Ankle Ligament Reconstruction

An ankle sprain is a common injury that occurs when the ankle is twisted or turned, and results in torn ligaments within the joint. This injury often causes pain, swelling and bruising, and if it does not heal properly, it may lead to chronic ankle instability or repeated ankle sprains. Ankle ligament reconstruction is a procedure commonly performed on patients experiencing chronic ankle instability and repeated ankles sprains. It is effective in repairing torn ligaments, tightening loosened ligaments and improving the overall stability of the joint.

The Ankle Ligament Reconstruction Procedure

The ankle ligament reconstruction procedure is performed on an outpatient basis while the patient is sedated under general anesthesia. Different techniques may be used by the surgeon, depending on the condition of the ankle. During the procedure, torn ligaments may be repaired with stitches or sutures, two ligaments may be reattached, or part of a lateral tendon around the ankle may be used to repair the torn ligament. After the procedure is complete, a splint or cast is applied to the ankle. This procedure may take up to 2 hours to perform.

Risks of Ankle Ligament Reconstruction

As with any surgery, there are possible complications associated with ankle ligament reconstruction which may include:

  • Reaction to anesthesia
  • Nerve damage
  • Infection
  • Bleeding

After surgery, blood clots within the veins of the legs may also occur.

Recovery from Ankle Ligament Reconstruction

After surgery, patients will use crutches for up to two weeks. After this time, they may begin walking in a removable walking boot. Physical therapy is a crucial part of the healing process, and usually begins after about six weeks. Physical therapy treatments focus on improving range of motion without putting excessive strain on the healing tendons. Muscle-stengthening exercises and range of motion exercises may all be used to increase movement and mobility.

Most patients fully recover from ankle ligament reconstruction after three to four months, and at that time they can resume all regular activities including running and exercise.

Rehabilitation for Anterior Cruciate Ligament Injury

The anterior cruciate ligament (ACL), one of the most commonly injured ligaments in the knee, runs diagonally through the middle of the joint. About half of ACL injuries are also accompanied by damage to the meniscus, cartilage, bone or other ligaments in the knee, complicating the healing process. After the first aid treatment of rest, ice, compression and elevation (RICE), all patients with ACL injury require rehabilitation.

For some patients, physical therapy is done before and after a surgical repair. For others, the physical therapy alone is sufficient. If the patient undergoes rehabilitation without surgery, however, the knee may remain unstable during certain movements.

Nonsurgical Rehabilitation for ACL

Early therapy for ACL injury involves periodic applications of ice to reduce swelling. A knee brace is often worn for support and compression and crutches or splints may be used for a few days to keep weight off the affected knee. It is important to begin physical therapy soon after the injury occurs to prevent stiffness of the joint and muscle atrophy. Rehabilitation to help relieve pain, reduce swelling, prevent muscle spasms and increase mobility may include:

  • Electrical stimulation
  • Ultrasound
  • Light massage
  • Range of motion (ROM) exercises
  • Strengthening exercises
  • Isometric exercises
  • Exercises to improve balance
  • Proprioceptive exercises

The therapeutic routine will be adjusted to accommodate each individual patient's condition and tolerance level.

Postsurgical Rehabilitation for ACL

In order to give the patient the best chance of regaining full function of the knee, physical therapy begins right after the surgery to repair an ACL ligament. It may continue for several months until the patient is able to resume normal activities. Postsurgical rehabilitation takes place in stages as the weeks pass, a process known as functional progression.

During the first days after surgery, patients may be instructed in the use of a continuous passive motion (CPM) machine, although there is some controversy about whether this machine actually produces therapeutic results. In the ensuing weeks, rehabilitation will include some or all of the following:

  • Exercises to strengthen the quadraceps and hamstrings
  • Range of motion (ROM) exercises
  • Extension (stretching) and flexion (bending) exercises
  • Therapeutic walking
  • Ultrasound

Postsurgical rehabilitation for ACL usually takes several months. It may take a month or two more for patients to be able to fully engage in athletic activities.

Cruciate Ligament Injury and Repair

The cruciate ligaments are ligaments that cross, or cruciate, the knee, joining the femur and the tibia, and are prone to injury. Such damage is common in dogs, but rarely occurs in cats.

The knee is a complex and relatively unstable joint. The cruciate ligaments, both anterior and posterior, help to maintain the knee's stability during a wide range of motion, letting it work as a hinge, but restricting its side to side movement. When these ligaments are torn or ruptured, the animal becomes unstable and possibly lame, and eventually, particularly if the condition is not treated properly, arthritis sets in.

Reasons for Cruciate Ligament Injury

Extremely athletic dogs that overexert themselves through activities like roughhousing or jumping off docks, sometimes suffer cruciate ligament injuries, but this accounts for only a small number of such problems.

Usually, the injury, although it may appear to occur suddenly, has been coming on for some time. The inflammation, previously thought to result from the precipitating incident, is now viewed as a possible cause, since an animal that suffers a cruciate tear in one knee is much more likely to suffer a similar injury in the other knee.

Risk Factors for Cruciate Ligament Injury

While the precise causes of this problem are not known, certain breeds of dogs are at greater risk of developing the problem. These breeds include: rottweiller, cocker spaniel, Labrador retriever, German shepherd, toy and miniature poodle. Other risk factors may include:

  • Being over 4 years old
  • Being neutered
  • Having an underlying auto-immune disorder
  • Having joint disease or inflammation
  • Having received prolonged corticosteroid treatment

The reason for the connection between ligament damage and corticosteroid medication may be the result of the weight gain the medication causes, rather than an effect of the medication itself.

While less common in cats, cruciate ligament injury may occur if the animal severely twists its knee. Once the ligament is torn, the bones of the knee do not move normally and pain results. If the condition is severe, the cat may not be able to bear its own weight and may collapse if it attempts to stand.

Diagnosis of Cruciate Ligament Injury

Most often, the veterinarian is able to diagnose cruciate ligament damage through physical examination. Two physical tests are usually performed, called the positive cranial drawer test and the positive tibial compression test. These tests may require sedation of the animal, especially if it is large.

X-rays are administered to confirm the diagnosis of a cruciate injury and to eliminate other possible causes of the symptoms, such as a fracture or rheumatoid arthritis. If the doctor suspects another underlying disease, a specimen of joint fluid may be obtained for laboratory analysis.

Treatment of Cruciate Ligament Injury

There are two types of treatment available, depending on the extent and duration of the ligament injury.

Non-surgical Treatments

For dogs weighing less than 15 pounds and cats, non-surgical treatments may help animals to return to normal functioning. These include physical therapy, restricting the animal's exercise and administering anti-inflammatory medications. In many cases, treatment also includes restricting the animal's diet in order to promote weight loss.

Surgical Treatments

Typically, a cruciate ligament injury in a larger animal is treated with surgery to repair the tear. There are several types of surgical procedures performed, using either the patient's own tissue, material from tissue banks, or artificial grafts to make the repair. There is also a procedure in which a cut is made in the bone and a plate inserted to stabilize the knee.

Usually, animals will require 3 to 6 months of rehabilitation after surgery, depending on which surgery was performed and on their weight and overall health. Although they may recover with some physical limitations, may tire more easily after exercise, or may require occasional pain medication, they should be able to resume normal, happy lives.

Medial Collateral Ligament Sprain

The collateral ligaments are located on the sides of the knees. The medial collateral ligament (MCL) is located in the knee, connecting the inner side of the thigh bone to the shin (tibia) bone. The MCL helps the knee to resist force and keeps it stable against unusual movement. The collateral ligaments also control the sideways motion of the knee. This ligament may become torn or damaged as a result of direct impact to the outside of the knee. An injury may cause the MCL to loosen, stretch and possibly tear, resulting in pain and inflammation.

Symptoms of an MCL Sprain

Patients with an MCL sprain may experience the following symptoms on the inside of the knee:

  • Pain
  • Tenderness
  • Swelling

After an MCL sprain, individuals may also experience, instability, or the feeling that the knee is going to give way.

Types of MCL Sprains

An MCL sprain is diagnosed through a physical examination of the knee. Additional imaging tests may include an X-ray or MRI scan. The doctor determines the grade of the MCL sprain based on the extent of damage, which may range from a mild tear to a complete rupture. MCL sprains may be classified as:

  • Grade 1 sprains occur when the ligament is mildly damaged
  • Grade 2 sprains occur when the ligament has been stretched and loosened
  • Grade 3 sprains occur when the ligament is completely torn

Grade 2 sprains are commonly referred to as a partial tear of the ligament.

Treatment of an MCL Sprain

Treatment for an MCL sprain varies based on the severity of the injury, but it can normally be treated with conservative methods that include:

  • Rest
  • Ice
  • Compression
  • Elevation
  • Knee brace

A physical therapy program may help to strengthen and restore function to the knee. In severe cases, when the ligament has torn completely and not healed properly, surgery may be necessary for repair.

Posterior Cruciate Ligament Tears

The posterior cruciate ligament (PCL) is one of four ligaments that helps support the knee and protects the shin bone (tibia) from sliding too far backwards. The cruciate ligaments are located inside the knee joint and cross over each other, forming an "X". The anterior cruciate ligament is in the front and the posterior cruciate ligament is located behind it in the back of the knee. These ligaments control the back and forth motion of the knee.

Injury to the PCL most commonly occurs when the knee is bent and an object strikes the shin, pushing it backwards. This is commonly referred to as a "dashboard injury" because it often happens during a car accident when the shin is forcefully pushed into the dashboard. A PCL tear may also be caused by a sports injury or a fall. In many cases, a posterior cruciate ligament tear occurs along with injuries to other parts of the knee, including other ligaments, cartilage and and bone.

Symptoms of a PCL Tear

Individuals with PCL tears may experience pain,swelling and limited range of motion within the knee. Some people may also experience a feeling that the knee has popped or given out, as it causes instability within the joint. In most cases, a PCL tear will make it difficult to walk.

Diagnosis of a PCL Tear

A PCL tear is diagnosed through a physical examination of the knee. Additional imaging tests may include an X-ray or an MRI scan which can show clearer images of a posterior cruciate ligament tear and help to determine if other knee ligaments or cartilage are also injured. A diagnostic arthroscopy may also be performed to view detailed images of the tear.

Treatment of a PCL Tear

Treatment for a PCL tear varies based on the severity of the injury, but it is commonly treated with conservative methods that may include:

  • Rest
  • Ice
  • Gentle compression
  • Elevation
  • Immobilization with a knee brace

A physical therapy program may help to strengthen and restore function to the knee. If there is significant swelling that interferes with the mobility of the knee, a joint aspiration procedure may be performed to drain any excess fluid from the joint. In severe cases, when the ligament has torn completely and not healed properly, surgery may be necessary to repair or rebuild the ligament.

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