Can Torn Ligaments Heal On Their Own
Imagine you’re playing basketball when suddenly your left knee gives out on you. You land hard on your right ankle, which ends up fracturing as well. Next thing you know, you hear a loud crack and feel immediate pain in your left thigh. Your knee looks like it has been savaged by a wild animal.
The injury was severe enough to warrant an MRI, and subsequent X-rays revealed that both ligaments (a tendon with attached bone) were completely torn. The medial collateral ligament (MCL), located on the inside of the shinbone, wasn’t just cut; its fibers had been ripped apart, pulling them backward toward their attachment points at the upper end of the tibia (the long leg bone). And the lateral collateral ligament (LCL) on the outside of the lower part of the femur (thigh bone) was stripped cleanly away from its corresponding spot on the top of the fibula (smaller bone in the back of the foot). Both ligaments are crucial for stability; they connect bones to other bones across the joints where they meet, and provide support for the knee. But now they both looked ready to fail — or worse yet, reinjure themselves.
It would be another six months before these two athletes returned to action. In the meantime, though, the MCL and LCL underwent reconstructive surgeries. During the procedure, doctors sutured together the remaining pieces of each ligament, using small metal anchors inserted into holes drilled through the bones. Then, after wrapping each ligament around itself several times, they stitched the ends together, too.
Afterward, the patients wore special braces until the wounds healed. Some took nonsteroidal antiinflammatory drugs to reduce swelling. The recovery time varied widely, but most suffered some degree of stiffness and soreness during activity immediately following surgery.
As expected, neither athlete experienced full range of motion in their knees for quite some time. Neither could squat down low without feeling discomfort. They couldn’t run fast without experiencing jarring impacts to the knee. A year later, however, both players were able to return to play. Although the injuries weren’t life-threatening, they still caused significant disruption to their pre-existing lifestyles.
This example demonstrates one reason why complete tears rarely heal naturally. The primary reason is because there’s a disconnect between the tissues that need healing and any chance of blood supply. Without sufficient blood flow, the injured area can’t receive the nutrients it needs to repair properly or stay healthy. Because of this problem, partial ruptures typically don’t heal spontaneously. Instead, they’ll often result in more damage if not treated appropriately.
But what about complete tears? Can these injuries heal on their own? Read on to find out.
Torn Collar Tendon Healing Facts
In addition to the MCL and LCL, there are four other major collars that help hold the head of our vertebrae firmly onto the spinal column. Two of those collars are called interspinous ligaments. These thin structures are located along the front portion of the spine and attach to the spinous processes, or tips, of the vertebrae. Together, the interspinous ligaments create a “corset”like structure that holds the spine stable. If either of these ligaments tear, the resulting instability can cause serious problems such as herniated discs or even paralysis.
When we examine the anatomy of the human body, we notice that many of the smaller muscles have tendons running throughout the length of their muscle bellies. When these tendons become stretched beyond their capacity, they may begin tearing. This type of injury is called a rotator cuff tear, and it affects the shoulder. Rotator cuff injuries aren’t limited to shoulders, though. Tendons in elbows, wrists and ankles can all get pulled loose and start to tear.
One particularly common way for tendons to suffer complete tears is when someone falls over backwards. While falling forward usually protects us from getting hurt, it can put force behind our bodies’ natural restraints. As a result, we can slam our hands against objects below us, causing the palms to compress our tendons. Compressing a tendon beyond its normal capacity can lead to a complete tear. It also damages surrounding cartilage, which doesn’t always respond well to conservative treatments.
If a complete tear occurs, the injured tendon must undergo surgical reconstruction. Afterward, surgeons insert metal implants made of pins, screws or staples directly into the bone adjacent to the tear. Over time, these devices gradually work their way deeper into the bone while anchoring it securely. To avoid infection, the surgeon must make sure that the anchor isn’t exposed. Once the implant reaches its intended destination, the wound heals and scar tissue eventually replaces the missing tendon. Patients wear splints or braces over the affected area until it’s fully healed. Sometimes, physical therapy is used to speed up the process.
We’ve learned a lot about how tendons heal, but what happens when ligaments go bad? Find out next.
Rupturing the Ligaments
While the MCL and LCL heal relatively easily, the same cannot be said for the ACL. The ACL connects the thigh bone to the shinbone, forming the outermost part of the knee. Its job is to keep the lower part of the femur sliding smoothly over the top of the upper part of the tibia. The ACL is susceptible to injury because it’s frequently stressed during sports activities. There are many ways that people injure this important stabilizer, including direct trauma, twisting and pivoting motions and sudden stops or starts.
A person who suffers a complete ACL rupture typically feels instant pain in the inner thigh and/or buttock. He might experience weakness in his hamstring, or his kneecap might pop out of place. An accompanying avulsion fracture involves the formation of a new bony prominence on the top of the tibia.
Although the ACL plays an essential role in supporting the weight of the body, it takes years for the ligament to reach its full strength. Young adults typically have greater ACL flexibility than older folks do. Even so, the ligament gradually builds up endurance over time. With age comes less flexibility and increased fragility. People who suffer ACL tears early in life may never regain full function.
Reconstructive surgery is required for complete tears. Surgeons use grafts obtained elsewhere in the body to replace damaged sections. Grafts come in two basic forms: autografts and allografts. Autografts involve removing a piece from somebody else’s body and stitching it back together to form the ligament. Allografts use donor grafts taken from cadavers or other people.
During the operation, doctors drill tunnels through the bone above and below the site of the original injury. Then they pull the grafted section of the ACL through the tunnel. Anchors or buttons secure the reconstructed section of the ligament onto the bone. Doctors then cover the entire procedure with a plastic barrier designed to prevent infections.
Patients face a lengthy period of rehabilitation after surgery. Their legs won’t bear much of their weight initially, and they’ll need crutches to move around. Within three weeks of surgery, they should begin walking with the aid of a cane. At first, the patient may only be allowed to walk short distances with moderate weights. Six to eight weeks later, he’ll be permitted to resume regular daily exercise. Full movement restrictions usually last for 12 months.
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