Dislocations, sprains, ligament ruptures: symptoms, treatment, operations

Muscle strain | Symptoms of sprains

Muscle strain can occur with sudden movements, with excessive physical exertion on unheated, undeveloped muscles. When stretched, damage to the muscle fiber structure occurs, which can be accompanied by swelling and hematomas.

Pain when moving and walking, limited mobility, limping are common signs of sprains not only of the ankle.

Muscle strain | Treatment

Muscle strain is a fairly common injury. An unpleasant situation that leads to injury can happen to a person of any age, and not only during dancing and sports, but also simply in everyday life. That is why everyone needs to know the tactics of treating muscle strains.

There are three main principles for treating muscle strains:

Cold
Fixation and support with a bandage
Peace

The remaining drugs are used as auxiliary therapy aimed at speedy muscle recovery and recovery of the patient.

What is a sprain

A sprain is a type of traumatic injury in which the integrity of the ligamentous apparatus of the joint is slightly impaired. This pathology is widespread throughout the world and has been observed in almost every person at least once in their life. If an injury occurs at least twice within six months, the injury is called chronic.

Unlike a tear, a sprain does not create two separate sections of the ligament. And also pain and swelling are much less pronounced.

Degree of damage

Classification of injury by degree:

First: about 20% of the ligament surface is damaged. Pain and swelling are mild and disappear within a few hours.
Second: 20 to 50% of the ligament is injured. A hematoma and massive accumulation of fluid form in the area of stretching. Symptoms go away after a few days.
Third: 50 to 80% of the ligament is damaged, but it is not considered to be torn. This degree is characterized by the formation of intense pain syndrome, as well as the inability to use a limb.

The degree of ligament sprain is determined by the size of its damage

First aid

Help with sprains involves applying ice and immobilizing the damaged joint. Further treatment should be carried out by a doctor.

Dry ice should be applied for 20 minutes. To immobilize the joint, it is necessary to apply a tight bandage, but for no more than 2 hours. You can apply cold on top for 20 minutes, this will reduce pain. Once 2-3 hours have passed, the cold compress can be repeated.

Only a specialist can determine the extent of the damage, so you must go to the emergency room.

If the pain does not go away, but, on the contrary, only intensifies, and the swelling and hematoma increase, then it is important to exclude the possibility of a fracture. It is impossible to visually distinguish a sprain from a fracture.

Main clinical manifestations of the disease

Immediately after receiving an injury, the patient complains of intense pain. It intensifies when trying to use the affected limb and subsides slightly at rest. After a few minutes, a hematoma begins to form in the area of injury, having a purple-bluish tint, the skin turns red and stretches. Due to inflammatory edema, the limb increases in size compared to a healthy one, as a result of which the patient experiences severe discomfort. The arm or leg becomes hot, and the overall body temperature may also rise as the body reacts to a stressful stimulus.

How to help a victim with a broken heel:

During his time working in the traumatology department, the author saw several cases where patients with a pronounced third-degree sprain calmly stepped on the injured limb without experiencing any discomfort. This was explained either by a rather high sensitivity threshold or by severe alcohol intoxication. That is why the absence of pain does not exclude the diagnosis of sprain.

Causes

Sprained joints and ligaments are more common in active people, but anyone can face this health problem. The recovery process is long, so it is better to take timely care of safe prevention methods and identify the factors that provoke this pathological process. The main causes of sprains may be the following:

careless movements, for example, twisting the foot, dislocating the shoulder, twisting the wrist;
professional, sports injuries, falls;
the patient is overweight;
chronic joint diseases;
uncomfortable shoes;
congenital anomalies of the musculoskeletal system;
professional sports.

Ankle dislocation: treatment
Ointment for sprained ligaments and muscles
Why do heels hurt: causes and treatment

First aid for an injured person

If you happen to be an accidental witness to an injury, do not be scared and lost again: competent actions will help to avoid the development of many unpleasant complications. The main thing to remember is that it is strictly forbidden to try to straighten a sprained ligament, and it is also recommended not to put any weight on the affected limb.

Working in the traumatology department, the author often encountered the consequences of incorrectly provided care. For a girl who sprained her ankle while walking in heels, eyewitnesses to the injury applied a tight pressure bandage, turning her foot in the other direction. This led to the development of serious swelling and severe pain, and the first-degree sprain almost turned into a rupture. The patient was examined by a doctor, she was given all the necessary manipulations, due to which complications were avoided. That is why it is so important to know how to behave in such a situation, and also to immediately call an ambulance.

Applying ice helps reduce swelling and pain

First aid algorithm:

Calm the victim. To do this, you can give him a few glasses of clean still water to drink.
Free the injured limb from clothing and shoes. This allows you to avoid tissue absorption with further development of edema.
If you have light painkillers (Ketorol, Diclofenac, Nise), offer them to the victim. Before doing this, you should find out if he has allergies.
Place ice or any other cold object on the sprained area. In this case, it is necessary to use a fabric lining so as not to provoke frostbite in the victim.
Elevate your limbs to improve blood circulation. To do this, you can use a roller made of clothing.

Signs of stretching

When sprained, almost all victims report pain. This is explained by the large number of nerve endings in the ligaments and blood vessels, which is why swelling also appears.

Pain and swelling are the first signs of a sprain, but there are other symptoms:

Formation of a bruise, hemorrhage in the tissue.
The damaged area swells.
Redness of the skin.
Motor activity is limited.
If you touch the injured area, you feel pain.
Increase in temperature (not always).
Hyperthermia at the site of injury.

The signs of a bruise and sprain are quite similar. In both cases, it sometimes happens that the victim does not feel pain in the first moments, so he continues to move on. But this is dangerous because the stretching only increases, since the mobility of the joint injures the tissue.

In addition to spraining, ligament rupture is possible, and this will require completely different help and treatment. In addition, the signs of a dislocation and signs of a sprain are also quite similar, so it is necessary to be able to distinguish them.

How is differential diagnosis of ligamentous sprain performed?

Most often, patients confuse a sprain with another common injury, which is also characterized by the presence of swelling, hematoma and impaired motor function - a fracture. To exclude this diagnosis, the victim immediately after he is admitted to the hospital is given an x-ray of the affected limb. In case of a fracture, you can see on the pictures a clear line separating the sections of the bone from each other, while in case of a sprain, only soft tissues suffer, which are not visible with this method of examination. To confirm the diagnosis, doctors use ultrasound diagnostics - studying the joint cavity and ligamentous apparatus using waves that are reflected from tissues of different lengths and create an image on the screen. In this way, inflammatory edema and heterogeneity of the ligament itself can be detected.

An ultrasound can confirm the diagnosis of a sprain.

Diagnostics

To make a diagnosis, the doctor collects a medical history of the injury, sees typical signs of a joint sprain, and prescribes instrumental examinations. X-rays are taken to differentiate different types of injuries.

In order to differentiate different types of injuries, patients with sprains are prescribed x-rays.

When pressing on the damaged area, pain is noted. The doctor sees swelling without deformation of the joint.

Grade 1 damage is determined by mild pain, minimal swelling and edema. A grade 2 sprain will be characterized by limited joint movement, the appearance of a hematoma, and swelling. At grade 3, severe pain, swelling and bruising are noted, while the joint is pathologically mobile.

Treatment of various degrees of sprains

If such an injury occurs, you should immediately go to the hospital. Despite the fact that the initial degree of sprain can be treated at home, doctors strongly recommend clarifying the diagnosis. All methods are divided into conservative (pharmaceuticals, physiotherapy, proper nutrition, massage and therapeutic physical education), as well as operative (restoring tissue integrity).

During the period of therapy and rehabilitation, it is imperative to abandon active loads. At the same time, it is forbidden to walk, swim, or train in the gym until the damaged limb is completely restored.

Drug therapy for sprains

The following remedies are used to treat injury:

Local anti-inflammatory drugs in the form of ointments, solutions and gels, which help relieve swelling of soft tissues, are applied at least twice a day. The most famous include: Dimexide, Menovazin, Voltaren, Fastum gel, Finalgon, Capsicum. To reduce the size of the hematoma, Heparin ointment and Troxevasin are used.
Injections of Diclofenac, Ketorolac, Tramal, Tramadol, Ibuprofen and Ketotifen, which eliminate inflammation and relieve pain in the area of injury. Thanks to precise injection into soft tissues, they begin to act much faster than ointments.
Painkillers that help relieve discomfort and block the conduction of nerve impulses from the area of injury to the brain.
Calcium preparations and vitamins from group B, which improve regeneration processes. These products can reduce the healing time by several times.

Photo gallery: pharmaceuticals used for sprains

Fastum gel relieves inflammatory tissue swelling, having a local effect

Troxevasin reduces the severity of hematoma several times

Ketorol has a pronounced analgesic effect

Surgical treatment of the injury

If conservative therapy does not bring the expected results within two to three weeks, doctors decide on the need for surgical intervention. Most often, this situation occurs with a third degree sprain, when most of the ligamentous apparatus is damaged.

In elderly people, regeneration processes may be slightly slower, their duration exceeds three weeks. This should be taken into account when prescribing a patient for surgery.

The main contraindications to surgical treatment of the disease are:

terminal conditions (liver and kidney failure, recent stroke, coma, heart attack);
allergies to anesthetic drugs;
underwent abdominal surgery less than three months ago;
age over 95 years;
alcohol or drug intoxication.

Surgery is performed under general or spinal anesthesia. The doctor sequentially cuts through the skin, fatty tissue and muscles with a scalpel, exposing the joint. Next, he finds the damaged areas of the ligament and, using special strong threads, sews them together to prevent further tears. A cast is applied to the injured limb, which must be worn for two to five weeks.

After connecting the ends of the damaged ligament, their healing occurs faster

Folk remedies as auxiliary techniques

For those who prefer to fight sprains at home, there are long-tested natural recipes. However, do not forget that their use is permissible only during the first stage of sprains, since such injuries can heal without medical help.

The advantages of traditional therapy include:

Photo gallery: folk remedies for sprains

Iodine mesh reduces inflammation

Plantain relieves soft tissue swelling

Burdock promotes better damage regeneration

Physiotherapy

Physiotherapy helps reduce swelling and pain, promotes rapid resorption of hematoma, accelerates the tissue healing process, and restores the tone of skeletal muscles.

Physiotherapy can begin no earlier than on the third day from the moment of injury. This is due to the fact that during the first three days, a hematoma forms in the area of injury, so procedures that improve peripheral blood flow can cause the bruise to increase in size.

Table: physiotherapy in the treatment of illness

Name of the technique	The essence of the procedure	Main effects
Paraffin therapy	Hot wax applications are applied to the area of injury	Heat generation, stimulation of metabolic processes and regeneration of damaged ligaments
UHF therapy	Using currents of varying frequencies and strengths to stimulate the stretch zone	Electric current helps to dilate blood vessels, thereby improving nutrition of soft tissues
Magnetotherapy	The influence of magnetic fields on the human body	Relieving swelling, reducing the severity of pain and muscle spasms
Darsonval	Impact on the skin using alternating current	Preventing the occurrence of various scars and contractures

Photo gallery: physiotherapy for sprains

Paraffin therapy improves regeneration

UHF therapy improves blood circulation in tissues

Magnetic therapy for sprains reduces pain

Massage and physical therapy for recovery

After prolonged inactivity, muscles and ligaments need regular training and stimulation. A well-chosen massage will help improve blood flow in the damaged area and also restore your limb to its former sensitivity. Doctors recommend visiting a specialist or regularly going to the clinic, but if you do not have such an opportunity, the procedure can be easily carried out at home.

How to help a victim with various injuries:

Before starting the massage, be sure to warm your hands, remove long manicures, remove rings and bracelets so as not to damage the skin. Using movements from the fingertips to the base of the joint, begin to rub the limb until it becomes warmer. After this, you can move on to patting and pinching, which stimulate blood flow to the damaged area. The duration of the procedure should not exceed ten to fifteen minutes.

Video: massage of the wrist joint

Stretching exercises

Therapeutic gymnastics, in turn, prevents muscle atrophy and the formation of various contractures that impair the physiological mobility of the limb. It is necessary to practice every day for several months to achieve optimal results. However, do not forget that if sharp unpleasant sensations appear, it is better to stop physical activity so as not to cause yourself a more serious injury.

What exercises can you use:

Carefully perform flexion and extension movements of the limb. If you cannot perform this movement due to pain or resistance, you should help yourself with your healthy arm or leg. The exercise must be repeated at least twice.
When spraining the wrist joint, use a special expander or a small elastic ball. By squeezing it several times in a row, you will feel the limb begin to tense. The number of repetitions is from ten to twenty-five.
From a sitting position on a gymnastic mat, extend both legs forward. Next, try to reach your fingertips with your palms. This exercise allows you to stretch the shoulder, elbow and knee joints at the same time. This must be repeated at least ten times.

Video: Exercises for Ankle Sprains

Recommendations for proper nutrition

After an injury, it is necessary to provide the body with building materials: proteins, fats and carbohydrates are involved in the formation of new cells and tissues. This is why it is so important to properly organize the diet of a patient with a sprain. During the period of treatment and recovery, doctors advise dividing all food into six doses, and the weight of one serving should not exceed three hundred grams. You should not raise your caloric intake to more than 4000: this may contribute to excess weight gain. All dishes should be served boiled, baked or stewed; you can fry them in a small amount of olive oil.

If you do not consume meat and dairy products, as well as any animal proteins, you must make sure that your diet includes the replenishment of all useful micro- and macroelements. To do this, you can purchase the necessary products at the pharmacy.

What foods should you exclude from your diet:

glazed cheese curds;
homemade pickles;
chips, crackers, snacks;
sausage and sausages;
noodles, porridge, instant puree;
store-bought sweets: chocolate, marmalade, marshmallows, marshmallows, waffles, various pastries with rich cream;
fast food and semi-finished products;
mayonnaise;
carbonated drinks;
packaged juices;
energy;
coffee.

Photo gallery: junk food

Energy drinks slow down your metabolism

Fast food is a source of trans fats and fast carbohydrates

Chips contain a lot of salt

Healthy foods

What you need to eat every day:

fresh vegetables and fruits;
berries;
porridge and various cereals;
lean meat and fish;
seafood (lobster, mussels, shrimp);
milk;
cottage cheese and yogurt without additives;
kefir, fermented baked milk, snowball, bifidok;
durum pasta;
homemade fruit drinks and freshly squeezed juices;
peas and legumes (chickpeas, lentils).

Photo gallery: food healthy for the body

Vegetables and fruits are rich in vitamins

Cottage cheese contains a lot of calcium

Meat is the best source of animal protein

Strengthening muscles after injury

Collagen Ultra for the treatment of sprains
When stretching muscles, treatment with traditional methods is effective in combination with taking Collagen Ultra, which has a targeted effect on muscle and connective tissue. By using a product with collagen together with local treatment with folk remedies, we achieve an effect on the damaged muscle both from the inside and outside, which ultimately leads to its rapid recovery - strengthening its structure and restoring elasticity.

PURCHASE COLLAGEN ULTRA FOR THE FULL COURSE OF TREATMENT >>

In 48 hours

muscle strain, the treatment of which was complete and adequate in the first day after injury, is significantly reduced. You can already apply light loads on the damaged muscles, perform smooth and gentle physical exercises in order to stretch them. It is useful to carry out physical exercises during hot baths - this will increase blood flow to the damaged muscle and speed up its recovery.

After an injury, small but regular exercise is necessary. If the muscle of the lower limb is damaged, you can slowly load the sore leg using walking with a cane. It is recommended to wear an elastic bandage during physical activity.

In the next 2 days

After an injury, it is possible to use physiotherapeutic treatment methods. Treatment of sprains is usually carried out using electrical myostimulation, acupuncture and other methods.

Treatment for sprains can last from 1 to 6 weeks. The most effective is an integrated approach using methods of official and traditional medicine.

Predictions and consequences of sprains

Like any other injury, this illness requires some time to heal. In the first degree of damage, the ligaments are restored within two to five days, while the second degree can take a person out of the usual rhythm of life for up to four weeks. In stage three sprains, regeneration takes two to six months. Do not forget that the older a person is, the slower the restoration of soft tissues occurs. This is directly related to inhibited metabolic processes and lower collagen content in the body. Also, during infectious diseases, the body spends most of its energy fighting the microbe: as a result, the ligaments are restored more slowly than in a healthy person.

It is especially important not to put weight on the affected limb during the rehabilitation period. In his practice, the author of the article encountered a patient who suffered an ankle sprain a week before an important competition. Doctors strictly forbade him to train and lean on his injured leg. However, the young man did not wait for the soft tissues to recover and began active physical activity. Unfortunately, while he was doing running exercises, the injury worsened: instead of spraining the ankle ligaments, a tear developed. As a result, the patient was urgently taken by emergency medical services to the traumatology department and operated on, and a plaster cast was placed on his leg. The athlete not only missed important competitions, but was also suspended from subsequent training for four months.

Possible complications of sprains:

Attachment of infection and development of inflammatory and purulent changes in soft tissues. Due to the weakness of the immune system during the recovery period, the body is especially vulnerable: even a recent cold or tooth decay can become a source of serious problems. Cellulitis and abscess are accumulations of purulent masses in the area of the joint and ligamentous apparatus, which impair the functions of the limb. Treatment is carried out only by opening it in a hospital. The patient will also need to take antibiotics for a long time.
Formation of contracture. At the site of a sprain, if the distance between the areas of the damaged area is quite large, connective tissue grows. It forms dense and elastic cords that deform the affected limb, as a result of which it cannot bend or straighten normally. Most often, this pathology develops with chronic sprain of the ligamentous apparatus. The only way to eliminate the problem once and for all is an operation during which the scar is excised.
Atrophy of muscle tissue in the damaged area. If a person constantly takes care of the injured limb and tries in every possible way to reduce the load on it even after a long period after the injury has healed, this leads to thinning and weakening of the muscles. An arm or leg can lose weight and significantly decrease in volume, which creates not only an external cosmetic defect, but also brings a huge amount of inconvenience in everyday life. To restore muscle mass, you need to eat right and exercise regularly.
Loss or decrease in tissue sensitivity. When an injury occurs, the neurovascular bundles located in the same area are often affected. As a result of this, a person feels the effect of pain, cold or any other stimulus much weaker. Treatment is carried out with physiotherapy or surgery.

Photo gallery: complications of sprains

Muscle atrophy may occur after a sprain

Phlegmon of the lower leg is a consequence of infection entering the injury area

Contracture of the fingers often occurs after a sprain of the wrist joint.

First aid for sprains

In order for the restoration of ligaments to be successful and as quickly as possible, it is important to follow a certain algorithm of actions immediately after the injury. For pain relief, NSAIDs are taken, the damaged joint is tightly bandaged, and a cold compress is applied to it.

Applying a tight bandage for sprains

Measures necessary for sprained ligaments:

ensuring rest of the sore limb before visiting a doctor, because a sprain may turn out to be a fracture;
applying a tight bandage using improvised means, these can be bandages, a headscarf, a scarf, or any item of clothing;
if the joint is too mobile, a splint should be applied, because then the likelihood of its rupture increases;
exposure to cold - a cold compress should be applied as soon as possible, using ice, food from the freezer;
taking a painkiller tablet - to alleviate the condition, it is recommended to take one tablet of a non-steroidal anti-inflammatory drug - Ibuprofen, Nurofen, Diclofenac, Nise;
transportation to the hospital - the victim needs to be taken to the hospital as quickly as possible, then the doctor will select treatment that will be carried out at home.

Until the signs of sprain subside, you will need to use local ointments, compresses, and observe a gentle regimen of physical activity. During the recovery period, you will need to do exercises to develop the joint; the doctor may also prescribe physiotherapeutic procedures and massage.

Meniscal tears

The menisci of the knee (internal and external) are a kind of cartilage pads between the bones that protect the articular cartilage and ensure smooth movements when walking.

A meniscus tear is damage to the cartilage formation, which is accompanied by injury to the structures of the knee joint. Injuries such as cruciate ligament injury and rupture of the collateral ligaments (the lateral ligaments of the knee) often occur simultaneously with a meniscus tear. Meniscal tears are common among athletes, especially representatives of contact sports.

The second reason for damage to the meniscus of the knee joint is degenerative disorders in cartilaginous formations. If the meniscus is damaged, the function of the entire joint deteriorates, pain, swelling, cracking and popping appear when bending the knee.

Dislocation

Quite often, joint dislocations are accompanied not only by rupture of ligaments and joint capsule, but also by damage to the skin, nerves and blood vessels. In 9 cases out of 10, the cause of dislocations is injury (fall, etc.) or sudden, careless movements. Thus, a sharp yawn or cry can provoke dislocation of the lower jaw.

The following groups of joint dislocations are distinguished:

Congenital dislocations, among which the leading ones are dislocations in the hip joint (usually bilateral). This pathology is detected in early childhood - when the child first attempts to walk, lameness and a specific “duck” gait are observed.
Acquired dislocations, which can be pathological (when pathological changes appear in the bones) and traumatic. Traumatic dislocations of joints occur due to insufficient strength of the ligamentous apparatus or discrepancy in the size of the articular surfaces.

We suggest you read: What does MRI of the cervical spine and neck vessels show?

First aid for a dislocation: under no circumstances try to straighten the joint yourself, this will increase the pain and aggravate the problem! Only a doctor can provide qualified treatment for a dislocation. Before the doctor arrives, you need to immobilize the injured limb using a splint and other available means. You can apply ice or a cold compress to your knee to relieve swelling and relieve pain.

Treatment for a sprain depends on the extent of the injury. As first aid, apply a cold compress and bandage the joint tightly.

If the ligaments are torn, surgical intervention is performed to stitch them together and a rehabilitation course is prescribed, consisting of physiotherapy and massage. Exercise therapy for dislocations and other injuries is carried out as prescribed by a doctor.

For a meniscus tear, treatment can be conservative or surgical. For significant meniscus tears that have caused significant limitation of joint mobility, meniscus surgery is performed (partial meniscal removal, miniscectomy, or meniscal transplantation).

If you are injured, we suggest you contact a paid 24-hour emergency room at the MedicCity clinic, equipped with all the necessary equipment (MRI, X-ray, etc.) for diagnosis and treatment. Highly qualified orthopedic traumatologists will provide professional assistance for any type of injury.

Treatment

With symptoms of a sprain, such as pain and limited mobility in the joint, fluid begins to accumulate in the tissues. This causes the injury site to swell and cause severe pain when touched or moved. Only a traumatologist can determine how damaged the limb is. In addition to the examination, he will definitely suggest an x-ray examination. After receiving the results, the doctor will prescribe the correct treatment.

The entire period of therapy can be divided into two main stages:

Acute period . Its duration ranges from one to two weeks, depending on the severity of the injury. For this period, the main principle of treatment should be immobilization. The damaged joint must be kept immobilized. For this purpose, a rigid bandage, splint or special orthopedic prosthesis is used. The injured area should be numbed. In the first hours after injury, it is recommended to apply ice. This manipulation will alleviate the patient’s condition. If edema is present, iontophoresis with anti-inflammatory drugs is prescribed. After the swelling and inflammation have been removed, it will be useful to undergo heat treatment using paraffin and ozokerite to normalize blood circulation. It is very important to maintain good microcirculation in and around damaged tissues. In some cases, the doctor prescribes radon baths. Such procedures will improve nutrition of muscles and joints and normalize metabolism. As soon as the patient’s condition begins to improve, he is prescribed massage and physical therapy exercises. This will make it possible to develop the damaged limb.
Recovery period . Its main task is to relax the muscles. The patient is asked to undergo electrical and thermal procedures. During this period, therapeutic massage will be useful. The patient is also offered to perform various exercises on special simulators. To strengthen muscles, it is recommended to go to the pool. Swimming will help the patient recover faster. The therapeutic effect can be enhanced if the pool is filled with brine water. This substance has anti-inflammatory and analgesic effects. With its help, you can improve not only blood circulation, but also metabolism in tissues.

It should be remembered that the following things should not be done in the first hours after injury:

take a hot bath;
rub the damaged area intensively;
Do massage.

Such manipulations can increase the development of edema and inflammation. If a crunch occurs in the joint and severe pain, you should immediately contact a traumatologist. Pain can be relieved with painkillers and anti-inflammatory drugs.

Using ointments on the injury site will also help relieve sprain symptoms such as swelling and pain. The following tools are suitable for this purpose:

Diclofenac;
Deep Relief;
Ibuprofen.

For mild and moderate swelling, it is recommended to use such means as:

Tpaymel;
Arnigel.

In any case, you should not self-medicate. The specialist will prescribe appropriate drug treatment, since only a doctor knows what a sprain is and how to treat it correctly. If a complete rupture of the ligament occurs, surgical treatment may be prescribed. With severe injuries, ligaments cannot always fully recover on their own.

Massage for sprains and torn ligaments (with video)

As already mentioned, a sprain is an injury that involves displacement and disruption of the integrity of the joints.

The places of attachment of ligaments, the tissue surrounding the joint, the synovial membrane of the joints, tendons, cartilage, muscles, blood vessels and nerves can be injured.

A sprain is usually accompanied by severe pain when moving, swelling in the injured area, and inflammation of the joints.

Massage for the treatment of sprained or torn ligaments, performed at home, helps reduce pain, improve blood and lymph flow in the area of the injured area, and restore normal motor activity of the joint.

We should not forget that you can start performing massage techniques only 24 hours after the injury. It is recommended to pre-warm up.

Before starting to massage the damaged area, it is recommended to massage the upper areas. For example, in case of injury to the ligamentous apparatus of the ankle joint, the lower leg is massaged, and in case of sprain of the knee joint, the thigh is massaged. In case of damage to the wrist joint, it is necessary to massage the forearm.

For sprained ligaments, it is recommended to carry out a preparatory massage 1-2 times a week. The procedure should not exceed 5-10 minutes. After this, the main massage begins. The time for massage of the injured area should be gradually increased (up to about 15 minutes).

When conducting a preparatory massage session, it is recommended to perform the following techniques:

Straight-line stroking.
Beak-shaped squeezing with the elbow part.
Circular kneading with the pads of four fingers. The techniques are repeated 4–5 times.

After the preparatory work, the main part of the massage begins, which includes:

Concentric stroking.
Trituration:

gimp-shaped rectilinear;
pincer-shaped spiral.

Stroking.
Beak-shaped rubbing, first with one hand and then with the other.
Stroking on the shin.
Calf Squeeze.
Concentric stroking on the ankle joint.
Rubbing on the ankle joint:

straight “tongs”;
spiral “forceps”.

Concentric stroking on the ankle joint. The techniques are performed 3–4 times.

If the patient experiences pain in the injured area, massage is not recommended.

Here you can watch a video of massage for sprains and torn ligaments:

Prevention

To prevent recurrent ankle sprains, it is important to strengthen the calf muscles. After an injury, it is recommended to pay attention to the shoes that you wear daily. If it is uncomfortable, has high heels or does not fit in size, you should change it, giving preference to orthopedic models.

It is also important to control body weight, and if before the ligament damage it exceeded the norm, it is important to bring the weight back to normal during and after treatment. This is easy to do with proper nutrition, regular exercise and an active lifestyle. If you dose the load on the lower extremities and avoid severe injuries and bruises, you will be able to prevent re-straining or rupture of the ankle ligaments.

Symptoms

The most common sign of a sprain is intense pain in the injured joint that occurs immediately after the injury. Sometimes the victim continues to move further, thereby further injuring the ligaments. After a certain time, swelling and hemorrhage appear at the site of injury. The pain becomes more severe and limited movement appears in the affected joint. A complete rupture of the ligament, on the contrary, is manifested by increased joint mobility.

1 degree stretch

In mild cases, the tendons are partially torn. Minor pain does not limit joint mobility. The swelling is mild. A gentle regimen and temporary rest are required.

Grade 2 sprain

The second degree of severity is characterized by moderate stretching and rupture of fibers. Sometimes the capsule may become damaged. The pain syndrome is severe, tissue swelling and hemorrhages appear, localized under the skin in the area of injury. Movements are sharply painful, and sometimes pathological joint mobility occurs.

3 degree stretch

Characterized by complete rupture of the tendons. The victim observes severe swelling and hyperemia in the area of injury. The hemorrhages are extensive, and joint instability is observed. There is no resistance when performing diagnostic tests. Such ligament injuries require surgical intervention, during which an orthopedic specialist stitches the torn ligaments. The recovery period from such an injury can take about 6 months.

Quite often, sprained ligaments lead to the formation of nodules at the site of tear or complete rupture of the fibers. These formations subsequently rub against neighboring tissues and provoke the development of a chronic inflammatory process in the joint, the appearance of constant, aching pain.

If a nerve rupture occurs, which occurs when the ligament is partially or completely damaged, a tingling sensation in the joint and constant pain appears. In addition, due to severe pain, vascular spasm, impaired blood circulation in the tissues and the appearance of degenerative phenomena in them are possible.

Many victims, having received an injury, do not know what to do if they sprain their ligaments and are in no hurry to seek help from a doctor, which is extremely undesirable to do. It is better to play it safe and be examined by a specialist to rule out certain joint and tendon injuries that can make physical activity problematic in the future.

But there are symptoms of a sprain that you should immediately consult a doctor if you notice:

Very severe pain, which makes it impossible to walk and perform movements in the joint.
Feeling of numbness in the area of the damaged joint or affected limb.
Extensive redness and bruising at the site of injury.
The joint becomes inactive or, conversely, mobility against the background of pain is pronounced.
A characteristic crunch and sharp, piercing pain appear in the affected joint.
A febrile syndrome is possible - chills, increased body temperature.
There are no signs of improvement several days after the injury occurred.

Important! The prognosis and consequences after a sprain depend on the severity of the injury, how effectively and quickly first aid was provided, and the scope of further therapy and rehabilitation measures.

Having received an injury, the victim will wonder what to do if the injury is sprained. Treatment of this pathology of any localization is divided into three stages:

First aid.
The main therapy is conservative, surgical or folk.
Rehabilitation.

Providing first aid for bruises and sprains: first measures and mistakes

If a person is injured, first aid should be provided immediately. The further recovery of the victim depends on how correct and fast the manipulations are performed.

The simplest and most effective first aid measures for sprains are:

Apply a tight bandage to the injured area; an elastic bandage, a regular bandage or a wide strip of fabric is suitable for this. When providing first aid for sprained ligaments, the bandage should be applied with slight tension so that the injured limb is well fixed, but blood circulation is not impaired. Apply the bandage so that the first turn of the bandage is not tight and passes through the joint itself, and the next layers of the bandage are placed alternately above and below the damaged joint, gradually diverging from it to the sides.
To provide first aid for bruises and sprains, you need to apply ice to the injured area and hold it for at least 1 hour. Keep the ice on the injury site for 1 - 2 minutes, then remove it and apply it again after a short period of time.
The affected limb must be placed in an elevated position.
The victim should not move the injured limb or step on the injured leg.

When providing first aid for a torn ligament, the following mistakes should not be made:

do not rub or massage the injured area;
Do not apply heat to the sprained area.

At the slightest suspicion of a dislocation or fracture, apply a splint to the injured limb.

If the limb on which the pressure bandage is applied turns pale or begins to take on a bluish color, it means that the bandage is applied too tightly. Bandage the limb.

After assisting with a sprained or torn ligament during transportation, it is advisable to create resting conditions and an elevated position for the damaged area (joint). The victim should not move independently, putting weight on the leg (in case of injury to the ligaments of the joints of the lower limb), as this can cause additional trauma.

The algorithm for providing first aid for a ruptured or sprained ligament is shown in this video:

What is stretching?

For people who lead an active lifestyle, such an injury is not uncommon. All it takes is one wrong move and the sprain limits your mobility. Human ligaments, despite their strength, are still capable of stretching and being damaged under load.

A sprain is an injury in which the connective tissue fibers that make up the ligaments are torn. Since they contain a large number of nerve endings and blood vessels, signs of stretching will almost immediately appear in the form of pain and swelling. Damage to the ligaments can be of varying degrees, the most serious being complete rupture.

The severity also depends on the number of fibers affected. Any sudden movements or heavy load can lead to signs of a joint sprain. Such injuries are not uncommon in children, athletes and those who prefer to lead an active lifestyle.

Classification by location of injury

When you sprain your leg, you need to determine the area where the injury is located. Typically, single and combined injuries appear in the ankle and knee joints.

However, there are other locations where ligament sprains can occur from exposure to various traumatic factors. There are 6 areas in total where tissue damage can occur:

foot. In this area, sprains of ligaments and tendons can occur due to increased stress on the compound. With this injury, limited motor functions are noted;
ankle (ankle). This area consists of a complex articulation of the bones of the lower leg and foot. Tendon and ligament sprains may occur simultaneously in this area;
knee. Muscle and ligament sprains often occur in the knee joint area. If they are damaged, the joint may lose stability;
hip. In this area, the internal muscle tissue is especially vulnerable; its ruptures occur quite often. Also sometimes sprains occur in this area;
buttocks. In this area, stretching of muscle and ligament tissue fibers may occur. But tendons are less susceptible to negative effects.

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First aid for injury

The cause of a sprained or ruptured joint ligament is always an injury, bruise, fall, careless movement or physical activity. Usually the patient knows when it occurred, since he feels acute pain at the time of tissue damage.

Treatment should begin immediately, without waiting for an ambulance to arrive or the patient to be taken to the emergency room.

How can you alleviate the condition immediately after injury?

Ensure complete rest. There is no need to move or move the affected limb to check how functional it is and where exactly it hurts - the doctor will do this later. By loading an arm or leg after an injury, you can aggravate the tear, turning it from partial to complete. Therefore, it is recommended to sit or lay the patient comfortably, to protect him from possible mechanical influences from the outside (for example, in public transport or a crowd).
Apply a pressure bandage. Ideally, use an elastic bandage, but if you don’t have one, a scarf, handkerchief, regular bandage, or towel will do. Such an improvised splint will not only additionally secure the injured joint, but will also prevent the formation of swelling and hemorrhage. At the same time, it is important not to completely compress large blood vessels - this will lead to blood stagnation and undesirable consequences.
Apply cold. If you don't have a heating pad with ice, you can use snow or cold water. The compress is applied for 15 minutes, then the procedure is repeated every 1-2 hours. Such measures also effectively and quickly relieve swelling, prevent hematoma, and can reduce pain. If there is a special spray or gel with a cooling effect, you can use that.
Reduce blood flow. Pain, swelling, and inflammation will be significantly lower if you ensure good blood flow from the affected limb. To do this, it needs to be raised above the level of the body. For this purpose, it is enough to place a bolster, a pillow, or a rolled-up jacket under your arm or leg.
Take painkillers. If the pain is very severe, you can take any analgesics before the ambulance arrives. For injuries such as sprains or torn ligaments, ibuprofen is recommended - it works exactly where you need it, quickly and safely.

Some patients (and there are many of them) are convinced that without doctors they know perfectly well how to treat a sprain, and begin active self-medication. Most often, after a few days they still have to consult a traumatologist, as complications of varying degrees appear.

What should not be done if there is a suspicion of connective tissue rupture?

In the first three days after the injury, warm the limb, apply a heating pad, make warm baths, warm compresses - this can cause purulent inflammation and the spread of infection;
Playing sports or lifting weights, doing any work related to physical activity - this can provoke a complete rupture of the ligaments, and this can only be treated surgically;
Massaging and rubbing the joint - this can also aggravate the condition of damaged tissues and cause hemorrhage and pain;
Drinking alcohol will temporarily eliminate the pain, at least the patient will not feel it. But in fact, the vessels dilate, blood flow accelerates, and after a few hours the condition will worsen.

A sprain can be quickly cured only with the comprehensive assistance of the doctor and the patient. At home, it will never be possible to carry out an accurate diagnosis and select the optimal medication and physiotherapeutic treatment.

Relying in this case only on folk remedies means voluntarily delaying the moment of recovery.

How to treat damaged ligaments with medications

Drug therapy is a mandatory element in the complex treatment of sprained or torn ligaments, no matter whether it is carried out in a hospital or at home. The following medications are usually prescribed:

Drugs from the group of non-steroidal anti-inflammatory drugs for internal use. These are diclofenac, ibuprofen, meloxicam, indomethacin. The tablets quickly relieve pain and swelling, stop inflammation. In mild cases, a 7-day course of treatment is sufficient; in case of complications, the duration of the course should not exceed 14 days in order to avoid disruption of the gastrointestinal tract.
Local anesthetics - lidocaine, novocaine, bupivacaine. These products are offered at the pharmacy in the form of a spray, which is convenient to apply directly to the affected joint. If the pain is very severe, the joint is injected with anesthetics from all sides - this procedure quickly eliminates even very intense, ongoing pain.
Warming ointments with extracts of bee venom, hot red pepper, ointment for joints with snake venom. These drugs increase blood flow and promote tissue repair; they are used when the acute period has passed and the inflammation has stopped. Such drugs are prescribed with great caution, as they often cause allergies in the patient.
Absorbable gels and ointments. For example, troxevasin helps to quickly get rid of unsightly hematomas and bruises, helps soften compactions and blood clots. But such remedies can only be used if the bleeding has completely stopped and the tissue has begun to recover. For open wounds and abrasions, absorbable drugs are also not used.

All of these methods refer to conservative treatment, which gives results for mild sprains or ruptures of ligaments.

In case of complete rupture of the ligaments, treatment is carried out only by surgery.

Surgery for torn ligaments

The operation is indicated for professional athletes with complete or extensive ligament rupture. If it was not performed in the first week after the injury, then the operation is performed no earlier than six weeks later.

This is explained by the fact that during this period a large amount of fluid and blood accumulates in the joint cavity, which will interfere with the operation and increase the risk of infection.

Which type of operation will be chosen and how the damaged tissues will be accessed depends on the type and location of the injury. If the damage allows, the ligamentous tissues are sutured; in severe cases, auto- or allotransplantation is performed.

For transplantation, the patient's ligaments from another organ, for example, the patella, are often used. In modern surgery today, a method such as arthroscopy is almost always used.

That is, extensive tissue dissection is not required to gain access to the ligaments. In this case, the rehabilitation period is significantly reduced.

Recovery period

The rehabilitation course of treatment allows you to quickly restore functionality to the ligaments and mobility to the patient, regardless of whether surgical or conservative treatment was performed. Three methods are used:

Physiotherapy;
Massage;
Physiotherapeutic procedures.

They should be used from the first days of treatment, gradually increasing the intensity and load. A sign that the load is too high at this stage is pain. If they occur during exercise, the rehabilitation program needs to be adjusted.

Gymnastics, massage, and various warm-ups can be performed at home if for some reason it is inconvenient for the patient to visit a clinic or day hospital. But medical supervision is still necessary.

In the case of serious injuries - for example, complete rupture of ligaments in professional athletes - it makes sense to undergo a rehabilitation course of treatment in a specialized medical institution.

Treatment with folk remedies

It’s worth warning right away that this type of injury cannot be quickly cured using folk remedies alone. Alternative medicine recipes are effective and safe only in case of minor injuries - they mainly help relieve swelling and pain.

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You can also use folk remedies during the recovery period to resolve hematomas and restore limb mobility. The following recipe is recommended:

Mix three tablespoons of medicinal clay, a spoonful of sugar, one grated potato tuber and half an onion. Apply as a compress several times a day until symptoms disappear.

Forecast

An ankle sprain usually has a very good prognosis. With proper treatment, most patients are able to resume their normal activities within a fairly short period of time - after 2-4 weeks.

It is important to note that the success of treatment depends on compliance with all doctor’s recommendations and on careful implementation of exercise therapy exercises.

The most important cause of chronic ankle instability after a sprain is inadequate rehabilitation.

If you don't exercise, damaged ligaments become weaker, increasing your risk of another sprain.

Classification

Since the entire human body consists of muscles and joints, the disease differs in location and types of damage:

Foot sprain. This pathology has a second name - ankle sprain, and is one of the common diseases that arise from the slightest sudden movement. Can qualify according to three degrees of severity:
Mild degree - characterized by minor pain, swelling is absent or invisible.
Moderate severity - the pain syndrome is more intense, swelling and bruising are pronounced, no deformation of the leg is observed. Signs of a sprain decrease after a few days of not walking.
Severe degree – the pain is severe, throbbing, there are disorders in the joint. Therapy is carried out only by a specialist.
Sprain of the ligaments holding the knee joint. This damage occurs due to a direct impact. Immediately at the moment of injury, a sharp pain occurs, which gradually calms down, and when you try to make any movements, it returns again. In addition, spraining is accompanied by swelling and problems with joint mobility.
Anterior sacral ligament sprain. This joint sprain occurs due to twisting of the hip and is most often suffered by football players. At the time of injury, the pain syndrome is severe, swelling gradually develops, which progresses without emergency assistance. The functioning of the joint apparatus is completely disrupted, movements are constrained and difficult to carry out.
Sprain of the acromioclavicular and sternoclavicular joints. This injury occurs after a fall on an outstretched arm or from a blow to the upper part of the shoulder. the damage is accompanied by intense pain, localized slightly above the site of the bruise, which is especially severe when trying to raise your arms. There is also hyperemia and increased sensitivity of the skin in the joint area. With severe trauma, deformation of the junction of two joints appears.
A shoulder sprain is caused by a fall on the shoulder.
Sprains of the hand. The wrist suffers most from this pathology. The injury is accompanied by pain and numbness. In adults, damage occurs due to injury, and in children, due to the insignificant density of the ligaments, a sprain can occur from a sharp jerk with the hand. Most often this happens when parents are in a hurry and forcefully pull their children along with them.
Damage to the neck ligaments is a rare pathology and occurs due to incorrect posture during sleep or a sharp turn of the head.

In addition, there is a classification according to the severity of the disease:

mild – it is characterized by rupture of joint fibers, motor function is not impaired, pain is tolerable;
medium - the fibers are damaged in several places, swelling appears, movements are limited and cause pain;
severe - ligament rupture, in which it is impossible to do anything with the injured limb, hemorrhages form under the skin.

The first two degrees can be treated at home using special warming ointments. The severe stage is treated only in a hospital setting; in some cases, surgical intervention is necessary. Diagnosis and treatment of sprains should be carried out by a specialist.

Traditional therapy

Folk remedies for sprains are allowed to be used only after consultation with a doctor. Treatment with these means involves the use of an alcohol compress and other lotions that activate regeneration processes, prevent inflammation, relieve swelling, and eliminate pain, which in turn will allow you to quickly restore joint function.

Effective recipes:

Raw potatoes should be grated and applied to the injured area. Use such applications several times a day.
The clay must be diluted to the consistency of sour cream, put the mixture in linen cloth and apply to the sore spot, bandage with an elastic bandage for several hours.
Ground aloe leaves are applied to injured ligaments and the limb is bandaged with a bandage. When the mixture heats up, it must be replaced with a new one.

All of the recipes listed are necessary for healing damage and stopping inflammatory processes.

Important! It should be borne in mind that traditional methods can be used only after examination. A doctor must evaluate the situation and determine how to treat the sprain. Traditional recipes can perfectly complement traditional medical methods, but they will not replace them completely.

When is surgery needed?

If the integrity of the ankle joint ligaments is damaged, the doctor decides to perform surgical treatment, during which the destroyed tissue is restored by stitching. The type of operation is determined by the doctor after diagnostic tests. Surgical therapy is carried out 1.5 months after the injury, because surgical manipulations immediately after the injury cause complications in the form of contractures. The surgeon sutures the damaged ligaments or sutures the end to the bone. If necessary, damaged tissue is removed.

What are the main symptoms of injury?

The clinical picture depends on where exactly the rupture occurred and what degree of severity it has. In total, there are 3 main degrees of severity, namely:

First degree: only part of the tendons is torn, while their mechanical integrity and continuity are preserved. Externally, it is difficult to determine the presence of swelling or swelling. The only thing that worries the patient is pain, but it is quite moderate. This type of sprain can be treated very quickly; 1-2 weeks are enough for a complete recovery. It is worth finding out from a specialist how to effectively treat a first-degree sprain.
The next level is a little more difficult. In this case, most of the ligaments are torn, and it is also possible that the capsules themselves may be torn. Movements are very constrained and accompanied by severe pain. Treatment lasts from 3 to 6 weeks.
The last degree is a complete rupture of the tendons. In this case, severe swelling occurs, subcutaneous bruising and instability in the functioning of the joint itself are possible. The pain is very pronounced, there is no resistance at all during the stress test. This type of sprain usually takes at least 6 weeks to heal. It is in this case that the possibility of independent healing is almost completely excluded, so the patient should definitely seek medical help.

Even with the most basic injury, it is better to consult a doctor who will determine the severity of the injury and tell you how to properly treat a sprain.

Sprain and rupture of knee ligaments

Knee sprains are the most common and mildest injury.

Clinic. Complaints of pain in the medial or lateral part of the joint, which arose acutely with forced extreme movement in the joint. A swelling appears at the site of damage, then a hematoma, gradually an effusion appears in the joint - its contours are smoothed out, the inversions protrude, pain is detected locally, active movements in the joint are limited.

If there are signs of sprain of the knee joint after first aid, treatment consists of immobilization with a plaster cast for 8-10 days in a position of slight flexion (170°) in the knee joint. During the period of immobilization, tonic muscle contraction is recommended, dosed exercise is allowed (prevention of atrophy). After cessation of immobilization, massage of the thigh muscles is prescribed. Working capacity is restored in 10-14 days.

A knee ligament rupture is a serious injury that causes instability of the knee joint.

Rupture of the tibial and peroneal collateral ligaments occurs at the moment of sharp abduction of the slightly bent tibia and its external rotation when the tibial ligament is damaged and adduction, internal rotation when the peroneal ligament is damaged. Often this type of injury is combined with damage to the menisci and anterior cruciate ligament. Ligaments are torn at the point of attachment or along their length.

Clinic. There is a history of characteristic trauma, pain and hematoma, hemarthrosis and reactive synovitis - smoothness of the contours of the joint, a symptom of “balloting” of the patella; pathological lateral mobility in the joint - increased deviation of the tibia outward or inward. If the meniscus of the knee joint is damaged, a “blockade” is possible; if the anterior cruciate ligament is damaged, a “drawer” symptom is possible. A rupture of the peroneal ligament may be accompanied by damage to the peroneal nerve. The severity of clinical signs of knee ligament rupture depends on the degree of damage to the ligament (partial or complete rupture).

Treatment. In case of incomplete rupture, the knee joint is immobilized with a circular plaster cast for 5-8 weeks. In case of severe hemarthrosis (synovitis), a joint puncture is performed, the contents are evacuated and a novocaine solution is administered. During the period of immobilization, dosed exercise is allowed, isotonic exercise therapy for the thigh muscles is prescribed. After the cessation of immobilization, active rehabilitation therapy is carried out - exercise therapy, massage, physiotherapy. Working capacity is restored 2-3 months after the injury.

If the ligament is completely torn, surgical treatment is indicated - suturing the ligament. If there is a rupture at the attachment site, the ligament is fixed to the condyles transosseously; if it is torn along its length, mattress sutures are applied. Immobilization is carried out with a plaster splint for 6-8 weeks. The son-in-law is undergoing rehabilitation treatment. Working capacity is restored 10-12 weeks after injury.

Rupture of the cruciate ligaments of the knee joint as an isolated injury is rare. More often, the anterior cruciate ligament is damaged in combination with injuries to the tibial collateral ligament. Ligament rupture can occur along the length, at the site of attachment and together with the bone plate.

Clinic. Patients note sharp pain in the joint, forced displacement of the lower leg, and sometimes a crunching sound. Severe hemarthrosis and synovitis, sometimes para-articular hemorrhage, are noted. Severe pain prevents the detection of pathological mobility. However, determining its presence and severity is extremely important for diagnosis and choice of treatment method. To relieve pain, a joint puncture is performed, blood and synovial fluid are evacuated, and 30-40 ml of a 1-2% novocaine solution is injected. After the onset of anesthesia, pathological mobility in the joint is determined: excessive mobility of the tibia bent at a right angle anteriorly (symptom of the “anterior drawer”), which is characteristic of damage to the anterior cruciate ligament, or posteriorly (symptom of the “posterior drawer”), which is characteristic of damage to the posterior cruciate ligament. Pathological lateral mobility of the lower leg is also determined.

Treatment. In case of sprains and partial ruptures of the cruciate ligaments, after first aid, the knee joint is immobilized with a splint at moderate flexion (160°) in the knee joint for a period of 8 weeks. In case of severe hemarthrosis (synovitis), the joint is punctured, the contents are evacuated and a 1% solution of novocaine 20-30 ml is administered. After cessation of immobilization, rehabilitation therapy is carried out. It is especially important to restore the strength and tone of the thigh muscles.

If the ligament (ligament) is completely torn, surgical treatment is indicated. It should be remembered that isolated ruptures are rare and during the operation it is necessary to eliminate all pathology (suturing the round ligaments, removing the damaged meniscus).

When the anterior cruciate ligament is ruptured in the proximal part, it is stitched with silk (nylon) threads, and the ligatures are removed through the bone canal in the lateral femoral condyle and fixed to the soft tissues. When it ruptures in the distal section, transosseous fixation is carried out on the internal condyle of the leg through the bone canal. In the joint cavity, the bone canals should exit to the site of attachment of the ligament. Access to the joint is parapatellar. Additional incisions are made in the condyles to create canals.

In case of rupture of the posterior cruciate ligament, the operation is performed from the posterior approach. When the proximal end of the ligament is torn off, it is sutured and the ligatures are removed through the bone canal in the medial condyle of the femur; when the distal end is torn off, the ligatures are removed through the bone canal in the tibia, running from back to front and downwards. When a ligament with bone plates is torn off, the latter is fixed with a screw and a transosseous suture. After surgery, a plaster splint is applied with the tibia flexed at an angle of 160° for 6-8 weeks. Subsequently, restorative therapy is carried out. Working capacity is restored after 10-12 weeks.