Ligament & Muscle injuries

Musculo-tendon unit: Origin - Muscle belly - Tendon insertion into bone

Blood supply of muscle & tendon; para-tenon, mesentery of tendon
Ligament: Attachment between articulating bones in a joint.
Rupture Complete disruption
Sprain: Partial rupture of ligament
Strain: Partial rupture of muscle fibers
Etiology:
1.

Trauma:
a.
One major trauma direct blow to an actively contracting muscle
_ Eccentric overloading of muscle tendon unit
b.
c.

2.

Repeated trauma
Incised wound

Predisposing factors:
a.
Old age decreased blood supply
b.
Systemic diseases- SLE, RA, hyper-parathyroidism, renal failure
c.
Local or systemic steroid therapy

Site of rupture:
Muscle:
Ligament:

Musculo-tendinous junction, belly, avulsion of tendon insertion

Attachments, mid substance

Classification: Grade: I : <25%, II : 25-50%; III: >50%

Treatment:
Muscle strain: Ice, rest, anti-inflammatory drugs followed by gentle & progressive
strengthening exercises
Muscle rupture: functionally important muscle in an active young man surgical repair
Ligament:
Grade I rest and analgesics
Grade II- POP
Grade III- Surgical repair

Muscle & Tendon Injuries

Tendo calcaneus, Gastrocnemius, Extensor mechanism of knee, Adductor longus, bicep
brachii, tricep, Pectoralis Major insertion, Hand tendon injuries.
1. Rupture of Tendo Calcaneus:
Etiology
Middle aged athletes hypo vascular area 2-6 cm above the insertion
Pushing off with weight bearing fore foot while extending the knee service in
tennis; direct blow
Symptoms
Sudden snapping sound with severe pain as if some body has struck the ankle
Inability to walk properly
Signs
Palpable defect
Inability to stand on tiptoe
Thomson / Simmond sign
OBrien needle test
Treatment
Conservative:
Old age with restricted activities Immediate POP with foot in
equines failure rate of 50%.
Operative:
Young athlete Direct repair with augmentation
Neglected rupture:
Reconstruction

2. Rupture of Extensor mechanism of knee:

1.
Rupture of patellar tendon Younger than 40
2.
Fracture patella- very active young adult
3.
Rupture of quadriceps insertion - older than 40
4.
Rupture of muscle belly young athlete
Etiology
Eccentric overload with knee partially flexed and foot planted stumble; example
of breaking a stick over a bent knee
Attrition in older age
Systemic disease
Symptoms
Pain, swelling of knee and inability to walk properly
Signs
Haemarthrosis
Palpable gap
Position of patella high in tendon rupture and low in quad rupture
Inability to lift straight leg and Extensor lag
Investigations
X-rays
Arthrography
MRI
Treatment
Primary repair with protection with tension wire
Muscle belly to be treated conservatively

Ligament Injuries
Deltoid and lateral ligaments of ankle, MCL, LCL, ACL & PCL of knee
Anterior cruciate ligament injuries (ACL)
Etiology
Twisting injury of knee combination with other lig. Injuries
Hyper extension of knee
Striking of dash board on a flexed knee
Symptoms
Popping sound, inability to walk, immediate swelling, Pain, giving way.
Signs
Anterior drawer sign
Lachmanns sign
Pivot shift and jerk test
Investigations
Arthrography
Arthroscopy
MRI
Treatment
Primary repair (within 2 weeks) Proximal or distal attachment, mid substance
Reconstruction
Instability despite adequate rehab
ACL substitute BTB, semitendinosus; attachment
Rehab