Torn acl injury: Torn ACL Symptoms, Recovery Times, Surgery, Women
Anterior Cruciate Ligament (ACL) Tears (for Teens)
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Anterior Cruciate Ligament (ACL) Injuries: Symptoms, Treatment, & Recovery
One of the most common ways people hurt their knees is by injuring their ACL (anterior cruciate ligament).
This is one of the bands of tissue that holds the bones together within your knee. It also helps to keep your knee stable. You can stretch or tear your ACL if you make a sudden movement or quick, sharp turn when you’re running or jumping. It’s often painful, and can make it hard to walk or put pressure on the injured leg.
How Does It Happen?
Athletes often get ACL injuries when they stop and quickly change directions while they’re running. People who play soccer, football, tennis, basketball or volleyball, or who do gymnastics are more likely to twist their knees by mistake when they compete than, say, cross-country runners, who simply move forward at a steady pace. Your speed — combined with the way that you twist or turn your knee — makes it likely that you’ll stretch or tear your ACL.
ACL injuries are more common among women than men.
What Are the Symptoms?
Many people hear a popping noise in their knee when they get hurt. But it doesn’t happen to everyone. More common symptoms include:
Pain. If you have a minor injury, you may not feel pain. You may feel sore along your knee’s joint line. Some people have trouble standing or putting pressure on the hurt leg.
Swelling. This is most likely to happen during the first 24 hours. You can reduce swelling by putting ice on your knee and elevating (raising) your leg by propping it up on a pillow.
Trouble walking. If you’re able to put pressure on your hurt leg, you may notice that it’s harder than normal to walk. Some people find that the knee joint feels looser than it should.
Less range of motion. After you damage your ACL, it’s very likely that you won’t be able to bend and flex your knee like you normally would.
How Is It Diagnosed?
Your doctor will want to hear exactly how you injured your knee. They’ll look at both knees to see if the sore one looks different. They may also order any of the following:
Continued
Tests.
Your doctor may ask you to lie on your back and bend your hips and/or your knees at certain angles. They’ll then place their hands on different parts of your leg and gently shift you around. If any of your bones move in a way that isn’t normal, that could be a sign that your ACL is damaged.
X-ray. Soft tissues like the ACL don’t appear on X-rays, but your doctor may want to rule out broken bones.
MRI or ultrasound. These exams can show both soft tissue and bone. If you have a damaged ACL, it should appear on the images.
Arthroscopy. This literally means to “look within the joint.” During the exam, an orthopedic surgeon makes a small cut in your skin. They insert a pencil-sized tool that contains a lighting system and lens (arthroscope) into the joint. The camera projects an image of the joint onto a TV screen. Your doctor can see what type of injury you have and repair or correct it, if needed.
What’s the Treatment?
It depends on how badly you’ve been hurt. Here are some of the options your doctor may give you:
First aid. If your injury is minor, you may only need to put ice on your knee, elevate your leg, and stay off your feet for a while. You can reduce swelling by wrapping an ace bandage around your knee. Crutches can help to keep weight off your knee.
Medications. Anti-inflammatory drugs can help to reduce swelling and pain. Your doctor may suggest over-the-counter medications or prescribe something stronger. For intense pain, your doctor may inject your knee with steroid medication.
Knee brace. Some people with a damaged ACL can get by with wearing a brace on their knee when they run or play sports. It provides extra support.
Physical therapy. You may need this a few days a week to get your knee back in working order. During your sessions, you’ll do exercises to strengthen the muscles around your knee and help you regain a full range of motion.
You may be sent home with exercise to do on your own.
Surgery. Your doctor may tell you that you need this if your ACL is torn badly, if your knee gives way when you’re walking, or if you’re an athlete. A surgeon will remove the damaged ACL and replace it with tissue to help a new ligament grow in its place. With physical therapy, people who have surgery can often play sports again within 12 months.
Symptoms, Causes Diagnosis, and Treatment
An anterior cruciate ligament (ACL) tear is an injury of the knee joint, and it usually happens while playing sports. It causes leg pain and instability of the knee. ACL tears are often seen in high-profile athletes such as football player Tom Brady, golfer Tiger Woods, and soccer player Frankie Hejduk. This is also one of the most common injuries among recreational athletes of all ages.
An ACL tear is diagnosed by a physical examination. You may need an imaging study such as an X-ray to determine whether you also have other injuries (like a bone fracture).
Depending on the extent of your injury and the severity of your symptoms, you may need treatment with physical therapy, a supportive brace, or surgery. Often, rehabilitation is part of recovery after surgical treatment.
Verywell / Brianna Gilmartin
Symptoms
You may hear a sudden pop and/or feel a sudden shift in your joint at the time of an ACL injury. Most people are surprised at how loud the pop can be, and sometimes bystanders can even hear it on the sideline of a football or soccer game.
Right after an ACL tear, you can rapidly develop hemarthrosis (bleeding into your joint). This causes swelling, redness, warmth, bruising, pain, and a bubbling sensation in the joint.
What to Look For
The signs and symptoms of an ACL injury are not always the same, so it is important to see a doctor if you experience any of the following:
- Knee pain or swelling that lasts more than 48 hours
- Trouble standing or walking on the affected knee
- Inability to support your weight on the affected knee
- A deformed or odd appearance of one side of your knee
With an ACL tear, your joint will be unstable and have a tendency to give out.
This can occur when you are participating in sports or even with simple movements like walking or getting into a car.
Sports Ability After an ACL Tear
Athletes often have difficulty after experiencing an ACL injury. Sports like soccer, football, and basketball rely on your ACL to perform common maneuvers such as cutting, pivoting, and sudden turns.
For this reason, athletes often choose to undergo surgery in order to return to their previous level of competition.
Causes
An ACL tear is most often a sports-related injury. ACL tears can also occur during rough play, motor vehicle collisions, falls, and work-related injuries.
About 60 to 70% of ACL tears occur without contact with another athlete. Typically, an athlete suddenly changes direction (cutting or pivoting), which causes excessive stretching and tearing of the ligament.
The ACL
A ligament is a strong band of connective tissue that attaches bones to each other, providing stability.
The ACL is one of four major knee ligaments. Along with the posterior cruciate ligament and the medial and lateral collateral ligaments, the ACL helps provide stability for your knee. The ACL is located in front of your knee and, along with your posterior cruciate ligament, it forms a criss-cross shape across the lower surface of your thigh bone and the upper surface of your shin bone to stabilize them.
When this ligament is stretched or pulled by your leg movements, it can rip. The size of the injury varies from a slight tear of connective tissue fibers to a complete tear and detachment.
ACL Tears in Women
Female athletes are especially prone to ACL tears. Research has shown up to an eight-fold increase in the number of ACL tears in female athletes compared with their male counterparts.
The reason for the increased risk has been debated for decades, and experts now believe that it is caused by differences in neuromuscular control.
Men and women position the knee differently during critical sports movements such as landing, cutting, and pivoting. The differences in male and female anatomy and hormone levels may also factor into the different rates of ACL tears.
Diagnosis
The diagnosis of an ACL tear relies on several methods. Along with listening to your symptoms, your doctor will perform a physical examination and assess your knee mobility, strength, and swelling.
Your doctor can evaluate the ligaments of your knee with specialized maneuvers that test the stability of your knee, including:
- Lachman test: The Lachman test is performed to evaluate the forward movement of your tibia (shin bone). By pulling the tibia forward, your doctor can feel for an ACL tear. Your knee is held slightly bent (about 20-30 degrees) and your femur (thigh bone) is stabilized while your tibia is shifted.
- Drawer test: The Drawer test is performed with your knee held with a 90-degree bend. Your tibia is shifted forward and back to assess your ACL by pulling forward and your PCL is assessed by pushing back.
- Pivot shift maneuver: The pivot shift is difficult to perform in the office, and it is usually more helpful in the operating room under anesthesia. The pivot shift maneuver detects abnormal motion of the knee joint when there is an ACL tear present.
During your physical examination, your leg strength and your other major knee ligaments will also be assessed.
Imaging Tests
You may also need to have an X-ray of your knee, which can identify bone fractures. A magnetic resonance imaging (MRI) study may also be used to determine whether your ligament is torn, whether you have sustained damage to your cartilage, and to look for signs of other associated injuries in the knee.
Keep in mind that while MRI studies can help in diagnosing injuries in and around your knee, an MRI is not always needed to diagnose an ACL tear.
Along with evaluating you for an ACL tear, your doctor’s assessment is also focused on identifying other injuries that may have occurred when you had your injury.
Grading ACL Tears
ACL sprains are graded based on how much the ligament is damaged.
- A Grade 1 sprain is a minor stretching to the ligament and your knee is still fairly stable.
- A Grade 2 is a partial ACL tear, with the ligament stretched so much that it is loose and damaged. These are relatively rare.
- Meanwhile, in the more common Grade 3 sprain, there is a complete tear of the ACL, with the knee joint becoming unstable and surgery almost inevitable if it is to be corrected.
Treatment
Many people who experience an ACL tear start to feel better within a few weeks of the injury. Most people do not need surgery after an ACL tear, especially if the ACL was only partially torn. If you don’t play sports, and if you don’t have an unstable knee, then you may not need ACL surgery.
Conservative Management
If you had a partial ACL tear, you may benefit from conservative management, which can include a combination of rest, pain control, and management of the swelling. Eventually, you can start physical therapy and/or use a knee brace. Physical therapy for a partial ACL tear includes strengthening exercises, balance exercises, and range of motion exercises.
Nevertheless, even if you don’t experience any pain, you might continue to have persistent symptoms of knee instability. There are several important factors to consider when making a decision about ACL surgery. You need to consider the frequency and the severity of your symptoms and whether you are prepared to undergo surgery and postoperative rehabilitation and healing.
Surgery
The usual surgery for an ACL tear is called an ACL reconstruction. A repair of the ligament is not usually possible, so the ligament is reconstructed using another tendon or ligament.
The are several different approaches to ACL surgery, and your doctor will explain which of these is best for you. For example, several types of graft can be used to reconstruct the torn ACL. Your doctor can use one of your own ligaments or you can use a donor graft. Typically, using your own ligament results in stronger healing.
There are also variations in the procedure, such as the new ‘double-bundle’ ACL reconstruction.
Risks of ACL surgery include infection, persistent instability, pain, stiffness, and difficulty returning to your previous level of activity.
Healing of an ACL Graft Takes Time
After surgery, it is important that the graft has time to heal or else it can fail. This process can take months.
The good news is that most people do not have any complications after ACL surgery.
Post-Surgical Rehabilitation
Post-surgical rehabilitation is one of the most important aspects of healing. Exercises focus on restoring motion and strength and improving the stability of the joint to prevent future injuries.
You can learn to do some exercises on your own while advancing at a steady pace.
Progressing too quickly or too slowly can be detrimental to your overall results from surgery, so it’s important that you continue to work under the guidance of your therapist and your physician throughout your recovery.
Braces
You may need to use a knee brace after ACL reconstruction surgery. These braces are designed to limit your range of motion, help stabilize your knee, and allow your ACL to heal the way that it should.
Not everyone needs a knee brace after surgery, and this decision is based on how much support your knee needs while healing.
Kids & Surgery
The decision about ACL surgery for children requires consideration of a number of factors that are not relevant for adults.
Surgery increases the risk of growth problems in children.
ACL surgery can cause growth plate disruptions, such as early growth plate closure or alignment deformities.
Childhood ACL Surgery
You and your child’s doctor will have to weight the risk of surgically induced growth plate problems with the risk of permanent knee damage if the ACL is not fixed.
A Word From Verywell
Preventing ACL tears is important. You may be at a higher risk of having a tear if you are an athlete or if you have already had an ACL tear before, even if it was surgically repaired.
Neuromuscular training may help improve your muscle control and reduce your chances of sustaining these types of injuries.
If you have had an injury, it is important that you wait long enough to heal before you return to playing. This can be difficult, especially for professional athletes and students who have athletic scholarships. Experts recommend waiting six to 12 months after a major ACL injury before returning to play. In the meantime, it is important to continue safely training so that your muscles will stay strong and so you won’t experience muscle atrophy.
Essential Guide to Understanding an ACL Tear
What does the ACL do?
Perhaps the most important ligament in the knee is the anterior cruciate ligament (ACL). It is no bigger than your little finger and runs from the front of your shinbone (tibia) to the back of your thighbone (femur). The ACL has several functions:
- It provides stability to the knee when twisting or turning.
- It prevents the tibia from moving forward relative to the femur.
- It is crucial to activities that require quick cutting and pivoting.
What types of ACL injuries are there?
There are three degrees of ACL sprains:
- In a first-degree sprain, the ligament fibers are stretched but not torn.
- In a second-degree sprain, some of the fibers are torn but others remain intact.
- In a third-degree sprain, all of the ligament fibers are torn, resulting in an ACL-deficient and inherently unstable knee.
How do ACL injuries happen?
There are two common ways that the ACL is injured:
- In the first situation, the individual may be running and quickly cut or pivot. This results in excessive stress and subsequent sprain of the ligament.
- The second scenario involves someone or something falling onto the knee while it is fixed in place. This excessive amount of force results in a strain on the ligament.
What are the symptoms of an ACL injury?
Symptoms of an ACL injury include:
- Hearing or feeling a “snap” or “pop” in the knee
- Immediate swelling and pain in the knee
- Difficulty walking without assistance
- Persistent knee instability, especially when running or pivoting on the knee
It is not uncommon to damage other structures in the knee with the initial ACL injury. This includes disruption of other ligaments, tendons, and/or cartilage of the knee. These other injuries can result in more pain and increased swelling, and complicate the diagnosis and treatment.
How is an ACL tear diagnosed?
In order to determine the cause of your symptoms and the extent of the injury, your doctor will ask you questions and perform a physical examination. X-rays are helpful in viewing the bony anatomy of the knee and can confirm or eliminate a diagnosis.
After your doctor has conducted the examination, he or she may recommend that you undergo more diagnostic tests, such as an MRI (magnetic resonance imaging) scan. An MRI allows your specialist to clearly see the muscles, tendons, and ligaments of the knee. This information helps him or her formulate a treatment plan tailored to your needs.
What are the treatment options for an ACL injury?
The decision to proceed with surgical versus nonsurgical treatment is determined by the patient’s overall health and physical activity.
There is a consensus among orthopedic surgeons that in a physically active patient, a torn ACL requires surgical reconstruction. Without an ACL, the knee is inherently unstable, and the patient risks further injury when participating in activities.
Immediately after injury, the treatment plan is focused on reducing the patient’s pain and swelling while increasing knee strength. Physical therapy can be very useful in this regard, and your specialist may wish that you see a physical therapist prior to surgery. If this is the case, surgery can be scheduled once the pain and inflammation are under control.
What happens during ACL reconstruction surgery?
ACL reconstruction is performed arthroscopically to ensure proper graft placement and minimize the risk of complications.
- The old, torn ligament is removed
- The ligament is replaced with a new graft harvested from one of several sources.
- An autograft is when the new ligament is harvested directly from the patient’s own patellar or hamstring tendon.
- An allograft is harvested from an outside source.
What can I expect during recovery from ACL surgery?
- After surgery, you can expect to be in a brace for up to a month.
- Approximately one week after surgery, you will see your specialist and begin physical therapy. The goal of these sessions is to decrease the postoperative pain and swelling while increasing your strength and range of motion.
- As your knee starts to feel better and the graft begins to strengthen, your specialist and physical therapist will clear you for increased activity.
- A brace may be prescribed for you to wear during athletic activities.
What is cold compression therapy, and why did my doctor recommend it?
Your doctor may prescribe a cold compression therapy unit for you to use after your surgery. Integrated cold and compression is clinically proven to:
- Reduce postoperative swelling
- Decrease pain
- Help you regain range of motion
Summit Orthopedics believes that the cold compression therapy unit will provide you with the best possible outcome in the days following your surgery.
More resources for you
ACL Tears
Introduction
The anterior cruciate ligament (ACL) is the most commonly injured ligament of the knee, and it is most frequently injured during an athletic activity. Sports are becoming an increasingly important part of day-to-day life in the United States, increasing the number of ACL injuries. This injury has received a great deal of attention from orthopedic surgeons over the past 15 years, and very successful operations have been developed to reconstruct the torn anterior cruciate ligament.
Anatomy
The ACL controls how far forward the tibia moves in relation to the femur. If the tibia moves too far, the ACL can rupture. The ACL is also the first ligament that becomes tight when the knee is straight. If the knee is forced past this point, or hyperextended, the ACL can also be torn.
This tearing of the ligament results in a loud pop and a feeling of instability in the knee. The ACL may not be the only ligament injured when the knee is twisted violently, such as in a clipping injury in football. It is not uncommon to see both the medial collateral ligament (MCL) and the ACL injured.
Causes
The major cause of injury to the ACL is sports related. Numerous types of sports-related activities have been associated with ACL tears. Those sports requiring the foot to be planted and the body to change direction rapidly (such as basketball) carry a high incidence of injury. Football is frequently the source of an ACL tear because it combines the activity of planting the foot and rapidly changing direction with the threat of bodily contact. Downhill skiing is another frequent source of injury, especially since the introduction of ski boots that extend higher up the calf. These boots move the forces caused by a fall to the knee rather than the ankle or lower leg. The ACL injury usually occurs when the knee is forcefully twisted or hyperextended. Many patients recall hearing a loud pop when the ligament tears and feeling the knee give out.
There has been a dramatic increase in the number of females who suffer ACL tears. This is in part due to the rise in women’s athletics, but studies have shown that female athletes are more likely to suffer this injury then their male counterparts. It is uncertain why this is the case. Initially, it was thought that females were at higher risk because of differences in training intensity. But more evidence suggests that there may be a difference in the anatomy of the female knee, or the female ligament may not be as strong due to the effects of the female hormone estrogen. These factors may lead to a higher risk of ACL injury for the female athlete.
Symptoms
The symptoms following a tear of the ACL vary in different people. Usually, swelling of the knee occurs within a short time following the injury. This is due to bleeding into the knee joint from torn blood vessels in the damaged ligament.
The instability caused by the torn ligament leads to a feeling of insecurity and weakness of the knee, especially when trying to change direction on the knee. The knee may feel like it wants to bend too far backwards.
The pain and swelling from the initial injury will usually be gone after two to four weeks, but the instability remains. The symptom of instability and the inability for the patient to trust the knee for support is what requires treatment.
Also important in making decisions on how to treat the knee is the growing realization by orthopaedic surgeons that long-term instability leads to early arthritis of the knee. Many orthopaedic surgeons feel that by treating the instability and performing a reconstruction of the ligament, the risk of developing wear and tear arthritis in the knee can be reduced.
Diagnosis
The history and physical examination is probably the most important tool in diagnosing a ruptured or deficient ACL. In an acute injury, the swelling is a good indicator. Any intense swelling that occurs within two hours of a knee injury usually means blood in the joint, or a hemarthrosis.
If the swelling occurs the next day, the fluid is probably from the inflammatory response. Placing a needle in the swollen joint and draining as much fluid as possible gives relief from the swelling and provides useful information to your doctor. If blood is found when draining the knee, there is a 70 percent chance it came from a torn ACL. X-rays of the knee may also be ordered on the initial examination to rule out a fracture. Ligaments and tendons do not show up on x-rays. However, bleeding into the joint also occurs when a fracture through the knee joint is present, or when portions of the joint surface are chipped off.
The most accurate of the noninvasive tests for the knee is the MRI scan. The MRI (magnetic resonance imaging) machine uses magnetic waves rather than x- rays, to show the soft tissues of the body. With this machine, we are able to “slice” through the area we are interested in and see the anatomy and injuries very clearly. This test does not require any needles or special dye and is painless.
If there is a question about what is causing the knee problem, arthroscopy may be used to make the definitive diagnosis. Arthroscopy is an operation where a small fiber optic TV camera is placed into the knee joint, allowing the orthopaedic surgeon to look at the structures inside the knee joint directly. The vast majority of ACL tears are diagnosed without resorting to surgery, and arthroscopy is usually reserved to treat the problems identified by other means.
Treatment
Initial treatment for ACL injury includes crutches and rest until the swelling resolves. The knee joint may be aspirated to remove the blood in the joint. The word “aspiration” means to remove fluid from the body. The knee is aspirated by inserting a needle into the joint and drawing out the blood.
Once the initial pain and swelling begins to resolve, physical therapy will probably be initiated to regain as much of the normal range of motion as possible.
One of the problems with a torn ACL is that small proprioceptive nerve endings in the ligament are torn as well. These nerves are there to give the brain information about where the body is in 3D space. These nerves are what make it possible for you to touch your nose with your eyes closed.
The joints rely on these nerves to fine tune the muscles’ actions to allow the joint to function properly. A good physical therapy program will help retrain these nerves and strengthen other muscles that will take over some of the functions of stabilizing the knee joint from the loss of the ACL.
To help replace the stability of the knee, an ACL brace may be suggested. These braces are fairly effective at preventing the knee from giving way during strenuous activity. Most of these braces must be fitted by a certified orthotist, a physical therapist, or physician. They are not the type you can buy at the drugstore. Most orthopaedists will recommend wearing a brace for at least one year after a reconstruction. So even if surgery is performed, a brace is a good investment.
If the symptoms of instability are not controlled by a brace and rehabilitation program, then surgery may be suggested. Most surgeons now favor reconstruction of the ACL using a piece of tendon or ligament to replace the torn ACL. Today, this surgery is most often done using the arthroscope. Incisions are usually required around the knee, but the joint itself is not opened. The arthroscope is used to perform the work needed on the inside of the knee joint. Most patients can expect at least one night in the hospital, although more and more surgeries are being done on an outpatient basis.
In the typical surgical reconstruction, the torn ends of the ACL must first be removed. Once this has been done, the type of graft that will be used is determined. One of the most common tendons used for the graft material is the patellar tendon. This tendon connects the knee cap (patella) to the lower leg bone (tibia).
Another very common graft combines two of the hamstring muscle tendons that attach to the tibia just below the knee joint — the gacilis tendon and the semitendinosis tendon. Studies have shown that these two tendons can be removed without affecting the strength of the leg. There are other hamstring muscles that can take over the function of the two tendons that are removed.
If it is used for graft material, about one third of the patellar tendon is removed, with a plug of bone at either end.
The bone plugs are rounded and smoothed. Holes are drilled in each bone plug to hold sutures that will pull the graft into place. The next procedure prepares the knee to receive the graft.
The intracondylar notch is enlarged so that there is no rubbing on the graft. This process is referred to as a notchplasty. Once this is done, holes are drilled in the tibia and the femur to place the graft.
These holes are placed so that the graft will run between the tibia and femur in the same direction as the original ACL. The graft is then pulled into position using sutures placed through the drill holes. Screws are used to hold the bone plugs in the drill holes.
Other types of materials are also used to replace the torn ACL. In some cases, an allograft is used. An allograft is tissue that comes from someone else. This tissue is harvested from tissue and organ donors at the time of death and sent to a tissue bank. There the tissue is checked for any type of infection, sterilized, and stored in a freezer. When needed, the tissue is ordered by the physician and used to replace the torn ACL. The advantage of using allograft is that the surgeon does not have to disturb or remove any of the normal tissue from the knee to use as a graft. The operation also usually takes less time because the graft does not need to be harvested from the knee.
After surgery, a physical therapist will be contacted to begin a rehabilitation program. Some type of rehabilitation will likely be required for six months after surgery to ensure the best result from the ACL reconstruction.
Most patients see the physical therapist about three times a week the first six weeks following surgery. Following the initial period, a home program may be initiated and monitored by the therapist.
Anterior Cruciate Ligament (ACL) Tears
The anterior cruciate ligament (ACL) is one of the main stabilizing ligaments of the knee, and when it is injured the knee may feel as if it will buckle and give out. Tears or ruptures of the ACL occur frequently in sports:
- As a result of cutting, pivoting, or single-leg landing
- Through a twisting force applied to the knee when the foot is planted on the ground or when landing on one foot
- From a direct trauma to the knee, usually the outside of the knee, as may occur in many contact sports, such as soccer and football
See How Knee Joint Problems Cause Pain
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ACL tears may be partial or complete. A complete tear of the ACL is also known as an ACL rupture.
Women and girls are most susceptible to ACL injury.
Injury to the ACL is painful and most individuals report a “pop” in their knee, followed by a feeling of instability. This feeling hinders athletic activities as well as simple daily activities such as walking down stairs. Surgery may be recommended to restore knee function, but is not always necessary.
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What Is the ACL?
Ligaments are strong fibrous bands that connect bones to other bones. In the knee, the ACL is one of the 4 main ligaments that connect the femur (thigh bone) to the tibia (shin bone).
See Guide to Knee Joint Anatomy
The ACL attaches to the knee at the bottom, back of the femur (thigh bone) and crosses diagonally through the knee joint to attach at the upper part of the tibia (shin bone).
The posterior cruciate ligament crosses the knee joint in the opposite direction, making an “X” shape (cruciate is from the Latin word for cross).
The ACL and PCL work together to stabilize the knee joint, especially during movement that involves sudden change of motion or impact.
The other two main knee ligaments, called the medial collateral ligament (MCL) and lateral collateral ligament (LCL), are located on either side of the knee and help prevent side-to-side movement.
Soft Tissue of the Knee Joint
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The ACL attaches to the knee at the bottom, back of the femur and crosses diagonally through the knee joint to attach at the upper part of the tibia. Read: Soft Tissue of the Knee Joint
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The ACL Injury Grading System
An ACL injury may be diagnosed when the ligament is overstretched or torn. The tear may be partial or complete; a complete tear of the ACL is also known as an ACL rupture.
- Grade I tears refer to a slightly stretched ACL. Symptoms are typically mild. The ligament can still keep the knee stable.
- Grade II tears refer to stretching of the ACL to the point of looseness. These injuries are often referred to as “partial” tears. Symptoms are more severe than Grade I tears. Range of motion may be restricted and the knee may occasionally feel unstable (the knee feels like it is “giving out”).1
- Grade III tears (ligament rupture) are complete tears (the ACL has been split in two). Grade III tears may also be referred to as an ACL rupture. A person may not be able to bear weight on the injured leg.
ACL tears can produce a range of symptoms, which can make it difficult to diagnose without further examination from a doctor.
References
- 1.Temponi EF, de Carvalho Júnior LH, Sonnery-Cottet B, Chambat P. Partial tearing of the anterior cruciate ligament: diagnosis and treatment. Rev Bras Ortop. 2015;50(1):9-15. Published 2015 Feb 14. doi:10.1016/j. rboe.2015.02.003
rboe.2015.02.003Symptoms of a Torn ACL
The anterior cruciate ligament (ACL) is one of four ligaments located in the knee joint, and is responsible for providing stability during walking and other activities. A torn or sprained ACL is a highly common knee injury, which affects more than 200,000 people in the United States each year, out of which approximately half undergo knee surgery. About half of all cases are moreover accompanied by other damages to the structures of the knee.
What Causes a Torn ACL?
ACL injuries most commonly occur in athletes, but can also happen while performing everyday activities, due to falling or tripping, or result from vehicle accidents. Especially, sports such as soccer, football, hockey, rugby, gymnastics, and skiing are associated with relatively high rates of torn ACLs. Tears or sprains are generally caused by (1) overextension or twisting of the knee joint; (2) getting hit hard on the side of the knee, for example during a tackle; (3) quickly turning or stopping while running at a high speed; or (4) landing improperly after a jump.
Interestingly, women are at a higher risk of sustaining ACL injuries than men, owing to slight differences in the female and male physiology, which make the ACL more susceptible to injuries in women. Furthermore, differences in muscular strength and mass, neuromuscular control, physical conditioning, and estrogen levels may also impact the strength or the ligaments in the body, and thereby their risk of getting injured.
Symptoms
The most commonly described symptom of a torn ACL is a loud “popping” sound and sensation in the knee joint at the time when the injury occurs. Immediately after, intense knee pain usually develops, making weight-bearing, and even walking, very difficult; and the knee may become unstable and buckle under your weight as you try to put weight on it. Within approximately six to 24 hours, bleeding within the knee joint will cause the knee to swell, and this swelling along with the accompanied inflammation may further limit movements to the joint and your ability to walk.
While the intense pain and swelling may subside temporarily with time, if a torn ACL is left untreated, the feelings of unsteadiness and discomfort will likely remain, and you may experience recurrent pain and swelling, as well as have your knees give way when walking, especially when going up or down stairs. If the injury is mild, you may only notice that the knee feels unstable or seems to give way when you are using it; however, even mild cases should not be ignored, and if you attempt to go back to sports before seeing a sports medicine or orthopedic trauma expert, there is a high risk that you may cause further damage to the structures of the injured knee.
How are ACL Tears Diagnosed and Treated?
ACL tears and sprains are diagnosed by physical examination, during which the doctor will look particularly for signs of tenderness, swelling, bruising and deformities; and compare the stability between the injured and healthy knee. Next, imaging studies of the knee, using for example x-ray or magnetic resonance imaging, are performed.
The treatment for ACL tears generally includes a combination of rest, physiotherapy, and/or orthopedic surgery. If you suspect that you have a torn ACL, contact your sports medicine or orthopedic trauma specialist immediately in order to ensure quick and accurate diagnosis and treatment.
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Operation for rupture of the Achilles tendon in Krasnoyarsk
Achilles tendon rupture – injury to athletes. It occurs most often due to a strong jump or while running. When injured, severe pain, swelling of the limb and loss of functionality appear.
In such a situation, medical assistance should be provided to the athlete immediately (within 24 hours). A minimally invasive technique is being performed.
Causes of tendon rupture
The Achilles tendon is located at the back of the lower leg, attaches to the calcaneus and participates in flexion of the foot at the ankle.
The tendon was formed for upright walking, without it a person would not be able to maintain an upright position of the body and walk on their feet. Despite its strength, the tendon is considered one of the most traumatic places in the lower leg.
In everyday life, a rupture can happen when sliding off steps, falling on a leg with an outstretched toe, bouncing on an extended leg, when the muscles of the lower leg are sharply contracted. Achilles tendon injuries are prone to those who neglect to warm up, immediately moving on to heavy loads on the muscles.
Treatment methods
The conservative method involves the complete immobilization of the limb in order to self-fuse the tendon. This method can only be suitable for those who themselves give up physical activity and an active lifestyle (often these are elderly people who move only within the apartment or in the area around the house). In other cases, it is shown to carry out the operation. The sooner the better.
The disadvantage of the conservative method is that the tendon may not heal even after prolonged immobilization.In other cases, the healed tendon itself loses strength due to scarring, resulting in repeated ruptures that require only surgical treatment. Only surgery will allow the leg to return to its previous mobility.
Indications for surgical treatment
The effect of stitching on the first day will be the best, but if this is not possible, the operation should be performed at least within the first week after injury.The longer the injured person waits for time, the further the ends of the tendon diverge under the action of the contractions of the lower leg muscles. In addition, the ends of the “Achilles” are exposed to crushing, resembling loose rags, which will not match, and will not grow together quickly and correctly.
The patient has the following complaints:
achilles tendon pain
discomfort, gait disturbance
clap while jumping, running
swelling, edema, sinking on palpation.
How is the Achilles tendon open suture operation performed?
Once the patient is admitted to the hospital, they are examined by a surgeon and anesthesiologist. Special splints are prepared, which immobilize the injured lower limb along its front part in the position of plantar flexion of the foot and the knee joint.
Achilles tendon surgery is performed under general anesthesia, local anesthesia, and spinal anesthesia.In this operation, a long incision is not necessary; access is made through an incision about two centimeters long above the rupture zone. The torn tendon is fixed to the calcaneus with special absorbable materials.
Contraindications for Achilles tendon surgery
poor general well-being of the patient
decompensated pathology of internal organs
severe bleeding disorders
unsatisfactory condition of the shin tissues, which prevents adequate regeneration of postoperative sutures
local infection of the skin and subcutaneous layer
How is the recovery period?
It is no longer possible to fully restore the strength of the tendon after the operation.Therefore, a repeated rupture can occur even with seemingly small loads. Complications may include infection, skin necrosis, severe scarring, limited mobility, and cosmetic defect.
Rehabilitation takes a long time. At this time, the patient moves with crutches. A patient after surgery on the Achilles tendon should be observed in the hospital for several days, and then can go home. Recovery after surgical treatment of Achilles ruptures lasts an average of 2.5 months.You can return to sports no earlier than six months later.
In addition to physical rehabilitation, physiotherapy is carried out aimed at eliminating postoperative edema, improving trophism and restoring muscle function.
Massage, magnetotherapy, UHF, electromyostimulation can be used.
Suture at rupture of the Achilles tendon in Krasnoyarsk
Undergo research and emergency surgery at the Medunion Clinic. We do not have queues and long waiting times for results.To sign up, call +7 391 202-95-54 or fill out the online form. Indicate the procedure you need and leave your details – our specialist will call you back and discuss a convenient time for the procedure.
Achilles tendon ruptures – A.K. Eramishantseva
Achilles tendon rupture is called one of the most common soft tissue injuries of the lower leg. Most often, the pathological condition is recorded in persons aged 30-50 years, leading a sports, active lifestyle.Among the patients with this problem who turned to our traumatologists in Moscow, there are many athletes or people who were actively involved in sports in the past.
Due to the anatomical features of this tendon, as a rule, it tears completely, in contrast to tears of other tendons, which are often partially torn.
Causes of Achilles tendon rupture:
- Direct injury, most often resulting from a blow to the tendon area.
- Sharp contraction of the soleus or gastrocnemius muscles.Most often it can occur while running, when falling from a height, with pathological flexion of the dorsum of the foot.
- Microtrauma of Achilles, “accumulated” as a result of a sports career.
- Cold start in training.
Symptoms of Achilles tendon rupture:
- Sharp soreness in the tendon area, which in its characteristics is similar to pain from a cut or blow.
- Swelling in the tendon area.
- Characteristic “failure”, which is revealed by palpation of the Achilles and is located 4-5 centimeters above the place of attachment of the tendon to the heel bone.
- Inability of the patient to stand on toes and bend the foot towards the sole.
- In a chronic case of rupture, atrophy of the leg muscles is observed.
Center for Traumatology and Orthopedics, GKB im. A.K. Eramishantseva provides high-quality diagnostic, treatment and rehabilitation services for ruptures of the Achilles tendon.Using modern diagnostic equipment, their clinical experience and high qualifications, traumatologists of our department restore hundreds of grateful patients to a full, unlimited life with trauma.
When an Achilles tendon rupture is diagnosed, x-rays are usually unsuccessful. Most often, the traumatologists of our department put it on the basis of complaints, anamnesis of trauma and an assessment of clinical manifestations. Modern diagnostic techniques such as ultrasound or MRI can be used.
We provide emergency and planned care for patients with acute or chronic rupture of the Achilles tendon.
Important! Due to certain circumstances, this injury is not compensated for on its own. At the first suspicion of it, you should seek the help of traumatologists, who will apply surgical treatment, whose goal will be to restore the torn tendon.
The method of suturing will be determined depending on the timing of the injury. It is possible to strengthen the tendon with the fascia of the patient’s thigh in cases where the injury is professional and the patient’s work is associated with a constant load on the Achilles.
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However, it should be noted that this retains the residual function of plantar flexion of the foot, since the muscles of the posterior tibial muscle, as well as the long and short peroneal muscles, support the function of the Achilles tendon and, after injury, may even partially take over its function. This explains the fact that some patients notice the trauma as such, but the actual diagnosis is delayed due to the fact that the function of the Achilles tendon seems to be preserved at first.Treatment of the Achilles tendon in Germany
The largest and strongest tendon in the human body is the Achilles, formed by the fusion of the flat tendons of the gastrocnemius muscle with the soleus. It is located on the back of the lower leg and is responsible for the flexion of the ankle joint.Between the tendon itself and the surface of the heel bone is a mucous bag, which reduces friction between them. After various injuries, an inflammatory process begins in this bag, which develops into an Achilles tendon bursitis, the treatment of which should not be postponed. Any delay in treatment can lead to tendon rupture and even complete immobilization of the joint.
Achilles injuries mostly affect people between 30 and 50 years of age. A tendon rupture usually occurs at a distance of 4-5 cm from the place of its attachment to the heel bone, since it is in this area that the level of blood circulation is reduced.
Achilles tendon injuries: causes
Treatment of the Achilles tendon may be needed for various reasons. By the type of impact, trauma can be:
- straight, for example hit with a sharp or heavy blunt object;
- Indirect, caused by sudden muscle contraction due to an unsuccessful fall, a sharp jump and other unsuccessful movements.
Often the cause of rupture and the need for surgery on the Achilles tendon is its degeneration resulting from prolonged inflammation or treatment with corticosteroids.
Symptoms of damage to Achilles
The first thing that a person feels when the Achilles tendon is damaged is acute pain. The moment of injury can sometimes be accompanied by an unpleasant crunch or crackle, as a result of which the functionality of the injured leg is markedly reduced. At the site of injury, edema occurs, which after a few days turns into a large hematoma, while capturing the entire lower part of the leg. If the Achilles tendon is not treated in a timely manner, then the risks of lameness or complete loss of leg performance are maximum.
Making a diagnosis
To determine the type of treatment – conservative or Achilles tendon surgery, it is necessary to correctly identify the cause of the pain. Due to the fact that X-rays do not linger in the tissues of the tendon, it is impossible to establish the likelihood of rupture using X-ray. To diagnose a rupture, specialists use magnetic resonance imaging and ultrasound diagnostics.
Regardless of the established diagnosis, partial injury, rupture or bursitis of the Achilles tendon, treatment in any case must be timely.
Achilles injuries: treatment by orthopedists in Germany
Depending on the severity of the injury, the Achilles tendon is treated with two main methods:
- conservative therapy;
- Achilles tendon surgery.
The essence of the conservative is to ensure tissue fusion by immobilizing the leg using special braces, plaster splints and cuts. The duration of such treatment is from 6 to 8 weeks and it is shown mainly to people whose physical activity is reduced.And when a person leading an active lifestyle or a professional athlete is diagnosed with Achilles rupture, surgery is the most effective way to restore the usefulness of the limb functions.
Surgical treatment of Achilles injuries
The most reliable and effective way to restore Achilles after an injury is surgery. And the faster it is carried out, the more satisfactory the result will be. Achilles tendon surgery is performed under spinal or local anesthesia and under general anesthesia.
Taking into account the prescription and nature of the injury, as well as the physiological characteristics of the patient, surgical procedures can be as follows:
- Subcutaneous suture. This method is used in cases when no more than a week has passed from the moment of damage and it is possible to completely match the torn ends of the Achilles;
- open suture for plantar muscle plasty. The method is used in cases where a displacement occurred during rupture and the ends of the damaged Achilles are not matched;
- Achilles plasty by means of the fascia of the gastrocnemius muscle is effective when the ends of the tendon have undergone excessive dislocation caused by the injury of 3 weeks or more.
Regardless of the complexity of the rupture of the Achilles, operations at a high professional level are carried out by specialists from German clinics using minimally invasive techniques. Surgeons perform stitching by endoscopic access or by means of separate skin punctures.
Postoperative rehabilitation
Achilles after surgery requires long-term rehabilitation. The first few days after the operation, the patient is monitored in a hospital.If necessary, treatment with antibiotics and analgesics is carried out.
After being discharged home, the patient is prescribed massage and physiotherapy exercises. In about 2.5 months, the performance of the Achilles tendon is restored.
90,000 Achilles tendon rupture, partial Achilles tendon rupture, surgery, rehabilitation
Achilles tendon rupture
Achilles tendon is the largest tendon of the musculoskeletal system in the human body.It consists of muscle fibers running behind the ankle joint, and flat tendons called aponeuroses. Another name is the calcaneal tendon, which is attached to the tubercle of the calcaneus.
The Achilles tendon is responsible for the functioning of the human foot, in particular, due to the contraction of its fibers, such movement of the foot is carried out, such as lifting to the toe. So that when the foot moves, the fibers of the Achilles tendon do not rub against the bone tissue of the heel and are not damaged, a mucous bag is located between them.The tendon itself is protected by a channel containing mucus, which protects the tendon from friction and injury.
A little history
Achilles tendon is one of the most important elements of the human musculoskeletal system, which provides direct walking. It is absent in all animals, including macaques, despite the fact that their anatomical structure is as close as possible to the human structure.
The Achilles tendon is not only the largest, but also the most enduring, which is explained by the need to withstand a lot of physical activity while walking.The name “Achilles” tendon got thanks to the hero of Greek myths Achilles. Achilles was a strong and courageous warrior whose physical ability no one could surpass.
The warrior received the strength thanks to his mother – Tethys, who, following the advice of a fortuneteller, immediately after the birth of her son, dipped him into Styx – one of the rivers of hell. Its waters were supposed to give the boy great strength and physical endurance. And so it happened, but, dipping her child into the water, the mother held her son by the heel, on which the water from the river did not fall.So the heel remained a vulnerable, unprotected place on the body of Achilles, but no one knew about it. Achilles turned the tide of the Trojan War for the benefit of his people, he would not only be a brave warrior, but he could also heal wounded soldiers.
Achilles was the commander in the battle for Troy, it was he who killed Hector – the Trojan prince. But Hector’s brother decided to take revenge on the hero of Greece, by all means. A poisoned arrow was fired from his hands, hitting the weakest point of Achilles – in the heel. Since then, the phrase “Achilles’ heel” has become an aphorism that indicates a vulnerable, unprotected place.
An interesting fact is that the arrow killed Achilles, hitting not in the tendon, but in the heel. The Achilles tendon in humans, although capable of withstanding heavy loads, is susceptible to various injuries when the degree of physical exertion becomes excessive. The tendon is often stretched, microscopic cracks appear on it, increasing the risk of rupture, and inflammation can occur in the tendon.
Causes of damage
Achilles tendon rupture occurs due to excessive physical exertion.In most cases, this type of tendon injury is diagnosed in people who play contact sports, and this is especially true for those disciplines where the lower limbs are involved, such as football.
When a tendon is tense and hit hard, it is called a direct injury. Complete or partial rupture of the Achilles tendon can occur due to indirect injury when the muscle fibers of the ankle joint are sharply contracted and the limb is extended.This is observed with intense jumping in football and basketball.
Another mechanism of damage to the Achilles tendon is the sudden bending of the foot to the back, which occurs when a person slips on a slippery surface. Achilles tendon rupture also occurs when a person falls on a straight limb.
Partial rupture of the Achilles tendon occurs when the heel is stabbed. This type of injury is called an open rupture type. If the cause of damage to the integrity of the fibers of the Achilles tendon was a fall or mechanical damage, this type of injury is considered a closed type or subcutaneous rupture.
The place on the tendon, which is more likely to rupture than others – a few centimeters from the point of its attachment to the heel bone tissue. The frequency of such an injury is explained by the fact that the smallest number of blood vessels passes here, respectively, the tendon does not receive the required amount of nutrients, which reduces the degree of its strength and endurance. But this theory does not find scientific evidence, since the blood supply along the entire length of the Achilles tendon is the same and complete.
Modern medicine explains the occurrence of rupture of the Achilles tendon by the presence of pathological processes when degenerative changes occur in it. Tendon fibers are made up of collagen, a proteinaceous substance responsible for the strength of the tendon, making it virtually impossible to stretch. The amount of collagen can decrease gradually with age, or due to the presence of various pathological processes in the body.
It also happens that due to a genetic predisposition, the amount of collagen is initially low.In such cases, degenerative-dystrophic processes begin to occur in the tendon. The tendon weakens and is no longer able to withstand the stress placed on it. With insufficient concentration of , partial rupture of the Achilles tendon can occur suddenly, without previous injury.
Prolonged intake of certain drugs can provoke a decrease in the concentration of collagen in muscle fibers. So, the strength and endurance of the Achilles tendon is negatively affected by a long course of drugs from the group of corticosteroids and antibacterial drugs.It does not matter what the method of taking these drugs is – local, in the form of injections, or general, that is, orally.
If a person, for medical reasons, takes a long course of corticosteroids and begins to notice frequent pain in the heel, it is recommended to stop taking medications so as not to provoke rupture of the Achilles tendon. Another provoking factor is chronic, sluggish inflammatory processes in the tendon, which lead to the gradual destruction of its fibers.
There is also a theory of mechanical damage – a sudden violation of the integrity of the fibers of the tendon is not always associated with the presence of pathologies of a degenerative nature. If the tendon is subjected to physical stress that exceeds the permissible limit of its endurance, cracks will appear on the fibers, which will rapidly increase as the load continues.
Mechanical damage to the tendon is associated with a violation of the well-coordinated interaction of the muscles of the ankle joint.Trauma can occur when the head of the ankle muscle pulls on the Achilles tendon, and the head, located in the inner part, is delayed in this process and is in a sunken position for a few seconds.
This mechanism of injury is most often observed in athletes who have not been engaged for a long period of time, after which they immediately began intensive training with a great load, when the muscles have had time to wean. The likelihood of injury increases between the ages of 30 and 50, when, although people do sports, they do it irregularly or do not want to spend time on a proper warm-up before training.
The cause of rupture can be microscopic cracks that appear as a result of often excessive stress, for example, when an athlete exercises more than his ability, not paying attention to muscle and tendon pain.
Another version of the rupture – the theory of hyperthermia – Achilles tendon rupture occurs due to heating of the tendon fibers during excessive physical exertion. Despite the high amount of collagen, it cannot be said that the Achilles tendon does not stretch at all.
During the load on the foot, energy is generated, about 10% of which is reborn into heat. For example, a person jogs, for 7-10 minutes of such activity, the local temperature of the tendon fibers rises to 45 °, due to which the fiber cells – tenocytes – suffer. Such heating of the fibers increases the likelihood of developing degenerative processes in soft structures.
Why does not all people go in for sports, hyperthermia cause the formation of degenerative processes with subsequent rupture of the tendon? It’s all about blood circulation.If the blood circulates in the right volume, it cools the fibers. But if the blood circulation is disturbed, hyperthermia leads to damage to tenocyte cells.
In the risk group, when the probability of rupture of the Achilles tendon is maximum, there are people aged 30 to 50 years. Medicine explains this by the fact that, due to age-related changes, tendon fibers gradually lose their collagen.
Another reason is related to the moral side and self-identification of a person. Many people in this age group, who do not have chronic diseases and who take care of their bodies, believe that they can go in for sports on an equal basis with the young, not realizing that the condition of the tendons and muscles is not right for them, and it is necessary to reduce the intensity of the load.
Clinical picture
Achilles tendon rupture is accompanied by the following symptoms:
- sudden onset of severe pain;
- a crack or click is heard;
- decrease in strength in the lower limb;
- inability to lean on the injured leg;
- Formation of an extensive bruise on the skin.
The motor function of the leg is impaired, the person cannot rotate the foot normally, due to the fact that the pain intensifies.A bruise forms immediately after rupture, constantly increasing the area of the lesion. If the fibers are partially torn, a small depression can be felt in the Achilles region.
A characteristic sign of damage to the integrity of the Achilles tendon is the inability to straighten the foot. There is a violation of gait, a person is forced to limp due to pain, often due to a pronounced pain symptom, it is not possible to step on the foot of the injured limb.
If the Achilles tendon is damaged, it is forbidden to press on it, massage, trying to stop the pain.To reduce the swelling, you need to apply a cold compress and get to the hospital as soon as possible.
Diagnostics
Achilles tendon rupture is diagnosed during a physiological examination of the patient. The patient needs to be told in as much detail as possible what he was doing at the moment when the injury occurred. Knowing the mechanism of damage to the tendon will make it easier for the doctor to diagnose.
Anamnesis is collected, which takes into account the presence of concomitant diseases that can cause weakness of the Achilles tendon, for example, bursitis, tendonitis, arthritis.With a pronounced symptomatic picture of tendon rupture, the diagnosis is not difficult, and the damage is determined during the examination.
To determine the presence of concomitant injuries to adjacent tendons and muscles, the doctor gently palpates the damaged area. To make an accurate diagnosis, stress tests are performed:
- shin compression method – when the doctor presses on the shin bone, the foot reflexively straightens. To get a reliable result, the test is carried out first on a healthy leg, then on a damaged limb, after which the general picture is compared;
- needle test – a thin needle from a syringe is inserted into the fibers on the Achilles tendon, after which the doctor begins to twist the foot in different directions and looks at how the needle behaves at the same time;
- knee flexion test – for the test, the patient needs to lie on his stomach, knees bent, feet looking up.If there is a rupture of the tendon, the foot on the injured leg will be lowered down, the person will not be able to align it;
- test using a sphingmomanometer – the cuff of the device is put on the leg, just above the tendon, it is inflated to 100 mm, after which the doctor rotates the foot. If, when performing these manipulations, the indicators of the device increase to 140 mm, the tendon is intact.
You don’t need to do all of these tests to make a diagnosis. After performing one of the tests of your choice, you can say for sure about the condition of the Achilles tendon, whether it is torn or not.Often, instrumental diagnostic methods are required, when, for example, the symptomatic picture is poorly expressed, the trauma is old, or there is a suspicion of damage to neighboring soft structures.
Radiography, ultrasound, MRI are used. Instrumental methods of examining the Achilles tendon are not basic and are prescribed in extreme cases, with special indications and are carried out only as prescribed by a doctor.
Therapeutic manipulations
At the Center for Sports Traumatology and Rehabilitation Medicine, the treatment of rupture of the Achilles tendon is approached individually, using conservative and surgical techniques.The choice depends on the severity of the clinical case, the presence or absence of concomitant diseases and degenerative processes, which can further lead to repeated rupture of the tendon fibers.
The non-surgical technique of rupture therapy implies a complete limitation of physical activity on the injured limb. For this, an immobilization bandage is applied, the wearing period of which ranges from 6 to 8 weeks. During immobilization, the torn ends of the fibers gradually come closer and grow together.
Despite the effectiveness of the conservative method of treating a rupture, immobilization of the leg may not be entirely convenient:
- The plaster cast itself is very heavy, and the person temporarily loses the ability to move the limb altogether.
- The second drawback is that after a long wearing of plaster , the rehabilitation of the rupture of the Achilles tendon will be quite long and difficult, which will delay the recovery time of the foot’s motor activity.
- Gypsum cannot be called a strong material, and therefore after a few weeks it will gradually begin to crumble.If the bandage is thin, it can burst, but if the plaster is made thick, it is a lot of weight.
Doctors recommend replacing the plaster cast with a more comfortable device for limb immobilization – an orthosis. There is another type of fixation bandages made of plastic plaster. Immobilization will be no less reliable, but the material itself is lightweight, and it will be easier for a person to handle it.
If the rupture is not severe and there are no risks of complications, partial fixation of the limb is performed, and a small “heel” is attached to the bandage so that the patient can lean on the injured leg.
Non-surgical treatment – cons and cons
Although conservative treatment of a rupture gives positive results, the method of temporary immobilization of a limb cannot be called the “gold standard”. If the success rate of such treatment were 100%, operations for rupture of the Achilles tendon would not be necessary. But, as medical statistics show, surgical intervention for this type of trauma to the musculoskeletal system is often performed.
During the rupture of the tendon fibers, blood is released, which enters the ankle joint, due to which an extensive hematoma forms, which interferes with the fusion of the torn ends of the tendon. Over time, the ends will still grow together, but some of the strength of the tendon will be lost.
Self-fusion is also dangerous because, due to the hematoma, the fibers will grow together by scarring the tissue. The tendon, due to the presence of scars on it, completely loses the ability to stretch slightly under excessive stress, which increases the risk of re-rupture.In addition, if previously the break was partial, with another damage, the fibers can break completely.
If degenerative processes are the cause of the rupture, the integrity of the fibers is not just broken, they break down and become like a washcloth. This type of rupture cannot heal on its own during conservative treatment.
Not always, even with mild trauma, the torn ends of the tendon grow together after temporary immobilization of the limb. A control X-ray is taken a few weeks after the dressing is applied.If the fibers do not grow together, or this process is so slow that it will cause further difficulties in the rehabilitation of the rupture of the Achilles tendon , the issue of surgical intervention is decided.
The indication for the use of a conservative technique with a temporary limitation of the load is the freshness of the injury, when no more than 1-2 hours have passed from the moment of rupture to the provision of medical assistance. In this case, the probability of self-splicing of fibers is maximum.
Non-surgical treatment of a rupture is also recommended in the case of an elderly patient who does not need intense exertion, does not play sports, and therefore a slight loss of its strength by the Achilles tendon will not cause much discomfort for him. If the patient is a young person, an active person or an athlete who plans to resume physical training in the future, the only effective method of treating a ruptured Achilles tendon is surgery.
Peculiarities of surgical treatment
The earlier the operation is performed after the rupture of the Achilles tendon , the more chances for a full restoration of the motor activity of the foot in the future. The difficulty in the surgical treatment of chronic trauma is due to the fact that after 20 days the torn ends of the fibers are gradually reduced, which makes their length decrease.
Since it is not possible to stretch the tendon, surgery may not help repair the damage.Depending on the severity of the clinical case, surgical intervention, during which the torn ends are sutured, is performed using general or local anesthesia, often using spinal anesthesia.
At the Center for Sports Traumatology and Rehabilitation Medicine, minimally invasive techniques are preferred in the surgical treatment of rupture of the Achilles tendon. The absence of the need for strip skin incisions significantly reduces the recovery period after surgery, the risks of complications are minimal.
But with a total rupture, the use of minimally invasive techniques is not always possible to do. During the classic operation with open access to the operated limb, an incision is made in the skin up to 10 cm long. The torn ends of the tendon are cleaned of blood and sutured.
There are many stitching methods, but the Krakow-style stitch is considered the gold standard. This method involves stitching the tendon fibers with threads, and then tying the threads together. The operation ends with layer-by-layer stitching of all wound structures.The disadvantage of this method of surgery is a large incision in the skin, which will leave an unaesthetic scar after the operation. This is especially unpleasant for women who, due to a postoperative scar, will have difficulty finding open shoes.
Minimally invasive tendon rupture therapy has several advantages:
- This surgical technique is called percutaneous. For the introduction of surgical instruments, several small punctures are made in the skin, after the operation they are tightened and become almost invisible.
- Recovery is much faster.
Despite the undoubted advantages of minimally invasive techniques, the lack of open access to the torn tendon has its drawbacks – limited surgical procedures. The doctor does not have access to the torn ends of the tendon, which is why there is a possibility of incorrect alignment, for example, stitching in a twisted state. As a result, in the future, the tendon will lose its strength, and the motor activity of the foot will decrease.
Another complication that can occur during the operation is damage to the nearby nerve endings fiber. To avoid these complications during minimally invasive surgery, you need to contact the best professionals who have tremendous experience – the Center for Sports Traumatology and Rehabilitation Medicine.
At the Center, the Achilles tendon rupture operation is performed using the Achilon suture system. A small incision is made in the skin, the length of which does not exceed 3 cm, but such an incision is sufficient to perfectly fold the torn ends of the tendon.
The greatest efficiency from surgical intervention can be achieved with a fresh injury, when no more than 2.5 weeks have passed since the tendon rupture. If the injury is old, that is, the gap was twisted more than 3 weeks ago, it is difficult to carry out stitching, since muscle contraction and a decrease in the length of the tendon will not allow the ends to be pulled together. In this case, they resort to plastic.
The operation is performed using the classical method. The essence of the method – a patch is cut from the upper part of the Achilles tendon, through which the torn ends are connected.If it is not possible to take the missing part of the tendon from the biological material of the patient himself, synthetic materials are used. The open type of surgical intervention is also resorted to in cases where the ends of the tendon, due to the presence of degenerative pathological processes, become loose.
Recovery
After the surgical intervention, it is necessary to limit the load on the limb, for which a fixing bandage is applied to it.For the first 2 weeks, movement is carried out only with the support of crutches.
For more convenience of the patient, it is recommended to immobilize the limb using a medical orthosis, the device of which allows you to correct the angle of inclination and extension of the foot. Gradually, the angle decreases, due to which a person will soon be able to move without the support of crutches. Wearing an orthosis or a plaster cast after a rupture lasts 2-2.5 months, but the individual characteristics of each organism play an important role.
Several decades ago, it was believed in orthopedics that rehabilitation could be carried out only after the fixation bandage was removed. But in 2-3 months of complete immobilization of the limb, the muscles gradually atrophy, and the restoration of their condition and functioning is a long and difficult process.
Specialists of the Center for Sports Traumatology and Rehabilitation Medicine prepare a rehabilitation program individually for each patient. You can start its implementation at a time when the injured limb is still immobilized.Correct, early rehabilitation significantly speeds up the recovery process and prevents possible complications.
The rehabilitation program includes the implementation of physical therapy exercises aimed at restoring the work of the muscles and tendons of the lower extremity. Exercises are performed only under the supervision of a doctor, as improper performance can cause complications.
What complications can arise?
The Achilles tendon, which was operated on after the rupture, will already be the same as before.Even a slight weakness in the fibers, which is invisible to a person, can cause repeated damage. The risk of rupture is higher if therapy is carried out with conservative methods. Due to the fact that the lower limb (both after surgery and during conservative treatment) is immobilized for a long time, there is a risk of blood clots forming in the blood vessels, which can break off and enter the lungs, causing an embolism.
To avoid these complications, immediately after a tendon rupture, you should contact the professionals at the Center for Sports Traumatology and Reconstructive Medicine.An important role is played by the patient’s compliance with all doctor’s prescriptions. The correct implementation of the rehabilitation program is a guarantee that the Achilles tendon after a rupture will recover correctly and quickly, so that a person can return to an active life and to sports activities.
90,000 “I’ve seen a torn Achilles twice.” A West Ham medic told how Yarmolenko was recovering from injury
Manager Manuel Pellegrini described him as a “special player” after goals from Norwich, Manchester United and Bournemouth.After recovering from the injury of Achilles Yarmolenko became one of the top scorers of West Ham. But it was hard to fight for such an excellent form.
A little less than 12 months ago, 29-year-old Yarmolenko suffered an Achilles break in a game against Tottenham. A rare but serious injury for a football player. It was a real blow for Yarmolenko. Just a couple of months after a high-profile move to West Ham and the Premier League, he faced months away from football.
With the help of Hammerhead Medical Director, Richard Collinge , Sky Sports told the story of Yarmolenko’s long comeback.
Read also Yarmolenko: Now not my 100%, but I feel that I will soon get in perfect shape
Injury
“I think it’s immediately clear: when a player gets such an injury, it’s very unpleasant. As soon as we ran out onto the field, it was clear that he was in serious discomfort, and the player was in a state of shock in this case. ”
When Yarmolenko grabbed his leg, the look on his teammates’ faces emphasized the seriousness of the injury even before Collinge and his medical team ran up to Andrei.
“You don’t see a torn Achilles very often. I have been in football for about 20 years and I think I have met a similar injury twice. They do not happen often, but they are very serious. ”
Recognizing the complexity of the injury, West Ham’s medical team knew to act quickly.
“His wife was at the game, so we took her to the medical office and explained the meaning of the injury. Andrey was shocked and disappointed. He joined a new Premier League team and wanted to make a good first impression.It was October, and this opportunity was taken away from him.
We put on a protective boot, gave him crutches and sent him for an MRI, which confirmed our fears: he damaged the Achilles. Such injuries need to be dealt with as quickly as possible. The injury occurred on Saturday, and by Monday morning Andrei had already undergone surgery in London to repair the tendon. ”
After the tumultuous hours that followed the injury, Yarmolenko faced the prospect of long months of recovery.
First day
After the operation, the injured leg was kept in a protective boot, which was removed only for light stretching exercises. During this depressingly slow period, his morale was as important as his physical recovery.
“Watching other players go to practice every day was hard for him. To help us get through the initial 10-week post-trauma period, we tried to be positive around it.Andrey is a very positive person himself, which also helped, but the players, manager and coaching staff were great next to him.
We also have a player care team at the club, which made sure that Andrey and his family knew that we were here to provide him with all kinds of support: from talking to a psychologist to contacting employees with whom he previously spoke in Ukraine. The team-for-team ethic helped Andrey get back to where he is now. “
Collinge and the coaching staff were interested in Yarmolenko to monitor his physical condition as actively as possible. There were workouts for his upper body and heart rate, and hydrotherapy to keep him fit.
Yarmolenko, a number of tasks were also set: “The most important thing that I realized during my work is that you need to give the player realistic goals for how the rehabilitation program will look like, and set new tasks during this period” .
Technology and tenacity
We started early and spent long hours at the club’s training base, but Yarmolenko’s attitude remained unshakable. Even at the end of the season, when his partners went on vacation, Yarmolenko still came every day to continue his fight to get back in shape.
His treatment was extensive and used modern technology. In the pressure chamber, Yarmolenko rode static bicycles, trained on a cross-trainer and ran on an anti-gravity track.
“Andrey performed work in a simulation environment with a height of three thousand meters. This helped his heart and lungs to work harder, so when he returned to the field, his body was not too depleted. He did very intense cycling work, and from December we gradually increased his body weight when he ran on the treadmill. ”
Regular weighing and body fat checks monitored Yarmolenko’s condition, meetings with a club nutritionist monitored diet, and massage and muscle stimulants helped to strengthen the muscles around the healing Achilles.
The morning pressure chamber workout in the afternoon was followed by additional work with strength and conditioning coaches, and weekly Pilates classes helped with flexibility.
“Every player wants to get back as quickly as possible, and we want it to be safe. Pressure chambers, cryotherapy chambers, muscle stimulators, shock wave machines and so on provide a lot of information. We always try to find what will help get a player back on the field faster, safer and more efficiently. ”
Pellegrini’s keen interest
West Ham boss Manuel Pellegrini was closely following the process. Yarmolenko may have been out of play, but like everyone else at the club with injuries, Pellegrini insisted that he participate in team meetings and feel part of the group.
“Pellegrini loves to be aware of what happens to the injured. I meet with him every morning and talk about every player whether he is ready or not.The manager also sees the players in the treatment room, walks in and asks how the treatment is progressing.
He maintains an open relationship with the injured, because the player still needs to feel like a part of the club and take part in his life. Pellegrini and his team are great at this. The players don’t feel left out by their injuries. ”
Back on the field
Yarmolenko’s work on the treadmill raised his strength in December, and in January he was ready to return to running on the grass.
The transition was again slow, calm and methodical. When regular running became active, he was able to join his teammates for some non-contact training in April, and eventually began contact work in May. But this was not the end of the road.
“When you bring a player back to the contact group, you need to build their confidence. There is nothing better for this than training. There is a lot that you can do during the rehabilitation period before he returns to full contact training.But he must be exposed to the stress and strain that the training puts on the tendon. ”
Yarmolenko’s body reacted well, and if the Premier League season lasted until June, he would have time to return to the field. However, given the timing of his recovery, Pellegrini and the medical staff agreed that it was best to back down and ensure that Yarmolenko was 100 percent ready by July 1, the start of the preseason.
This meant that after West Ham’s first team finished the season, Yarmolenko needed to find someone to train.
“We detained the U-23 team specifically to help Andrey and he was able to conduct additional training with them. He also returned to Ukraine and did some training with the national team, but we completely supervised this part to make sure he didn’t work too much ahead of time. ”
As his own vacation was reduced to a short weekend with his family, in the summer Yarmolenko focused on rehabilitation.
“These are the sacrifices to be made.People think the season ends in mid-May, but of course the medical, sports and science teams are on hand throughout the summer. As Andrey worked practically all summer ”.
Return
On July 1, when Yarmolenko arrived at the base, he was ready for battle and is now reaping the fruits of his work.
“Rehabilitation should not be taken lightly, because it is a process that requires an awful lot of input, and the result at the start of the season is a testament to how well Andrey went through it.To play at this level again requires tremendous mental toughness and positive thinking.
The hard work is still going on. We don’t get complacent. The demands of the Premier League are enormous right now, physically and mentally. When a player like Andrey gets injured, extra work needs to be done to help him stay in the game.
But he’s a good professional. He has been a sponge for the past twelve months and has absorbed all the information the staff provided.It’s very nice to see Andrei playing at the same level again. ”
90,000 Golden State Defender Thompson underwent Achilles Reconstruction
https://rsport.ria.ru/20201126/nba-1586394074.html
Golden State Defender Thompson underwent Achilles Reconstruction
Golden State Defender “Thompson underwent surgery to repair his Achilles
Three-time NBA champion Golden State defender Clay Thompson successfully underwent surgery to repair a torn Achilles tendon,” the website said… Sport RIA Novosti, 26.11.2020
2020-11-26T10: 28
2020-11-26T10: 28
2020-11-26T10: 28
Golden State Warriors
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clay thompson
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MOSCOW, November 26 – RIA Novosti. Three-time NBA champion Golden State defender Clay Thompson successfully underwent surgery to repair a torn Achilles tendon, according to the NBA website. Thompson sustained a leg injury during Golden State training on 18 November. The 30-year-old is expected to skip the 2020/21 season. Thompson previously missed the entire NBA season as he was recovering from surgery with a ruptured cruciate ligament in his left knee. Thompson made 615 regular season appearances in his 9-year NBA career and averaged 19.5 points and 3.5 rebounds.
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Golden State Warriors, National Basketball Association (NBA), Clay Thompson, basketball
MOSCOW, Nov 26 – RIA Novosti. Three-time NBA champion Golden State defender Clay Thompson successfully underwent surgery to repair a torn Achilles tendon, according to the NBA club’s website.
Thompson sustained a leg injury during Golden State training on 18 November. The 30-year-old is expected to miss the 2020/21 season.
Earlier, Thompson missed the entire NBA season as he was recovering from surgery with a ruptured cruciate ligament in his left knee.