation which is a really important part of the treatment for a hamstring injury – to get you back to normal and reduce the chances of you having another hamstring injury. You may need to see a physiotherapist or sports therapist for advice about the exercises to do but there is an outline below.

Avoid HARM for 72 hours after injury. That is, avoid:

  • Heat – for example, hot baths, heat packs, saunas. Heat has the opposite effect on the flow of blood to ice. In other words, heat encourages blood flow. So, heat should be avoided in the early stages of an injury, when inflammation is developing.
  • Alcoholic drinks, which can increase bleeding and swelling and decrease healing.
  • Running or any other form of exercise which may cause further damage.
  • Massage, which may increase swelling and bleeding. However, as with heat, after about 72 hours, gentle massage may be soothing.

Other measures

  • Painkillers, such as paracetamol: paracetamol is useful to ease pain.
  • Anti-inflammatory painkillers: these medicines are also called non-steroidal anti-inflammatory drugs (NSAIDs):
    • Note: National Institute for Health and Care Excellence (NICE), a well-known source of guidance for doctors in the UK, does not recommend that anti-inflammatory painkillers be used in the first 48 hours after an injury. This is because of concerns that they may delay healing. However, the evidence for this is old and of low quality. More recent studies suggest the benefits of taking NSAIDs for the short term, outweigh the risks. 
    • These medicines may have side-effects, such as an increased risk of bleeding and ulcers. They should only be used short-term, unless your doctor specifically says otherwise.
  • Rub-on (topical) anti-inflammatory painkillers: again, there are various types and brands of topical anti-inflammatory painkillers. There is debate as to how effective these are compared with tablets. Some studies suggest that they may be as good as tablets for treating sprains. Others suggest they don’t help. However, the amount of the medication that gets into the bloodstream is much less than with tablets and there is less risk of side-effects.
  • Strengthening your hamstrings is the best protection against hamstring strain.
  • In severe cases where the muscle is torn, you may need surgery. The surgeon will repair the muscle and reattach it.

Recovering from a hamstring injury

Recovering from a hamstring injury may take from days to months, depending on how severe the strain or tear is. A grade III injury can take several months to heal; you’ll be unable to resume your usual training or play sport during this time.

Most hamstring injuries, even grade III injuries, heal without surgery. In severe cases, crutches or splinting may be necessary. In rare cases, where there is a complete rupture where the hamstrings join the pelvic bones at the top, surgery is necessary.

Lack of use, particularly if splinting, results in muscle shrinkage and the formation of scar tissue where the tear is healing. Excessive scar tissue prevents healthy muscle function, as it doesn’t stretch and move as normal muscle does.

To avoid these complications rehabilitation exercises need to begin early (except grade III injuries):

  • After a few days, once the pain has subsided, you should start to do regular gentle hamstring stretches followed by a programme of gentle exercise, such as walking and cycling.
  • Always warm up before exercising and cool down afterwards.
  • Stop if pain returns.
  • To avoid injuring yourself again, you should only return to a full level of activity when your hamstring muscles are strong enough.
  • Your physiotherapist or sports therapist will be able to advise you on returning to your sport and on a suitable graded exercise programme, which might include:
  1. Starting with decline treadmill running.
  2. Moving to steep decline treadmill running.
  3. Doing hamstring strengthening exercises using a pulley system to reduce the load.
  4. Doing regular hamstring exercises.
  5. When strength has returned, a gradual return to the desired sport can be attempted. Running should be re-introduced gradually.
  6. Full return is usually possible only after maximal flexibility and strength have been obtained.

Re-injury is extremely common. Athletes are highly motivated and are likely to have set personal goals for training, timing and performance. However, re-injury not only prolongs recovery, it also increases the risk of permanent damage.

How to prevent a hamstring injury

As with all sports-related muscle injuries the risk can be reduced by close attention to muscle strength. This is true both for preventing a first injury or a recurrence.

  • A regular period of warming up your muscles before the intended athletic activity will reduce the risk.
  • Improve the strength of the hamstrings. Examples would be:
    • Horizontal power manoeuvres, such as repeated single leg broad jumps, combined with:
      • Traditional resistance training that targets the hamstrings, such as hamstring curl.
      • Nordic hamstring exercises (see below).

What is a Nordic hamstring exercise?

Nordic hamstring exercises are exercises that have been specifically designed to target the hamstring muscle at the point where is is most likely to be injured. They have been shown to reduce the risk of a first hamstring injury by 65% and the risk of a recurrent injury by as much as 85%. Some studies don’t show that they are as effective as this but it would seem that it depends on how well the people doing them adhere to the exercise programme – in other words, if you don’t do them regularly, they won’t work as well.

They should be done regularly but only gradually increase how many are done and how often. They are intense and will cause delayed-onset muscle stiffness (DOMS) but this should not put you off doing them. (DOMS Is the medical term for the aching you can get in your muscles 24-48 hours after exercise.). They should NOT be done if you have a recent hamstring injury, unless advised to do so by your physiotherapist or sports therapist. They are best done with a partner. 

How to do a Nordic hamstring exercise

  • Kneel up with your hands in front of you.
  • Your partner sits on the floor behind you and holds down your ankles.
  • Then lower yourself towards the ground as slowly as you can.
  • As soon as you can no longer hold yourself you drop down to the floor but use your arms to push yourself back up immediately, ie DO NOT use your hamstrings to get back up.

If you do not have a partner these exercises can be done by trapping your feet and then using your hands to walk yourself back up. However, this should be supervised by someone familiar with the exercises, at least initially.

What is the outlook for a hamstring injury?

The outlook (prognosis) is generally good, but can require a period of rest by avoiding running and athletic competition, followed by adhering to a rehabilitation programme of exercises. The length required for recovery varies depending on the severity of the muscle injury.

Pulled Hamstring Prevention & Treatment

A hamstring injury is a tear or strain to the tendons or large muscles on the back of the thigh. Often referred to as a pulled hamstring, it is a common injury in athletes and can occur in different severities. There are three grades of hamstring tears: grade one is a mild strain or muscle pull, grade two is a partial muscle tear, and grade three is a complete muscle tear. A hamstring injury can occur when any of the muscles or tendons are stretched beyond their limit. They often occur during sudden, explosive movements, such as sprinting, jumping, or lunging, but they can also occur more gradually.

Prevention of Pulled Hamstring

To avoid a hamstring strain there are multiple steps you can take:

  • Warm-up before physical activity
  • Stretch after physical activity
  • Boost the intensity of your physical activity slowly
  • Strengthen the hamstrings and glutes as a preventative measure

The best way to prevent injuries to the hamstring is through strength training for the surrounding muscles and stretching before any physical activity that could strain the hamstring muscle.

Treatment of Pulled Hamstring

When a hamstring injury occurs take the following actions to help speed healing:

  • Use an elastic bandage around the leg to keep down swelling
  • Apply ice for 20-30 minutes every three hours
  • Elevate the leg on a pillow while sitting or lying down
  • Take an anti-inflammatory painkiller such as ibuprofen, Advil, or Motrin.

You should consider seeing your doctor if you have any concerns about your hamstring pain. More specifically, consult your doctor if you think it is a severe injury, it is not healing, or your symptoms are getting worse. With a complete detachment, you will be in acute pain, may hear a popping sound, and might have significant bruising. Your doctor can also advise you as to when to return to normal activities and what exercises to do in order to help recovery. Physical therapy is sometimes required for full healing.

Express Care for Pulled Hamstring

While most hamstring strains can be cared for at home, sometimes the tear may be more severe.  Some grade three hamstring tears may even require surgery.  If your pain is intense and cannot be controlled with rest, ice, compression, and elevation (the RICE) protocol) along with anti-inflammatory medication, it is time to head to the Express Care Clinic at Colorado Springs Orthopaedic Group. Call 719-622-4550.

Learn more from Dr. Huang in this interview about Hamstring Injury Prevention and Treatment:

Did you Pull a Hammy? Here’s What You Should Know

One minute your favorite football player is running for a touchdown, the next they are crumbled on the ground grabbing the back of their leg. Looks like they’ve pulled a hammy!

If you’re a fan of watching sports, then you’ve probably seen an athlete go down once or twice with a hamstring injury. Although not the prettiest sight to behold, hamstring injuries are quite common among runners and athletes—and can even occur with regular daily activities.

Whether you are a weekend warrior or a couch potato, learn more about your potential risk, treatment options and how to prevent injury.

What is a hamstring injury?

A pulled hamstring is usually a strain or tear to the large muscles that run down the back of your thigh. Typically, most occur in the thick, central part of the muscle where tendons and muscle fibers join. Less commonly, you can injure the hamstring tendons themselves. Tendons are soft tissue structures that attach muscle to bone. The most common site of a hamstring tendon injury is at its attachment to your pelvis on the bone where you sit.

If you’ve recently pulled a hammy, you may wonder if it’s a tear or just a strain. But when it comes to differentiating a strain versus a tear, Tyler Collins, MD, an orthopedic sports medicine surgeon at TOCA at Banner Health in Arizona, said they are more or less the same thing but are graded according to their severity.

“A strain is an injury to a muscle, which at the low end is a stretch of a muscle and at the most severe end is a complete tear,” Dr. Collins said. “Hamstring injuries are usually graded from 1 to 3, with a type 1 strain being a stretch of the muscle or minimal tear, a type 2 being a partial tear and a type 3 being a complete tear of the muscle. Tendon injuries are graded in the same way but are referred to as sprains instead of strains.”

What are the symptoms?

As Dr. Collins just mentioned, hamstring injuries are graded 1 to 3 depending on the severity. The symptoms you may experience will depend on the severity, but usually can include some pain, swelling and weakness in your hamstrings.

Grade 1: With a grade 1 injury, you’ll most likely be able to finish that run or game, but not without some swelling and mild pain. It may take only a few days to heal.

Grade 2: With a grade 2 injury, or partial tear, your pain may be more immediate and severe. You may experience swelling and significant pain at the site and loss of some strength in your leg. There may be some mild bruising as well.

Grade 3: With severe hamstring tears, or a grade 3 injury, you may have a “popping” sensation at the time of injury. In this case, the tendon may tear completely away from the bone and may even pull a piece of bone away with it. These usually cause a very severe amount of bruising.

With grade 2 and 3 injuries, it can take a few months to heal on the low end, but as many as 6 months for the most severe injuries.

What causes hamstring injuries to occur?

The main cause of hamstring injuries is due to muscle overload, when your muscle is stretched or pulled beyond its capacity or is challenged with a sudden load.

“You are more likely to strain or tear your hamstring if you subject yourself to riskier activities where you could sustain a sudden stretch or injury to that area,” Dr. Collins said. “Also, if a muscle is not consistently being worked or loaded (if you are more sedentary) you are more likely to sustain a more serious strain with a given injury.

Age, unfortunately, makes any injury more likely as tendon and muscle tissue tends to degenerate with age. We are usually less active as we age as well. Greater activity and strength training/stretching can help mitigate this.

When should I see the doctor?

Severe hamstring injuries are usually very obvious. You’ll likely feel a pop or sudden, sharp pain up near your buttocks and there is usually a larger amount of bruising. Many times, the entire back of your thigh will turn purple or black. If that is the case, you should see someone immediately and get an MRI. Rarely you can tear your hamstring without bruising but you will notice a pop and severe pain in your buttock or thigh.

“In short, if you felt a pop after a significant injury and have pain near your buttock see someone right away,” Dr. Collins said. “If the pain is more mid-thigh and there is no bruising this is usually something that will heal over time so you should only seek treatment if the pain persists and does not improve for several weeks.”

What are my treatment options?

Treatment for hamstring strains or muscle injury generally never involve surgery as muscle tissue will heal just as well with or without surgery. Treatment for hamstring sprains or tendon injuries will vary depending on the severity of the injury. Low grade hamstring sprains heal pretty quickly with non-surgical treatments, while more severe tears may require surgical treatment.

“Many partial tears will heal, but if they do not over a period of 6 to 12 weeks, you can consider more aggressive treatment such as injections or surgery,” Dr. Collins said. “Muscle strains tend to heal over time but can be reaggravated. Sometimes these can linger for months especially if you are involved in sports or higher-level activities.”

With complete tears, if the tendon is retracted more than a few centimeters or you are very active, you will usually do better with surgery. This is best done within a few weeks of the injury as it usually can help restore normal function and strength. If surgery is not done immediately, this can lead to permanent strength loss and continued pain. Later reconstructive surgery is usually not as successful and is higher risk.

How can I prevent them from happening altogether?

“Your best bet to prevent injury is a combination of good stretching and a strengthening program for the core and lower body,” Dr. Collins said. “Good hamstring stretching and strength training tend to prevent or minimize injury.”

If you think you just pulled a hammy, don’t wait. Schedule an appointment with a Banner Health expert. Whether you’re a casual athlete, weekend warrior or professional athlete, our sports medicine doctors provide services for everyone. Visit bannerhealth.com to learn more.


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ACL Injury Edison NJ | ACL Injury Patellar Hamstring Edison NJ

Anterior cruciate ligament (ACL) reconstruction hamstring method is a surgical procedure that replaces the injured ACL with a hamstring tendon. Anterior cruciate ligament is one of the four major ligaments of the knee that connects the femur (thigh bone) to the tibia (shin bone) and helps stabilize your knee joint. Anterior cruciate ligament prevents excessive forward movement of the lower leg bone (the tibia) in relation to the thigh bone (the femur) as well as limits rotational movements of the knee.

A tear of this ligament can make you feel as though your knees will not allow you to move or even hold you up. Anterior cruciate ligament reconstruction is surgery to reconstruct the torn ligament of your knee with a tissue graft.

Causes

An ACL injury most commonly occurs during sports that involve twisting or overextending your knee. An ACL can be injured in several ways:

  • Sudden directional change
  • Slowing down while running
  • Landing from a jump incorrectly
  • Direct blow to the side of your knee, such as during a football tackle

Symptoms

When you injure your ACL, you might hear a loud “pop” sound and you may feel the knee buckle. Within a few hours after an ACL injury, your knee may swell due to bleeding from vessels within the torn ligament. You may notice that the knee feels unstable or seems to give way, especially when trying to change direction on the knee.

Diagnosis

An ACL injury can be diagnosed with a thorough physical examination of the knee and diagnostic tests such as X-rays, MRI scans and arthroscopy. X-rays may be needed to rule out any fractures. In addition, your doctor will often perform the Lachman’s test to see if the ACL is intact. During a Lachman test, knees with a torn ACL may show increased forward movement of the tibia and a soft or mushy endpoint compared to a healthy knee.

Pivot shift test is another test to assess ACL tear. During this test, if the ACL is torn, the tibia will move forward when the knee is completely straight and as the knee bends past 30° the tibia shifts back into correct place in relation to the femur.

Procedure

The goal of ACL reconstruction surgery is to tighten your knee and to restore its stability.

Anterior cruciate ligament reconstruction hamstring method is a surgical procedure to replace the torn ACL with part of the hamstring tendon taken from the patient’s leg. The Hamstring is the muscle located on the back of your thigh. The procedure is performed under general anesthesia. Your surgeon will make two small cuts about 1/4 inch long around your knee. An arthroscope, a tube with a small video camera on the end is inserted through one incision to see the inside of the knee joint. Along with the arthroscope, a sterile solution is pumped into the joint to expand it enabling the surgeon to have a clear view and space to work inside the joint. The knee is bent at right angles and the hamstring tendons felt. A small incision is made over the hamstring tendon attachment to the tibia and the two tendons are stripped off the muscle and the graft is prepared. The torn ACL will be removed and the pathway for the new ACL is prepared. The arthroscope is reinserted into the knee joint through one of the small incisions. Small holes are drilled into the upper and lower leg bones where these bones come together at the knee joint. The holes form tunnels in your bone to accept the new graft. Then the graft is pulled through the predrilled holes in the tibia and femur. The new tendon is then fixed into the bone with screws to hold it into place while the ligament heals into the bone. The incisions are then closed with sutures and a dressing is placed.

Risks and complications

Possible risks and complications associated with ACL reconstruction with hamstring method include:

  • Numbness
  • Infection
  • Blood clots(Deep vein thrombosis)
  • Nerve and blood vessel damage
  • Failure of the graft
  • Loosening of the graft
  • Decreased range of motion
  • Crepitus (crackling or grating feeling of the kneecap)
  • Pain in the knee
  • Repeat injury to the graft

Post-operative care

Following the surgery, rehabilitation begins immediately. A physical therapist will teach you specific exercises to be performed to strengthen your leg and restore knee movement. Avoid competitive sports for 5 to 6 months to allow the new graft to incorporate into the knee joint.

Anterior cruciate ligament reconstruction is a very common and successful procedure. It is usually indicated in patients wishing to return to an active lifestyle especially those wishing to play sports involving running and twisting. Anterior cruciate ligament injury is a common knee ligament injury. If you have injured your ACL, surgery may be needed to regain full function of your knee.

Other Knee List

ACL Reconstruction Hamstring Fountain Valley CA


Anterior cruciate ligament (ACL) reconstruction hamstring method is a surgical procedure that replaces the injured ACL with a hamstring tendon. Anterior cruciate ligament is one of the four major ligaments of the knee that connects the femur (thigh bone) to the tibia (shin bone) and helps stabilize your knee joint. Anterior cruciate ligament prevents excessive forward movement of the lower leg bone (the tibia) in relation to the thigh bone (the femur) as well as limits rotational movements of the knee.

A tear of this ligament can make you feel as though your knees will not allow you to move or even hold you up. Anterior cruciate ligament reconstruction is surgery to reconstruct the torn ligament of your knee with a tissue graft.

Causes

An ACL injury most commonly occurs during sports that involve twisting or overextending your knee.  An ACL can be injured in several ways:

  • Sudden directional change
  • Slowing down while running
  • Landing from a jump incorrectly
  • Direct blow to the side of your knee, such as during a football tackle

Symptoms

When you injure your ACL, you might hear a loud “pop” sound and you may feel the knee buckle.  Within a few hours after an ACL injury, your knee may swell due to bleeding from vessels within the torn ligament. You may notice that the knee feels unstable or seems to give way, especially when trying to change direction on the knee.

Diagnosis

An ACL injury can be diagnosed with a thorough physical examination of the knee and diagnostic tests such as X-rays, MRI scans and arthroscopy. X-rays may be needed to rule out any fractures. In addition, your doctor will often perform the Lachman’s test to see if the ACL is intact. During a Lachman test, knees with a torn ACL may show increased forward movement of the tibia and a soft or mushy endpoint compared to a healthy knee.

Pivot shift test is another test to assess ACL tear. During this test, if the ACL is torn, the tibia will move forward when the knee is completely straight and as the knee bends past 30° the tibia shifts back into correct place in relation to the femur.

Procedure

The goal of ACL reconstruction surgery is to tighten your knee and to restore its stability.

Anterior cruciate ligament reconstruction hamstring method is a surgical procedure to replace the torn ACL with part of the hamstring tendon taken from the patient’s leg. The Hamstring is the muscle located on the back of your thigh. The procedure is performed under general anesthesia. Your surgeon will make two small cuts about 1/4-inch-long around your knee. An arthroscope, a tube with a small video camera on the end is inserted through one incision to see the inside of the knee joint. Along with the arthroscope, a sterile solution is pumped into the joint to expand it enabling the surgeon to have a clear view and space to work inside the joint. The knee is bent at right angles and the hamstring tendons felt. A small incision is made over the hamstring tendon attachment to the tibia and the two tendons are stripped off the muscle and the graft is prepared. The torn ACL will be removed and the pathway for the new ACL is prepared. The arthroscope is reinserted into the knee joint through one of the small incisions. Small holes are drilled into the upper and lower leg bones where these bones come together at the knee joint. The holes form tunnels in your bone to accept the new graft. Then the graft is pulled through the predrilled holes in the tibia and femur. The new tendon is then fixed into the bone with screws to hold it into place while the ligament heals into the bone. The incisions are then closed with sutures and a dressing is placed.

Risks and complications

Possible risks and complications associated with ACL reconstruction with hamstring method include:

  • Numbness
  • Infection
  • Blood clots (Deep vein thrombosis)
  • Nerve and blood vessel damage
  • Failure of the graft
  • Loosening of the graft
  • Decreased range of motion
  • Crepitus (crackling or grating feeling of the kneecap)
  • Pain in the knee
  • Repeat injury to the graft

Post-operative care

Following the surgery, rehabilitation begins immediately. A physical therapist will teach you specific exercises to be performed to strengthen your leg and restore knee movement. Avoid competitive sports for 5 to 6 months to allow the new graft to incorporate into the knee joint.

Anterior cruciate ligament reconstruction is a very common and successful procedure. It is usually indicated in patients wishing to return to an active lifestyle especially those wishing to play sports involving running and twisting. Anterior cruciate ligament injury is a common knee ligament injury. If you have injured your ACL, surgery may be needed to regain full function of your knee.


90,000 Plica Syndrome Is One Of The Major Causes Of Knee Pain

Are you one of those people whose knee pain affects their daily activities? Many medical factors cause knee pain, especially internal knee pain, and you may not be aware of many of them. Plica’s syndrome is one of these factors and it is one of the most common causes of pain in different people. How well do you know about this syndrome? Plick syndrome is a collection of symptoms that can affect people’s lives in the first three decades of their life, regardless of gender.According to a 2017 study, there are several types of this syndrome with a prevalence of 3 to 30% in European populations. These statistics show its prevalence as the main cause of knee pain. It is better to read more about this syndrome now to see if your knee pain is also caused by it.

Anatomy of the medial plate

It is best to first get a general understanding of the knee anatomy and plica position. A thick tissue membrane called the joint capsule covers the bones that make up the knee joint.A thin membrane of tissue, called the synovial layer, covers the inner surface of the knee capsule, and its cells are responsible for the secretion of joint fluid. Sometimes part of this synovial layer folds into the joint space, which you know as the plica fold. There are four types of knee plies: suprapatellar, medial, infrapatellar, or lateral; Among these, medial plica is more susceptible to injury, and medial plica syndrome is more common. This plaque is a remnant of fetal synovial tissue located on the inside of the knee.According to orthopedic surgeons, approximately 50-70% of us have a medial plica that does not cause any problems. But how does this cause knee pain?

How Does Plick Syndrome Occur?

Any activity or injury that irritates Plick will cause Plick’s syndrome. This syndrome develops over time in people who constantly bend or straighten their knees during activities such as cycling, running, and using stair lifts. However, doing hard and unusual exercises before the body is ready, and accidents, can irritate plica and cause knee pain.If you have a structural problem that affects the joint between the patella and the femur, you are more likely to have plik syndrome. These structural problems can be related to knee alignment or muscle weakness around the thighs.

What are the symptoms of Plica syndrome?

The main and common symptom of Pliki syndrome is knee pain, especially in the medial and anterior knees. And patients rarely feel pain behind the patella.It is interesting to know that knee pain caused by this syndrome is painful rather than sharp and gets worse when you put more pressure on the knee, such as using a ladder, squatting, or bending. There are also various additional symptoms that differ from person to person, depending on the type and intensity of the injury. Some of these symptoms are:

  • Difficulty sitting for a long time
  • Feeling of fixation of the knee after sitting on a chair for a long time
  • Feeling unstable on the stairs
  • A clicking or popping sound is heard when the knee is bent.This sound arises from the sliding of the thickened plate over the condylar surface of the femur inside the knee joint.
  • Knee pounding sensation, which is often present in the early morning but gradually disappears after daily exercise.
  • When you press on the kneecap, you will find a swollen plate
  • Feel the knee leaving

In addition to knee pain, which of the above symptoms do you have? Some patients say that we only have one or a few of these symptoms, so this means our knee pain is not caused by plica.However, this is an incorrect attitude, because all these symptoms do not appear in a person, and their types and severity differ from patient to patient. If so, talk to your doctor if you need precise information about this syndrome and its symptoms.

How is Plik’s syndrome diagnosed?

Diagnosing Plik’s syndrome is sometimes difficult, even for your doctor. As discussed earlier, various factors contribute to the onset of knee pain, especially internal knee pain, and diagnosis that requires special approaches.For example, a meniscus tear or tendinitis can also cause knee pain, but the diagnostic methods are different. So how is plica syndrome diagnosed?

Clinical Examination

The specialist will consider the possibility of studying the patient’s medical history and conducting a clinical examination. Each surgeon undergoes his own series of examinations, making a relative diagnosis of the disease. Clinical examinations are a series of tests that accurately indicate a doctor’s diagnosis and treatment options, but they are not definitive.Orthopedists perform these tests to assess three aspects: the patellofemoral joint / extensor mechanism, joint damage, and knee instability. Each of these three categories has its own tests, which are:

  • Patella and Hip Tests Include J-Mark, Q-Angel, Patellar Tracking, MPFL Palpation Test, and Patellar Slip
  • Articular Impairment Tests Include the McMurray Test, Apley-X (Grind), Bohler Test, Squat Test, and Duck Test
  • tests for knee instability include hallux valgus (abduction) and varus (adduction) tests, Cabot maneuver, anterior, and posterior box test, Lachman test, quadriceps active testing, axis shear (jerk) test, and Nouss slip pivot shift test

These measures help to diagnose plick syndrome, although they are not always definitive.And possibly confused with other causes of knee pain. As a result, orthopedists often use advanced technology to obtain accurate results and diagnose Plick syndrome.

Is Plica Syndrome Shown on MRI?

Many people assume that the use of X-rays to diagnose plik syndrome is acceptable, but doctors have found that this procedure is not effective in detecting plik. This is where magnetic resonance imaging (MRI) of the foot comes to the rescue.This technique uses magnetic waves to indicate problems such as tears in the meniscus and knee ligaments. Therefore, MRI can easily show any inflammation and damage to the plate.

Does Plica Syndrome Go away?

This question may be a question for many patients. Do you know, why? People believe that knee problems will never heal and that treatments will not work. In the case of plick syndrome, the opposite is true, so even at home you can correct this knee problem. Research shows that about 60% of Plick patients recover successfully within 6-8 weeks with nonsurgical treatment.This is a promising statistic, so if your doctor diagnoses Plica syndrome, don’t worry because it will be treated. In the continuation of this article, you are given all the necessary and basic methods of treating this syndrome.

Treatment of Plik’s syndrome

Fortunately, Plick Syndrome responds well to treatment compared to other causes of knee pain. When it comes to treatment, you might think that this means knee surgery, while Plik surgery is the latest and rarest choice in treating the problem.Self-help and exercise are the main treatment options for plick syndrome, and patients often get good results.

Self-help methods

Try to reduce or stop activities that cause stress on the knee, such as running, jumping, or climbing stairs, before taking any action. Other alternative activities, such as swimming, can help you keep fit. Use anti-inflammatory drugs such as ibuprofen to relieve pain.Doctors also recommend placing an ice pack on your knee for 20 minutes every two to three hours to reduce inflammation. These are self-help tasks that are best done before starting the practice exercises for the treatment of inflamed plica.

Exercises

The most effective treatment for Plik syndrome is exercises that strengthen the muscles around the knee, such as the quadriceps and hamstrings. Consult a physical therapist on how to do these exercises correctly, as improper performance can lead to other serious knee injuries.And the good news is that patients experience improvement 6-8 weeks after starting exercise and physical therapy. These practice exercises are:

Quadriceps Strengthening

Having strong quadriceps is beneficial because it reduces the risk of plica inflammation. According to statistics, people with weak quadriceps muscles were more likely to develop inflammation in the plica. This is because the plica is indirectly attached to the muscles of the quadriceps.You now know that you need to strengthen your quadriceps muscles to heal irritated platelets. Exercises to strengthen these muscles include:

  • Exercise for a set of quads
  • Leg Press Exercise
  • Exercise bike
  • straight leg raises
  • Mini Squat
  • Swimming
  • Walk
  • Cycling
  • Using the elliptical machine

Hamstring Stretch

In addition to strengthening your quadriceps, you should also strengthen your hamstrings.The muscles behind your thighs or hamstrings allow you to stretch your legs back and bend your knees. These large muscles do not play a significant role in daily activities such as walking, and most of them are used in strength training such as running, jumping, and climbing. Hence, hamstring injury is a significant source of plica inflammation. To strengthen the hamstring muscles, it is best to do the following exercises regularly:

  • Standing, bend your knee: To maintain balance, stand up straight and grab the back of a chair or table with both hands.Stand on one leg, bend the knee of the other leg and hold it for three seconds.
  • Bend the knee with the resistance tape: Tie the resistance tape to the sole of the foot on one side and the other to the ankle. Lie on your stomach, bring your knees to your hips and hold for three to five seconds.
  • Air Squat
  • Partner Hamstring Curls
  • Fixed Leg Dumbbell Deadlift

In most cases, these therapies relieve the symptoms of Plik syndrome and make patients feel better.But what if the symptoms don’t go away after two to three months?

Intra-articular corticosteroid injection

This injection aims to reduce the pain and symptoms associated with this syndrome so that patients can participate in exercise therapy programs. Unfortunately, some patients rely solely on intra-articular corticosteroid injections and skip physical therapy. Even if symptoms improve after the injection, you should exercise because if you don’t have strong quadriceps and hamstrings, your plica may become inflamed again.But physical therapists should tell you not to do anything that puts stress on your knee 24 to 48 hours after the injection. Otherwise, you may experience knee pain after the injection.

Additional proposed procedures

In addition to your exercise therapy programs, your physical therapist may recommend additional effective treatments for Plik syndrome. For example:

  • Massage or manipulation of the knee joint
  • Knock on the knee or put on the support bracket
  • Wearing orthoses
  • Use herbal extracts to reduce inflammation
  • Wear appropriate medical footwear

Surgery

Will I need surgery? Undoubtedly, this question is in the minds of many patients.As mentioned earlier, medial plica surgery is the last option for improving this condition. Surgeons recommend surgery if none of the treatments or exercise programs heals the plica inflammation and the patient’s symptoms and pain do not worsen over time. You may be one of those people who are afraid of surgery, but you should know that Plica surgery, which is called arthroscopy, is painless and simple surgery. So what is arthroscopy? “During this operation, the surgeon inserts a fiber optic camera inside the knee joint to directly see the internal structure of the knee joint.This way, the doctor can see the inside of the knee and diagnose inflammation in the plica and treat it at the same time. This is an outpatient procedure and your doctor will usually use sedatives for your comfort during surgery. This means that you can return home on the day of your surgery. Arthroscopy is an innovative technology for identifying the causes of knee pain that has paved the way for the treatment of knee problems.

Recovery from surgery

The recovery period after arthroscopic surgery varies from patient to patient depending on various factors.For example, the anatomy and physiology of the patient, as well as the type of procedure performed with arthroscopy, are important factors. It takes two to six weeks to fully recover. During this time, you should rest and avoid activities such as exercise, shopping, or lifting heavy items. Your doctor will refer you to a physical therapist after surgery to help you strengthen your knee again. You start with light exercise that reduces pain and swelling, and gradually strengthen your quadriceps and hamstrings with more strenuous exercises.If you continue with this program, you can be sure that your knee pain will completely improve in 3-4 months.

Could Plica Syndrome Return?

The answer to this question is yes and no. If you’ve used non-surgical treatments for Plik syndrome, this problem may return. But how? Let’s say you rely solely on corticosteroid injections and do not engage in strengthening exercises. In this case, the symptoms will reappear after a short period of time.Or, if you miss your exercise program, you may not be able to get rid of your knee pain.

On the other hand, after arthroscopy the plica may grow back, but it will no longer be asymptomatic. Under these circumstances, plica syndrome will not return, and you can safely go about your favorite things. But in general, to avoid any kind of knee injury, you need to be very careful and maintain a healthy lifestyle. A balanced diet, a healthy weight, exercise, and knowing how to sit properly have a significant impact on knee health .

summarize

This article gives you everything you need to know about Plik’s Syndrome. But, in short, plica is present in most people’s knees and usually doesn’t cause problems. According to research, plica is located in 87% of the knees on the top of the patella, 72% of the knees on the inside, and 86% on the bottom of the knee. Upper and lower knee plies rarely cause pain, and what causes internal knee pain is the medial plica. For more information on medial knee pain, click here to read the related article.However, it is debatable whether Plick syndrome is hereditary or not. What is your opinion? Please write us your valuable comments below.

Muscle Imbalances: Testing and Training Functional Eccentric Hamstring Strength in Athletic Populations

As an important parameter in assessing the risk of people being kept below limb injury 1 , a relationship was found between the strength of the knee flexors and extensors. In particular, there is an increased likelihood of hamstring injury when ipsilateral or bilateral imbalances in the hamstring strength are present when the strength of quadricep is compared to 2 .Therefore, many athletic scientists and practitioners test knee flexor and extensor strength to determine whether an athlete is at risk for hamstring injury. However, different testing methods are used that do not allow for direct comparisons between methods ( e.g. , different speed reductions, different muscle actions and field tests versus laboratory testing) 3 , 4 , 5 , 6 , 7 , 8 , 9 .Although different testing methods provide different bits of valuable information regarding strength levels, the methodological approach for testing the strength of isokinetic femoris muscle should be unified to include comparisons across individuals, populations, and times.

Although estimates of ipsilateral imbalances between knee flexors and extensors have been frequently described using the conventional concentric hamstring concentric quadriceps ratio (H / Q CONV ) 10 , 11 , Joint activation of knee flexors and extensors occurs during all movements and goes through opposite compression modes.Explain, the knee extensors are mainly involved in locomotion during jumping and working, whereas the knee flexors are mainly involved in stabilizing the knee during landing and launching the slowing lower limb and countering the fast and strong concentric contractions of the extensors. Since most movements in sports require simultaneous concentric knee extension and eccentric knee flexion, a relative strength comparison between the two would be worthwhile. Therefore, eccentric knee flexor strength relative to concentric knee extensor strength is often tested and is known as “functional ratio” (H / Q FUNC ) 12 .

Compared to the H / Q ratio CONV , where values ​​can range from 0.43 to 0.90 12 , the H / Q ratio FUNC can range from 0.4 to 1.4 13 , indicating that data from different protocols should not be compared with each other. Although the maximum concentric torque decreases as concentric speed increases 14 , , 15 16 , the eccentric torque is greater than the concentric torque speed increases 16 , 17 .So the H / Q ratio of FUNC may come up with a value of 1.0 as the roll-off test rate increases 13 , 18 . Since most athletic movements occur at high speeds, knee extensor and flexor strength testing is likely more environmentally acceptable at higher speeds. Therefore, such strength test protocols should include a gradual increase in speed in a stepwise progression.

If isokinetic testing shows a large discrepancy between eccentric hamstring and concentric quadricep strength, the discrepancy should be narrowed through training.For this purpose, the reduced strength of the knee extensors should never compensate for the weak knee flexors due to the more favorable H / Q FUNC ratios, especially in athletic environments. Another option would be to gradually and intensely increase the strength of the knee flexors so that the hamstrings become stronger, especially in the quadriceps, at high speeds. Therefore, if isokinetic testing reveals definite hamstring weakness, preparation intervention will likely need to increase hamstring strength, especially during eccentric muscular action.As with all training activities, follow-up testing should be conducted to determine the effectiveness of the eccentrically oriented hamstring strength training program, and further adjustments may need to be made. The purpose of this paper is to describe how to test isokinetic functional eccentric hamstring strength, identify potential hamstring weakness, and propose ways to correct functional hamstring weakness.

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Knee arthroscopy. Gap PKS

Anatomy

The knee joint is not only the largest in the human body, but also the most complex. It is formed by three bones: the femur on top, the tibia on the bottom, and the patella (patella) is located in front of these bones. Both the femur and the tibia have two expanding bony protrusions – the condyle: external and internal.The external condyle is also called lateral (from the Latin word lateralis – external), and the internal condyle is called medial (from the Latin word medialis – internal). The main movement of the knee joint is flexion, while the patella lies in a special groove between the outer and inner condyles of the femur.

The contact surfaces of the femur, tibia and patella are covered with smooth cartilage that facilitates sliding.

Between the femur and the tibia there are menisci – cartilaginous layers of a lunate shape, which increase the stability of the joint, increasing the contact area of ​​the bones, act as shock absorbers and perform some other important functions.

The stability of the bones relative to each other is ensured by the ligaments of the knee joint. The most important ligaments in the knee are:

  • Cruciate ligaments, which hold the lower leg from displacement anteriorly (anterior cruciate ligament) and posteriorly (posterior cruciate ligament).
  • Tibial collateral ligament (internal lateral ligament), which keeps the lower leg from deflecting outward.
  • Peroneal collateral ligament (lateral lateral ligament), which keeps the lower leg from deviating inward.

The anterior cruciate ligament is located in the very center of the knee joint, from above it is attached to the outer condyle of the femur, after which it goes down and slightly outward and attaches to the depression on the tibia (anterior intercondylar field), where some of its fibers are connected to the menisci. The posterior cruciate ligament is located perpendicular to the anterior cruciate ligament posterior to it, and if you look at these ligaments from the front, you can see how they form a cross, which gave these ligaments their name – cruciate ligaments.The average length of the anterior cruciate ligament is 3 centimeters and the width is 7-12 mm.

The anterior cruciate ligament, like other ligaments, is mainly composed of strong collagen fibers that practically do not stretch. These fibers inside the bundle are twisted in a spiral at an angle of 110 degrees. Based on the places of attachment of the ligament and its course (from top to bottom, front to back and outside to the inside), its role becomes clear: the anterior cruciate ligament keeps the lower leg from displacement anteriorly and inward.

Anatomy of the knee ligaments: ACL – anterior cruciate ligament, PCL – posterior cruciate ligament

As part of the anterior cruciate ligament, two bundles are distinguished: anterior-internal and posterior-external. This two-bundle structure of the anterior cruciate ligament provides better stability in the knee joint at different angles of flexion. Some scientists even distinguish a third – intermediate beam.

The anterior-internal bundle is one and a half times longer than the posterior-external (on average 37.7 mm versus 20.7 mm) and wider (8.5 mm and 7.7 mm).During the work of the joint, these two beams are in a complex interaction. With the knee extended, they are almost parallel to each other when viewed from the side and intersect when viewed from the front. If the knee is bent, then the anterior-inner bundle is lengthened, and the posterior-outer bundle is shortened.

Anterior cruciate ligament of the knee: two-bundle structure. PV – anterior-internal bundle (blue line), ZN – posterior-external (green line). Left – side view, knee extended; in the center – side view, knee bent; right – front view, knee extended

In addition to the fact that the anterior cruciate ligament of the knee joint performs a stabilizing function (keeps the lower leg from moving forward and inward), it also has nerve endings that signal that the knee joint is in the camo position, bent or unbent.

The anterior cruciate ligament has virtually no blood vessels.

Causes of rupture of the anterior cruciate ligament and causes

Anterior cruciate ligament sprains and injuries are very common injuries. For example, in the United States, about 200 thousand ruptures of the anterior cruciate ligament are diagnosed annually, of which 100 thousand cases are operated on for reconstruction (plastic) of the anterior cruciate ligament. Among all the other ligaments of the knee, the anterior cruciate ligament is injured most often, for example, ruptures of the anterior cruciate ligament occur 15-30 times more often than ruptures of the posterior cruciate ligament.In sports, rupture of the anterior cruciate ligament in women occurs 4-10 times more often than men.

Based on the function of the anterior cruciate ligament (keeping the lower leg from displacement forward and inward), it becomes clear the mechanism of injury, in which the anterior cruciate ligament is stretched or ruptured. As a rule, twisting on a porn leg, when the body with the thigh rotates outward, and the lower leg with the foot remains in place.

However, in fact, the mechanism and causes of rupture of the anterior cruciate ligament are more complicated.Fundamentally, as the causes of rupture of the anterior cruciate ligament, direct injury (contact mechanism: impact on the lower leg, thigh) and indirect injury (non-contact mechanism: twisting on the leg during sudden braking, landing after a jump, etc.) can be distinguished.

Deflection of the lower leg outward and twisting of the thigh inward. This mechanism of rupture of the anterior cruciate ligament is the most common. Often, such a rupture of the anterior cruciate ligament occurs in handball, basketball, football and volleyball, when you need to turn sharply when running or when landing after a jump with a turn of the body inward from the supporting leg.With this mechanism of injury, a rupture of the internal meniscus can also occur. If this movement is very strong, then three structures are possible: the anterior cruciate ligament, the internal meniscus, and the internal lateral ligament. This injury to the knee joint is also called the “unlucky triad” or “knee joint explosion”. This name stuck to the name of the surgeon O’Donoghue, who first described it in 1950.

“Unhappy triad”: with a strong deflection of the lower leg outward and rotation of the thigh inward, a rupture of three structures is possible: the anterior cruciate ligament (1), of the internal meniscus (2) and the internal lateral ligament (3)

Inward deflection of the lower leg and outward twisting of the thigh. This mechanism of rupture of the anterior cruciate ligament of the knee joint is opposite to the previous one, while a meniscus rupture is also possible, but external.

Phantom Stop. This bursting mechanism is possible when falling off alpine skis. For example, when falling backwards, the right ski lifts up and only its rear end comes into contact with the snow. As soon as the ski enters the snow (the edge of the ski represents the “ghost foot”), it makes a turn and causes external rotation of the lower leg (pronation).The knee joint is bent at a right angle. This mechanism can also lead to icholated damage (complete or partial rupture) of the anterior cruciate ligament without damaging the menisci and other structures (posterolateral angle).

Ski boot driven mechanism. This mechanism is most common in skiers wearing taller, stiffer boots. For example, when falling backwards, the top of the boot transfers the load to the top of the tibia in a “drawer” manner.The thigh bone is pushed back and the lower leg is held in place by the back edge of the high boot. The anterior cruciate ligament is stretched and torn. The fixed forward bend in all modern ski boots contributes to this type of break.

Contact mechanisms. An anterior cruciate ligament rupture may result from a direct blow to the knee, thigh, or lower leg. In this case, a deflection of the lower leg may occur outward, inward or anteriorly. A rupture of the anterior cruciate ligament can also occur as a result of hyperextension of the knee (hyperextension).Hyperextension can be caused by a direct blow to the knee from the front or by a blow to the lower leg. In addition, a rupture of the anterior cruciate ligament with a strong blow to the upper part of the lower leg from behind. Contact mechanisms of trauma are rare.

Factors contributing to rupture of the anterior cruciate ligament

Angle between thigh and lower leg. Looking at the skeleton from the front, you can see how the thigh connects to the lower leg at an angle called the quadriceps angle or Q-angle.The size of the Q angle is determined by the width of the pelvis. Women have a wider pelvis than men, so women have a larger Q-angle than men. A large angle Q leads to the fact that when the tibia is deflected outward, the load on the anterior cruciate ligament is greater and therefore it breaks more easily.

Q-angle for men and women

Width of intercondylar notch (Notch notch). The anterior cruciate ligament is located in the knee joint in the intercondylar notch. In women, it is narrower than in men, and with movements in the knee joint, the space around the anterior cruciate ligament is less, and it can even rub against the edge of the outer condyle of the femur, which contributes to rupture.When the lower leg is rotated with extension at the knee, the narrow intercondylar notch can clamp the anterior cruciate ligament and tear it.

The intercondylar notch (circled in red) is narrower in women than in men, which contributes to rupture of the anterior cruciate ligament

Thigh muscle strength. In addition to the ligaments, the thigh muscles play an important role in the stability of the knee joint, which with their tendons are attached to the tibia of the lower leg.In women, the muscles of the thigh are weaker than in men, and therefore the anterior cruciate ligament is heavily loaded to ensure stability of the knee joint.

Thigh muscle alignment. The anterior thigh muscles (quadriceps or quadriceps) and hamstrings work differently in women than in men. When the knee is bent, the female quadriceps contracts more strongly, which pushes the lower leg forward, pulling the anterior cruciate ligament. At the same time, the back muscles of the thigh, which prevent the shin from moving forward, respond more slowly than in men.This creates the prerequisites for rupture of the anterior cruciate ligament.

Hormone profile. Certain hormones (estrogen and progesterone) may be causing the rupture of the anterior cruciate ligament. Some scientists believe that they reduce both the strength of the milestones, not only the anterior cruciate, and their elasticity. This elasticity (the ligaments can stretch 4-5% of their length without tearing) generally protects against many injuries, allowing more energy to be absorbed before the ligaments break.

All these factors together explain the greater likelihood of rupture of the anterior cruciate ligament in women, but can each of these factors work in men as well? for example, males also have an increased Q-angle or a narrow intercondylar notch.

Prevention

In sports, ruptures of the anterior cruciate ligament are more common in women, but in everyday life they occur equally often in both men and women. Prevention of anterior cruciate ligament ruptures mainly concerns only sports, and includes mandatory warm-ups, strengthening and proprioceptive training, as well as changing the technique of running, jumping and jerking movements.Unfortunately, there is currently no generally accepted program for the prevention of anterior cruciate ligament injuries.

What are the injuries of the anterior cruciate ligament?

As we have already mentioned, the anterior cruciate ligament can stretch up to a certain limit (by 4-5% of its length). If the force is greater, then a partial rupture of the ligament may occur (micro-rupture of individual fibers), and if the force is even greater, then a partial rupture will occur, and, finally, if the force continues to increase, then a complete rupture of the anterior cruciate ligament will occur.

American Medical Association for Anterior Cruciate Ligament Injury Classification

(American Medical Association for Athletic Injuries)

I degree:

small sprains of the anterior cruciate ligament (micro-tears). Characterized by pain, moderate limitation of movement in the joint, moderate swelling of the knee joint, preservation of joint stability

II degree:

moderate sprains of the ligament (partial tears).They have the same signs as minor sprains, but this injury tends to recur many times, since after a partial rupture, the ligament becomes weaker and its repeated injury can occur much easier

III degree:

full breaks. Severe pain, swelling, limitation of movement, often impaired support, instability of the knee joint.

However, in fact, there are more variants of damage to the anterior cruciate ligament.For example, as we mentioned, the anterior cruciate ligament has two bundles. There are ruptures of one of the bundles (anterior-internal or posterior-external). In this case, the detached bundle of the anterior cruciate ligament can dangle in the knee joint and block movements, giving a picture similar to the block of the knee joint with a ruptured meniscus.

In addition, the so-called Segond fracture is also possible. It is sometimes called an intercondylar eminence fracture.

Segond fracture (separation of the anterior cruciate ligament from the point of attachment to the tibia with a bone block).The radiograph on the right shows not only a Segond fracture at the site of the anterior cruciate ligament (blue arrow), but also at the site of attachment of the lateral lateral ligament (red arrow)

In addition, as we have already noted, a rupture of the anterior cruciate ligament can be combined with ruptures of the menisci and other ligaments of the knee joint (posterior cruciate, external lateral, internal lateral).

Symptoms of rupture of the anterior cruciate ligament

An anterior cruciate ligament injury is usually preceded by a knee injury, immediately followed by pain and severe knee swelling.When the anterior cruciate ligament ruptures, a crackling sound is often heard, but this is a nonspecific symptom that also occurs with ruptures of other ligaments of the knee. In addition, at the time of injury, a sensation of “dislocation” of the lower leg anteriorly or laterally is possible. In such cases, you need to see a doctor.

First of all, the traumatologist will find out the mechanism of injury, which will help to suspect not only damage to the anterior cruciate ligament, but also other structures (for example, the posterior cruciate ligament, external and internal lateral collateral ligaments).

When the anterior cruciate ligament ruptures, blood enters the joint cavity – this condition is called hemarthrosis. In the first few days after the injury, this hemarthrosis and pain can be so pronounced that a full examination of the joint by the doctor’s hands is impossible, namely, thanks to the examination by the doctor’s hands, a diagnosis of rupture of the anterior cruciate ligament can be made. This examination may be performed later, when the acute pain and hemarthrosis have subsided. As a rule, instability of the knee joint or a feeling of “failure” in it is found by this moment.This is due to the fact that the developed anterior cruciate ligament does not keep the lower leg from displacement anteriorly and medially (anteromedial or antero-internal instability of the lower leg in the knee joint).

Diagnosis of rupture of the anterior cruciate ligament

After the doctor is thoroughly familiar with the mechanism of injury, he will begin testing your knee joints. First of all, a healthy knee is examined in order to familiarize the patient with the examination technique, as well as in order to be able to compare the test results on a healthy and diseased leg.There are a number of special tests to detect anterior instability of the lower leg in the knee joint. The principle of these tests is that the traumatologist provokes the lower leg to move anteriorly, and if the anterior cruciate ligament is torn and does not fulfill its function, then the lower leg will succumb and shift. There are three main tests that determine the anterior-internal instability of the lower leg at the knee joint: the anterior drawer test, the pivot shift test, and the Lachman test.

Front drawer test. The leg is bent at the knee at a right angle, the doctor pulls the lower leg towards himself, assessing its displacement in comparison with a healthy knee. Additionally, the test is performed with the foot turning in and out

If the test of the front drawer gave questionable results, then for a more accurate measurement of the instability of the lower leg in the knee joint, a special device is used – an arthrometer, which allows you to assess the mobility of the lower leg with an accuracy of a millimeter

Pivot shift test or Jerk test

Lachman test.The test is carried out with the knee bent at an angle of 20-30 degrees. The degree of displacement of the lower leg forward, as well as the sensation at the moment of stopping, are assessed. Anterior cruciate ligament insufficiency4 and anterior lower leg instability are divided into three grades based on comparison with the healthy leg. The first degree corresponds to an increase in displacement by 1-5 mm (ie, the mobility of the lower leg of the diseased leg is 1-5 mm greater than that of the healthy one), the second – by 6-10 mm, and the third – by more than 10 mm.

As we have already noted, in the first few days after the injury, knee pain and hemarthrosis make such an examination impossible, but if time is not lost immediately after the injury, that is, an examination is carried out before the edema develops and the patient begins to instinctively resist the doctor’s manipulations, then these tests are possible.You can reduce pain and improve the quality of the examination by aspirating (removing with a syringe) blood from the joint.

With a thorough history taking and careful examination, testing of the joint, rupture of the anterior cruciate ligament can be diagnosed without additional research methods. But, since it is necessary to exclude other injuries (fractures of the condyles of the tibia and condyles of the femur, fractures of the patella, fracture of the Segond, tears of the menisci, lateral ligaments, etc.), the doctor uses other instrumental methods of examination (X-ray, magnetic resonance imaging, Ultrasound).

Radiation diagnostics. To exclude fractures, X-rays of the knee joint are performed in standard projections. The Segond fracture, mentioned above, is an avulsion fracture of a portion of the tibial condyle. This fracture is more common in children and adolescents. The next most valuable method for detecting concomitant injuries is magnetic resonance imaging. Its accuracy for diagnosing an anterior cruciate ligament rupture is 95% or more, but usually the use of magnetic resonance imaging (MRI) is a safety net, since the diagnosis is often obvious on examination with the hands.Moreover, MRI can even be harmful, since the study can show a “terrible” rupture of the ligament, but in fact it will not give instability – and in such a situation, the doctor and patient may be inclined to unnecessary surgery. Among orthopedists, traumatologists, sports doctors there is even a special designation for such cases – VOMIT, which is the English-language abbreviation for victim of modern imaging techniques (victim of modern imaging methods of examination, which includes MRI).

In 80% of cases, magnetic resonance imaging also reveals subperiosteal hematomas in the area of ​​the outer condyle of the femur and the outer part of the tibia.

Magnetic resonance imaging of the knee. On the left is the normal anterior cruciate ligament. In the picture, it looks like a uniform dark strand. On the right is a rupture of the anterior cruciate ligament in its upper part. The bundle in the picture is not whole and bright.

Treatment

A rupture of the anterior cruciate ligament does not mean at all that the only possible treatment for such an injury will be surgery. The indication for surgery is not the fact of rupture of the anterior cruciate ligament itself, but the anterior-internal instability of the lower leg in the knee joint that has developed as a result of the rupture.Partial ruptures of the anterior cruciate ligament in most cases do not lead to instability of the lower leg, since the remaining part of the ligament can quite successfully stabilize the lower leg in the knee joint. Full breaks also do not always lead to instability. For example, a detached anterior cruciate ligament can be soldered to the posterior cruciate ligament, and in this case, there will be no instability under non-resistance loads, and, accordingly, this condition will not require surgery. It should be noted once again that the anterior cruciate ligament ho and the main stabilizer, but not the only one (there are other ligaments, muscles, joint capsule), and even with a complete rupture, the remaining intact structures can provide stability at a certain level of physical activity.

Before we talk about treatment, it is worth separating injuries and ruptures of the anterior cruciate ligament by age. Fresh injuries can be distinguished when several days have passed after a knee injury, there is blood in the knee (hemarthrosis) and pain is still pronounced. Stale cases (up to 3-5 weeks), when the edema subsides, but the ligament has not yet grown together (meaning the possibility of “soldering” of the anterior cruciate ligament to the posterior one or fusion of a partial micro-rupture). And finally, 3-5 weeks after the injury, a period can be distinguished when all dysfunctions of the joint are caused only by the insufficiency of the damaged anterior cruciate ligament, and not by pain or swelling of the acute injury.

In the acute period, when the injury (sprain, partial or complete rupture) of the anterior cruciate ligament is fresh, treatment is aimed at relieving pain and swelling (hemarthrosis) of the knee joint. Immediately after the injury, do not try to move without assistance, it is advisable not to step on the injured leg at all – after all, the load can aggravate intra-articular damage. Immediately after the injury (and in the first 2-3 days), you need to apply cold, use anti-inflammatory drugs (analgesic pills, capsules).Rest for the knee joint is important – which implies limiting both the axial load on the leg (you cannot step on the leg or you can step with partial support) and the range of motion. To limit the range of motion, a plaster splint can be used, which completely excludes movements to the knee joint, or an orthosis, which allows both to completely prohibit movements and to restrict them to a given amplitude due to special adjustable hinges. In the presence of severe hemarthrosis, it is necessary to suck the blood accumulating in the knee joint with a syringe – this will significantly reduce the pain.

Knee support

In the second period (stale rupture), which begins after the relief of acute pain in the knee joint and hemarthrosis, they begin to gradually restore movements and begin to train muscles. Exercise that strengthens the hamstrings and quadriceps femoris will help you return to normal joint mobility more quickly. The trained muscles themselves can stabilize the knee joint, which is very important when the anterior cruciate ligament is damaged.If there are no other injuries (ligaments, menisci), then the exercises are performed with increasing amplitude and intensity, excluding only those movements that provoke instability. To limit these movements, it is advisable to use a knee brace at all times. 3-5 weeks after the injury, after the range of motion and muscle strength have been restored, the orthosis is removed and the activity is further increased.

The widespread practice of completely immobilizing the knee joint with a plaster cast for 5-6 weeks is incorrect, as it can lead to permanent limitation of movement in the joint (contracture), muscle atrophy.Of course, if damage to the anterior cruciate ligament is accompanied by other injuries of the knee structures (menisci, other ligaments), then the treatment tactics in the second period may be different, for example, the doctor may reasonably completely prohibit movements in the knee joint or, conversely, recommend an urgent operation.

In the third period, the joint is assessed from scratch. Roughly speaking, if there are no signs of instability at the required level of physical activity, then conservative treatment can be considered successful.If, at the required level of physical activity, there are signs of instability (pain, knee disobedience, slipping, buckling, etc.), then the anterior cruciate ligament can be considered untenable and surgery may be the way out in such a situation. However, it is important to understand that the level of physical activity after the end of the second period when immobilization was carried out, i.e. complete or partial immobilization with an orthosis, it is not restored immediately, but in a few weeks. That said, it is important to continue training the anterior and posterior thigh muscles, which can compensate for the torn anterior cruciate ligament.If, after all this, instability of the knee joint remains with the necessary physical exertion, then a diagnosis of chronic anteromedial instability is made, which is treated only by surgery.

Conservative, i.e. non-surgical treatment of isolated injuries of the anterior cruciate ligament is recommended or may be effective in cases where:

  • with partial rupture without signs of instability in the acute period
  • for complete ruptures without signs of instability in daily life in athletes who no longer plan to return to sports
  • with low physical demands (sedentary lifestyle).
  • in children and adolescents with uncovered areas of bone growth
  • in the elderly (ligament ruptures in children and the elderly are rare – about 5% of all ruptures)

Conservative management of anterior cruciate ligament injuries usually does not work well in people returning to vigorous sports. Pain, swelling, and instability periodically occur in 56–89% of athletes with anterior cruciate ligament ruptures after conservative treatment.It is important to note that instability increases the risk of subsequent trauma to intra-articular structures (menisci, other ligaments). In addition, in an unstable knee joint, the cartilage wears out more, which leads to the development of arthrosis of the knee joint. Without surgery, the probability of returning to professional sports after complete ruptures of the anterior cruciate ligament is no more than 20%.

In professional athletes, the operation to restore the anterior cruciate ligament can be performed immediately after injury, i.e.That is, without the stage of conservative treatment. In addition, immediate surgery may be appropriate if the rupture of the anterior cruciate ligament is accompanied by damage to other intra-articular structures. For example, with a concomitant meniscus rupture, its torn off and dangling flap can block movements in the knee joint and, accordingly, a full-fledged conservative movement in this case is not possible in principle.

Surgical treatment. The operation is performed if, after conservative treatment, the stability of the joint does not meet the requirements of physical activity.It should be noted that the operation gives the best results against the background of good movements in the knee joint and strong muscles, which once again emphasizes the importance of the conservative stage of treatment. On average, operations to restore the anterior cruciate ligament in non-athletes are performed 6 months after the rupture, but this does not mean that later the operation is not needed. It happens that it is done 5-7 years after the injury. In principle, the operation can be performed at any time after the injury, except for those cases when severe arthrosis has developed in the knee joint against the background of the rupture of the anterior cruciate ligament and the subsequent instability of the knee joint.

The ideal candidate for surgery is a young, agile person with objective (i.e. detectable by the doctor) and subjective (felt by the patient) signs of instability, who wants to play sports that require frequent jerking and jumping. On the contrary, for older patients, with existing degenerative changes in the joint, not participating in competitions and without complaints of joint instability, conservative treatment, physiotherapy exercises are more suitable.

It is impossible to suture a torn anterior cruciate ligament – grafts are used to restore it, i.e.e. other tendons (patellar ligament autograft, hamstring autograft, allografts) or synthetic proteas. The only exception, perhaps, is the Segond fracture (separation of the intercondylar eminence). In this case, the bone block that has come off along with the ligament can be fixed in place.

Scheme of surgery for Segond’s fracture

Even during the first attempts at surgical reconstruction of the anterior cruciate ligament, it was noticed that simple stitching does not give good results, and this is often technically impossible.The search began for the optimal reconstruction method using various materials: from artificial to auto- and allografts. Autografts are ligaments or tendons that are taken from the patient himself from another place (patellar ligament, hamstring tendons, etc.). Allografts are specially treated ligaments or tendons of other people.

The operation to restore the anterior cruciate ligament is called “anterior cruciate ligament plasty” or “knee stabilization”.The essence of the operation is that the torn ligament is removed, and a substitute is placed in its place. Now such operations are performed with little trauma thanks to arthroscopy. The essence of arthroscopic operations is that they are performed without incisions, but through small punctures 1-2 centimeters long. Through one of the punctures, an arthroscope (optical part of a video camera) is inserted into the joint, which allows you to examine the knee joint from the inside. During the operation, the surgeon looks at the monitor and sees everything that is happening at the moment in the joint, with a high magnification – from 40 to 60 times.Through another puncture, miniature instruments are introduced, with which the operation is performed. Arthroscopy allows you to perform the finest manipulations on the knee joint with minimal damage to the surrounding structures and the joint itself (for example, suturing or removing part of the menisci, cartilage transplantation, ligament reconstruction). During the operation, the surgeon looks at the monitor and sees everything that is happening at the moment in the joint, with a high magnification – from 40 to 60 times. The use of modern instruments and highly sensitive optics allows performing the finest manipulations on the knee joint with minimal damage to the surrounding structures and the joint itself (for example, suturing or removing part of the menisci, cartilage transplantation, ligament reconstruction) – and all this through 2-3 small incisions.

Knee arthroscopy

The reconstructed anterior cruciate ligament should ideally match the intact anterior cruciate ligament in strength, location and function. The problem of strength is solved by an adequate choice of material for plastic, and the location of the graft becomes paramount. Usually it is passed through the canals in the tibia and femur so that the position of the graft matches the normal ligament as closely as possible.

For a successful reconstruction, it is necessary to select the correct degree of tension on the graft and firmly fix it. The graft tension determines its functionality: a loosely stretched graft does not provide stability to the knee joint, a tight graft can break or limit the range of motion in the knee joint.

Patella ligament reconstruction. This ligament connects the patella to the tibia. The autograft is cut off from the tibia and patella with bone fragments, thus creating a ligament with bone blocks at the ends.In the tibia and femur, canals are drilled out into the cavity of the knee joint. The internal openings of these canals in the joint are located in the same places where the anterior cruciate ligament was attached. The ligament graft is passed into the joint cavity through the tibial canal. The ends of the graft of the prosthesis are fixed in the bone canals using special metal or biopolymer absorbable screws. The titanium screw is very durable, but it does not dissolve, which will create technical difficulties during possible subsequent operations.In general, we find absorbable screws to be preferred in younger patients. Sometimes such a graft is called a BTB-graft from the English abbreviation BTB: bone-tendon-bone (bone-tendon-bone). It is these bone graft blocks that are fixed in the canals of the femur and tibia with screws. Such fixation has an important advantage: the bone block of the graft quickly grows together with the canal walls – in 2–3 weeks, which is significantly less than the period of strong adhesion of the tendon to the bone, which is required, for example, in a hamstring graft.The edges of the cut patellar ligament from which the graft was taken are sutured.

Diagram of anterior cruciate ligament plasty with patellar ligament graft (BTB graft)

Principle of fixation of the graft bone block with titanium or absorbable screw

Radiograph after knee stabilization surgery with BTB graft. Bone blocks were fixed with titanium screws, which are clearly visible on the radiograph.Absorbable screws are radiolucent and therefore not visible.

Arthroscopic stabilization of the knee joint: plastic anterior cruciate ligament BTB – graft (from the patellar ligament with bone blocks of the patella and tibial tuberosity)

Hamstring autograft. This graft is sometimes referred to as a hamstring graft. The tendon of the semitendinosus muscle of the thigh is used as a material for transplantation, which is removed with a special instrument (stripper) through an incision 3-4 centimeters long.

After taking the tendon of the semitendinosus muscle, it is folded in half, sutured, and, just like with the BTB graft described above, channels are drilled in the femur and tibia through which the new ligament is passed, pulled and fixed. Sometimes, for plastics, not one tendon is taken, but two (from the semitendinosus, tender or semimembranous muscles). There are more options for fixing such a graft than BTB – staples, buttons, pins, screws, etc.

Options for fixing the femoral part of the graft: A – EndoButton, B – Mulch screw B – TransFix, D – RigidFix, D – absorbable screw, E – EZLoc.

Options for fixing the tibial part of the graft: A – AO patch with screws, B – WasherLoc, C – spiked patch and screw, D – staples, D – threads to the screw (Suture-post fixation ), E – absorbable screw, F – IntraFix, Z – GTS system (sleeve and expansion screw).

Postoperative radiographs (left – frontal view, right – lateral view): the autograft is not visible as it consists of soft tendon tissue.Fixation of the femoral part of the graft with the endobutton system (Endobutton,
Smith & Nephew, USA), and the tibial part was fixed with a brace.

There is still no consensus among traumatologists about which autograft is better. Reconstruction with an autograft from the patellar ligament is more traumatic and recovery after such an operation is more difficult due to injury to this ligament. But on the other hand, it is believed that such an operation is more reliable, the bone blocks of the graft grow together with the canal walls faster, it is knitted more stably, and it can withstand loads better.Although, if the surgeon has mastered the technique of performing hamstring reconstruction surgery, comparable results are obtained. With the second method of surgery (from the tendon of the semitendinosus muscle), fewer incisions are made and in the future it will be almost imperceptible that there was surgery on the knee. In the first technique (from the patellar ligament), the operation will be reminded of a 5-centimeter scar at the site of the incision through which part of the patellar ligament was taken. But it is often subtle.

Allografts are tissues obtained from a donor.After a person dies, the anterior cruciate ligament or other ligament is collected and sent to a tissue bank. There she is checked for all infections, sterilized and frozen. When an operation is needed, the doctor sends a request to the tissue bank and receives the desired allograft. The source of the allograft can be the patellar ligament, hamstrings, or the Achilles tendon. The advantage of this method is that the surgeon does not have to cut the graft from the patient’s body, disrupting his normal ligaments or tendons.This operation takes less time, because time is not wasted on the allocation of the graft. Allografts have a risk of non-engraftment. In our country, such operations are practically not performed.

For a better restoration of the two-bundle structure of the anterior cruciate ligament, there are also two-bundle reconstruction techniques, when two grafts are installed or one consisting of two handles.

Complications

The success rate for anterior cruciate ligament reconstruction is very high, but complications are still possible.One of the most common is limitation of the knee joint mobility (contracture). For prophylaxis, the joint is fully extended immediately after the operation and maintained in an extended state. As early as possible, begin exercises that increase the range of motion, trying to achieve 90 ° flexion in a week. In addition, it is important to maintain the mobility of the patella in order to minimize scarring of the ligaments connecting it to the femur as much as possible. Another possible complication is pain in the anterior part of the knee joint (patellofemoral arthrosis), which is possible after taking a BTB graft.Also, after taking a BTB graft, there are rare fractures of the patella or ruptures of its ligament, from where the graft was taken.

In addition, the operation may be unsuccessful – the graft may break or be pulled out of the bone canals. In this case, you have to do one more operation, revision. To prevent this complication, it is important to carefully select the sites for the bone canals and rigidly fix the graft, and the patient himself must strictly follow all recommendations in the postoperative period, during rehabilitation.The literature describes isolated cases of compartment syndrome after plastic surgery of the anterior cruciate ligament.

Forecast

The aim of the anterior cruciate ligament reconstruction surgery is to return the patient to the desired level of physical activity as soon as possible and to avoid complications, which primarily include arthrosis. The improvement of surgical techniques and rehabilitation methods has led to the fact that more than 90% of patients continue to go in for sports and are completely satisfied with the results of treatment.The average rehabilitation period is 4-6 months, but some professional athletes successfully start competitions even after 3 months. The admission criteria for sports activities may differ, but they are always guided to one degree or another by the results of functional tests, the patient’s feelings and examination data. The most generally accepted criteria are as follows: restoration of the range of motion, an increase in the displacement of the lower leg according to goniometry data by no more than 2-3 mm compared to the healthy leg, the strength of the quadriceps muscle is not less than 85% of the norm, restoration of the strength of the posterior group of thigh muscles, all functional indicators are not less than 85% of the norm.

90,000 What are the most common symptoms of a hamstring injury?

The hamstring is a tendon that attaches a significant muscle group on the back of the thigh to the bone. This muscle group – the hamstring muscles – is commonly referred to as the hamstring, so most hamstring injuries are actually muscle group injuries and not the actual hamstring tendon. Hamstring injuries range from minor to severe, tension to complete rupture of the muscles, and there are several symptoms of a hamstring injury that alert the sufferer of the injury.Most symptoms of a hamstring injury include sudden pain or tearing in the area of ​​the hamstring muscles; swelling or bruising may also appear after an injury.

Hamstring injuries are common in sports, especially those involving sprinting mixed with quick stops and starts and jumping or lunges such as basketball, football, and college football. Many hamstring injuries are immediately noticeable and are often caused by a sudden jerk, resulting in the general identification of a pulled hamstring.Symptoms of a hamstring injury may include sharp pain in the hamstring muscles that suddenly appears during sports activities, a feeling of tearing in the hamstring muscles, or a popping or clicking sound. Often, an athlete who is pulling his or her hamstring will not be able to continue the exercise and, in some cases, may not be able to handle it.

Since pain is usually felt immediately in the hamstring region, the athlete is almost always aware that an injury has occurred.Straining or stretching the hamstring is usually accompanied by soreness in the hamstring area and possible swelling. For more serious injuries, such as a ruptured hamstring, the back of the thigh may feel bruised and the skin area may turn black and blue. Sometimes, muscle damage can feel like imperfection and can be detected by touching the skin.

Most hamstring injuries are curable without surgery, although surgery may be necessary in severe conditions, such as a complete muscle rupture.Minor hamstring injuries can be treated at home without consulting a doctor. In these cases, doctors recommend resting and icing the affected area along with compression and elevation – these four combined forms of treatment are collectively referred to as RICE. Symptoms of a hamstring injury that require medical attention include redness spreading from the affected area, any numbness in the area, and an inability to bear any weight on the affected leg. Recurrent hamstring injuries should also be evaluated by a doctor.

OTHER LANGUAGES

90,000 What is tendovaginitis?

What is tendovaginitis?

Tendovaginitis is an inflammation of the tendon and tendon sheath, the so-called tendon sheath. Tendon sheaths are tubes of connective tissue around the tendons filled with a lubricating fluid that reduces the friction of the tendon as it moves. The tendons themselves are covered with a thin membrane.If this membrane becomes inflamed or changes in its structure due to constant overstrain, a pulling pain occurs in the projection of the tendon. The tendons of the wrist are most commonly affected. However, tendovaginitis can occur in all tendons if they pass through the tendon sheath. Typically, inflammation of the tendon sheath is not caused by infection, but is the result of constant overstrain.

How does inflammation begin

Tendon sheaths reduce friction and tendon wear.The synovial fluid inside the vaginas acts as a lubricant that makes it easier for the tendon to move back and forth.

If this original design is overloaded – for example, due to too intense training or monotonous work on a personal computer, the tendon sheath becomes inflamed. The inflamed area hurts, swells, and often turns red.

Signs and Symptoms

The main symptom is intense attacks of pain. Pain is typical when trying to move and when moving.Pressing on the tendon causes pain. Without treatment, the pain increases and may even occur at rest. Sometimes you can hear the sound of friction when driving.

Prevention

It is best to avoid repetitive wrist flexion and extension. Sometimes it is enough to use an ergonomic keyboard and mouse for this. If this is not possible, take regular breaks.

How is tenosynovitis treated?

With tenosynovitis, the wrist joint must be immobilized.This is one of the first recommendations of doctors.

Acute tenosynovitis usually lasts several days. Without proper treatment, the disease becomes chronic and does not go away for several weeks or months.

After treatment

After elimination of the inflammation, the wrist can function as before. To avoid overloading in the future, we recommend that you follow the correct orthopedic regimen, and for stress use special orthopedic braces or splints.

Bandages and orthoses of the medi company

Human body

Ligament damage often occurs during sports.

Tendons and ligaments

Rotan: “I have a sprain on the back of the thigh and an inflammation of the hamstring”

Rotan: “I have a sprain on the back of the thigh and an inflammation of the hamstring”

In one of the central games of the 21st round of the Ukrainian football championship in which irreconcilable rivals met – Kharkiv Metalist and Dnipropetrovsk Dnipro, midfielder Ruslan Rotan left the field in the middle of the second half (61 minutes) due to injury …

At that moment, the hearts of Dnipro fans skipped a beat, because objectively speaking Ruslan Rotan is a pillar in the center of the team’s field. As shown by the same game against Metalist, at the moment neither Kravchenko nor Shakhov are able to fully “close” the position in which the player of the Ukrainian national team is playing.

That is why on the eve of the game with Dynamo Kiev at the Dnepr-Arena next Sunday, no less important than in Kharkiv, the Dnipropetrovsk football fans were very interested in the question: what about Rotan?

In order to find out the news about Ruslan’s state of health and whether he will be able to play against Dynamo, I called the footballer himself.“After the examination, it turned out that I had a sprain on the back of the thigh of my right leg,” said the midfielder. – Thank God that there is no muscle tear – this shortens the recovery time. Another problem was added to this problem: an inflammation of the hamstring, which worried me even on the eve of the game with Metalist.

Now the footballer is undergoing a rehabilitation course at the club base, which includes various procedures: ultra sound, cryotherapy, magnet, EHF and others.According to Ruslan, he will have 4 days without training, after which the footballer hopes to go over to light loads and run.

When asked if he will be able to enter the field of Dnipro-Arena next Sunday in the game against Dynamo, Rotan himself replied that “I would very much like to have time to recover and help my partners in the game with the principal rival – Dynamo … However, I myself assess my chances of entering the field as 50/50 – it all depends on how my body accepts the treatment procedures. “

Alexander Duvbakov

90,000 Dutch footballers targeted by racist attack

An unpleasant incident occurred the other day with the Dutch national team players in Poland. During a training session at the stadium in Krakow, where the Dutch training base is located, the team’s black players were verbally attacked using foul language and sounds that mimic the cry of a monkey. For this reason, the players, who were insulted from one of the sectors of the stadium, were forced to move to the opposite half of the field and continue training there.

After training, Dutch captain Mark van Bommel was seething with indignation. “It’s a real shame, especially after returning from Auschwitz (the Dutch team visited a concentration camp on Wednesday) that we encountered this. team from the field, “he threatened.

Contrary to expectations, the usually intolerant of racism, UEFA officials chose to hush up the outbreak of the scandal, expressing doubts that the insults were racially motivated.Meanwhile, football players and their families, not hoping to receive the support and protection of UEFA from racist attacks, find a solution to this problem on their own. The families of two dark-skinned England players Theo Walcott and Alex Oxlade-Chamberlain simply refused to travel to the European Championship. And the black striker of the Italians Mario Balotelli warned those who decide to express dissatisfaction with his skin color: “I will kill anyone who throws a banana at me.” Alexander Petrov

The Croatian national team loses valuable personnel.

A few days before its start at the European Championship, the Croatian national team lost one of the key midfielders Ivo Ilicevic due to an injury.The 25-year-old was injured in training on Wednesday, and initially it didn’t seem too serious. But later the doctors found that the midfielder had a torn calf muscle and he would need surgery, which means that he would no longer be able to play at Euro 2012.

The injured Ilicevic will be replaced by 20-year-old Shime Vrsalko from Dynamo Zagreb. However, the matter may not be limited to one replacement. Defender Vedran Corluka sustained a hamstring injury in training on Thursday and will now undergo an in-depth examination to decide whether he can compete in the European Championship.Croats will play their first match at Euro 2012 on Sunday against Ireland. Alexander Petrov

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