LIGAMENT INJURIES

A ligament is made up of specific fibres, like an elastic rubber band which connects a bone and a cartilage, a bone to a meniscus, a bone to a bone, ligaments are very strong and when a ligament is stretched or torn it is called a sprain.

 LOCATION AND COMMON CAUSES OF LIGAMENT TEAR AND SPRAIN:

Any movement which causes extreme or unnatural turning and twisting can cause the ligament to undergo extreme stress and leads to sprain or a tear. The most common ligaments affected are

Knee:  The main ligaments of knee are anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament and lateral collateral ligament, the ACL is the most commonly injured ligament and the lateral collateral ligament injury treatment involves treating the illio-tibial band along with the ligament.

Ankle:  In ankle the inversion injuries that is ankle bending inwards causes more common injury to the lateral ligament injury complex which includes anterior talofibular (ATFL), calcenofibular and posterior talofibular (PTFL) ligaments. The medial deltoid ligament is lesser common. A high ankle sprain is more common in athletes and involves the distal tibiofibular ligaments

Wrist: The most common ligament injuries in wrist is the triangular fibrocartilage complex (TFCC) and the scapholunate ligament

Shoulder: shoulder joint is kept stable with different ligaments and any dislocation of the joint can cause injuries to these ligaments the common are Superior glenohumeral ligament and inferior glenohumeral ligament, usually using regenerative medicine protocols to tighten these ligament are sufficient to heal them

Along with these ligaments of back illio-lumbar ligament of spine, the interspinous ligament is common to undergo sprain and whiplash injuries causes’ injury to the neck ligaments as well.

Diagnosis and treatment of ligament injuries

Usually clinical examination history and using imaging modalities like real time musculoskeletal examination using ultrasound gives a good picture of the grade of tear and sprain and along with it MRI can be ordered to have even more accurate diagnosis

The grading of sprains/tears are done as follows

Grade 1; mild sprain with some changes in fibre structure but no tear

Grade 2: swelling some fluid collection with partial tear with no joint instability

Grade 3: complete sprain and tear with joint instability

Ligament injury Treatment

For any acute and mild to moderate grade 1 and 2 tears first line of treatment is conservative using RICE approach (REST, ICE, Compression  and elevation) once the swelling has subsided over some days advanced management can be planned  which includes minimally invasive injections.

For mild to moderate ligament injuries (grade 1 and 2 and some times grade 3)  treatment like ACL, lateral collateral ligament injury treatment, TFCC (triangular fibro cartilage of the wrist) and ankle ligament sprain  is done using the best and most advanced treatment modality that is using orthobiologics and regenerative medicine protocol, where under image guidance and with precision specific blood products are injected to the tear site which helps in healing and getting the strength of the ligaments back, this ligament tear treatment using your own cells has advantages of less down time, faster recovery no scar and less complications which are associated with surgery.

Surgery is only required in very complex cases of ligament tear where the ligament has totally torn and no fibre connection is seen on MRI and has retracted more than 5 to 6 mm, even then if you want can avoid surgery unless there is instability in the joint as surgeries come with their own risk and also aggravate arthritis development in longer stages.

Osteoarthritis in young adults, why is it happening so soon and how to prevent?

Osteoarthritis is a progressive disease of the joints in which the cartilage which cushions the bones and absorbs the shock wears down, causing pain, stiffness and swelling around the knee joint, in over period we see a bone on bone phenomenon.

According to Indian data millions of patients are suffering from OA knee with a prevalence rate of 25 to 35% of which women are more common than men(C p PAL IJO 2016, 10.4103/0019-5413.189608)

Making it one of the most common arthritis in India, though it is age relegated but nearly 18to20% of arthritis is from injury to abjoint or posttraumatic arthritis and this is not only restricted to athletes layman and general public are also not spared the trauma of it which happens due to repetitive stress injury, over weight and genetics.

We need to understand that our knee is just not bone and cartilage but a complex structure formed of ligaments, soft tissue, tendons, nerves and fat and any event which can destabilize or injure any one of the structure can lead to early arthritis in the younger age group the main components which trigger these events are.

A. Injury to the ligaments

B. Injury or damage to the cartilage

C. Meniscal tear or tear of the labrum

D. early arthroscopy procedures in the young adults which increases risk of OA manifold.

Recent paper in Journal of Athletics Training highlights how small injures to the joints can get blown up into full arthritis over the period, eg a small rent in cartilage or meniscus can lead to bone swelling and can in turn put more pressure on the spot leading to multiple rents in cartilage and end up damaging the surrounding ligaments and joint structure, the single biggest issue which we can fix and can prevent early arthritis in knee is instability, which is easily diagnosed on dynamic use scanning and education of few points.

The person suffering from popping sensation and cracking in knee sounds but no pain is a potential arthritic patient in long run and should be evaluated by a regenerative and musculoskeletal physician who understands instability of joints better.

We see a lot of patients with these instability issue and opt for stress mask USG to identify the instability and the loose ligaments, if you had some knee injury in recent times and suffering from such issues we opt for PRP for ligaments to strengthen and tighten the ligaments and cartilage to provide better stability to the joint in order to prevent OA later stages.