If a ligament rupture has to be operated on

Torn ligament: Often there is no need to operate

Transmission date: 03/25/2014 8:15 p.m. | archive
One wrong movement and the ligaments in the ankle can tear.

A wrong step, an awkward movement or an accident - a torn ligament can happen quickly. With this diagnosis, surgery is often performed and the torn ligament is sewn back together or, if necessary, replaced. But more recent studies show that this is often not necessary and sometimes even has disadvantages for the patient. Conservative treatment helps many sufferers at least as well.


Orthosis stabilizes the joint

This is especially true for the ankle, which is stabilized and held together by several short ligaments. If the foot kinks inwards, the outer ligament is stretched a lot and, in the worst case, can tear completely. In the meantime, conservative treatment for torn ligaments in the ankle has become the standard therapy, as the outer ligament grows back together well on its own when the joint is immobilized. For this, the patient is fitted with a so-called orthosis that stabilizes the ankle day and night and prevents it from twisting inwards or outwards again. This allows the outer ligament to heal back together as tightly as possible. This is important because if the ligament grows too loosely together, the joint can remain permanently unstable.

Cruciate ligament rupture increases the risk of osteoarthritis

In the case of a cruciate ligament rupture in the knee joint, surgery has long been considered the only sensible therapy. But here too, doctors have rethought. The two cruciate ligaments in the knee joint hold the upper and lower leg bones together. Without it, the knee joint would be completely unstable, especially when flexing. If, for example, in a sports accident, the lower leg is twisted in the joint, the anterior cruciate ligament is overstretched and tears. For those affected, a cruciate ligament tear often feels like a bang going through the knee. It starts to vibrate, to tremble. The torn cruciate ligaments can no longer stabilize the knee, so that orthopedic surgeons can make the diagnosis with simple movement tests.

Tears of the anterior cruciate ligament have so far been operated particularly often because the doctors wanted to prevent the development of osteoarthritis. During the procedure, the broken cruciate ligament is replaced with a tendon graft, thereby stabilizing the knee again. But recent studies show that a cruciate ligament rupture generally increases the risk of osteoarthritis - regardless of whether or not an operation is performed. The cruciate ligament does not grow back together as it did before, but scar tissue that is almost as stable is formed between the ligament ends. In the case of only slight instability in the knee, conservative treatment with lymphatic drainage for relief, physiotherapy and targeted muscle-strengthening exercise therapy can therefore be completely sufficient.

When does an operation make sense?

Surgery is still preferred for very young patients and competitive athletes. It should be noted that after a cruciate ligament operation it takes six to eight months before the knee can be fully loaded again. In addition, the operation is not always successful: In 10 to 15 percent of patients, the tendon does not grow properly after the operation, so that the knee may be more unstable after the operation than before. This is why experts nowadays advocate an individual decision for each patient in the event of a cruciate ligament tear.

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Visit | 03/25/2014 | 8:15 pm