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Muscle rupture in the anterioir thigh

Thigh

Diagnosis: MUSCLE RUPTURE IN THE ANTERIOR THIGH
(RUPTURA MUSCULI)


Anatomy: A rupture can in principle occur to all muscles in the thigh, however, ruptures most often happen in the anterior muscle (M quadriceps femoris) which has the function of stretching the knee and flexing the hip. The anterior thigh muscle consists of four muscles (M vastus lateralis, M vastus medialis, M rectus femoris and the deep lying M vastus intermedius).
 

  1. Spina iliaca anterior superior
  2. M. iliopsoas
  3. Lig. inguinale
  4. Tuberculum pubicum
  5. M. pectineus
  6. M. adductor longus
  7. M. gracilis
  8. M. adductor magnus
  9. M. rectus femoris
  10. M. sartorius
  11. M. vastus medialis
  12. Tractus iliotibialis
  13. M. vastus lateralis
  14. M. tensor fasciae latae et tractus iliotibialis
  15. M. gluteus medius

THIGH FROM THE FRONT

Cause: When a muscle is subjected to a load beyond the strength of the muscle (jump, kick), a rupture occurs. The vast majority of ruptures are partial muscle ruptures. The weakest point is often at the junction between the muscle tendon and the muscle belly. Muscle ruptures in children and adolescents are relatively rare compared with adults.

Symptoms: In slight cases a local tenderness is felt after being subjected to load (“sprained muscle”, “imminent pulled muscle”). In severe cases sudden shooting pains are felt in the muscle (“partial muscle rupture”, “pulled muscle”) and in the worst case a sudden snap is felt rendering the muscle unusable (“total muscle rupture”). The following three symptoms are characteristic in connection with muscle injuries: pain upon applying pressure, stretching and activation of the muscle (stretching knee) against resistance. With total ruptures a defect can often be seen and felt in the muscle, and above and below the rupture a swelling can be felt (the contracted muscle belly and bleeding). The most frequent place for partial ruptures on the anterior thigh is approximately 10 cm below the upper front iliac crest projection (spina iliaca anterior superior) in the rectus femoris muscle.

Acute treatment: Click here.

Examination: In very slight cases (light muscle sprains) with only minimal tenderness and no discomfort when walking normally, medical examination is not necessarily required. The severity of the tenderness is however, not always a measure of the extent of the injury. In cases of more pronounced tenderness or pain, medical examination is required to ensure the diagnosis and treatment. The diagnosis is usually made following normal medical examination, however, if there is any doubt concerning the diagnosis, ultrasound scanning can be performed, as it is the most suitable examination to ensure the diagnosis (Ultrasonic image). The larger the bleeding as assessed by ultrasound scanning, the longer the period needed to heal the injury (article).

Treatment: The treatment of the vast majority of muscle injuries today involves relief and rehabilitation. It is only in very rare cases that surgery is indicated (e.g. total rupture in the anterior muscle tendon close to the attachment on the upper knee cap where surgery is recommended very quickly (article). Even large ruptures in the thigh muscles will usually be able to be healed and rehabilitated without giving functional disorder (but often cosmetic disfigurement with an irregular thigh muscle).

Rehabilitation of children and adolescents: INSTRUCTION

Complications: If steady progress is not experienced, you should be medically (re)examined to ensure that the diagnosis is correct or whether complications for muscle ruptures have arisen.

Muscle rupture in the posterior thigh

Thigh

Diagnosis: MUSCLE RUPTURE IN THE POSTERIOR THIGH
(RUPTURA MUSCULI)


Anatomy: A rupture can in principle occur to all muscles in the rear of the thigh, however, ruptures most often happen in the large posterior muscles in the centre of the thigh (M biceps femoris, M semitendinosus, M semimembranosus) which have the function of stretching the hip and flexing the knee.
 

  1. M. biceps femoris (caput longum)
  2. M. semitendinosus
  3. Caput breve m. bicipitis femoris
  4. M. plantaris
  5. Tendo m. bicipitis femoris
  6. M. gastrocnemius
  7. M. sartorius
  8. M. gracilis
  9. M. semimembranosus

THIGH FROM THE REAR

Cause: When one of the posterior thigh muscles is subjected to a load beyond the strength of the muscle (typically sprinting), a rupture occurs. The vast majority of ruptures are partial muscle ruptures. Muscle ruptures in children and adolescents are relatively rare compared with adults.

Symptoms: In slight cases a local tenderness is felt after being subjected to load (“sprained muscle”, “imminent pulled muscle”). In severe cases sudden shooting pains are felt in the muscle (“partial muscle rupture”, “pulled muscle”) and in the worst case a sudden snap is felt rendering the muscle unusable (“total muscle rupture”). The following three symptoms are characteristic in connection with muscle injuries: pain upon applying pressure, stretching and activation of the muscle (flexing knee) against resistance. With total ruptures a defect can often be seen and felt in the muscle, and above and below the rupture a swelling can be felt (the contracted muscle belly and bleeding). The most frequent place for partial ruptures on the posterior thigh is the large posterior muscles in the centre of the thigh (M biceps femoris, M semitendinosus, M semimembranosus) which have the function of stretching the hip and flexing the knee.

Acute treatment: Click here.

Examination: In very slight cases with only minimal tenderness and no discomfort when walking normally, medical examination is not necessarily required. The severity of the tenderness is however, not always a measure of the extent of the injury. In cases of more pronounced tenderness or pain, medical examination is required to ensure the diagnosis and treatment. The diagnosis is usually made following normal medical examination, however, if there is any doubt concerning the diagnosis, ultrasound scanning (or MRI scanning) can be performed, as these are the most suitable examinations to ensure the diagnosis (Ultrasonic image). The larger the bleeding as assessed by ultrasound scanning, the longer the period needed to heal the injury (article).

Treatment: The treatment of the vast majority of muscle injuries today involves relief and rehabilitation. It is only in very rare cases that surgery is indicated Even large ruptures in the thigh muscles will usually be able to be healed and rehabilitated without giving functional disorder (but often cosmetic disfigurement with an irregular thigh muscle).

Rehabilitation of children and adolescents: INSTRUCTION

Complications: If steady progress is not experienced, you should be medically (re)examined to ensure that the diagnosis is correct or whether complications for muscle ruptures have arisen.

Muscular bleeding in the anterior thigh

Thigh

Diagnosis: MUSCULAR BLEEDING IN THE ANTERIOR THIGH
(HAEMATOMA MUSCULI)


Anatomy: The thigh muscles are dealt up in three muscle groups (muscle compartments) of powerful, partially unyielding, muscle membranes (fascias): a front, an inner and a rear muscle compartment. The anterior thigh muscle consists of four muscles (M vastus lateralis, M vastus medialis, M rectus femoris and the deep lying M vastus intermedius).
 

  1. Spina iliaca anterior superior
  2. M. iliopsoas
  3. Lig. inguinale
  4. Tuberculum pubicum
  5. M. pectineus
  6. M. adductor longus
  7. M. gracilis
  8. M. adductor magnus
  9. M. rectus femoris
  10. M. sartorius
  11. M. vastus medialis
  12. Tractus iliotibialis
  13. M. vastus lateralis
  14. M. tensor fasciae latae et tractus iliotibialis
  15. M. gluteus medius

THIGH FROM THE FRONT

Cause: If a muscle is subjected to kicks or the like the muscle belly, which contains blood vessels, is pressed against the bones inflicting a contusion and rupture of the muscle fibres and blood vessels. The rupture usually occurs deep in the muscle. In other cases the bleeding can occur after a large or smaller muscle rupture in the anterior thigh. The bleeding can either penetrate the muscle membrane and spread over a large area, or it can accumulate in the muscle.

Symptoms: Pain and swelling in the muscle. In some cases a hard, tender accumulation can be felt (accumulated bleeding in the muscle), in other cases a bluish discoloration of the subcutis (the bleeding has penetrated the muscle membrane and spread into the sub cutis). The pain is aggravated upon activation and stretching of the muscle.

Acute treatment: Click here.

Examination: In slight cases with only minimal tenderness and no discomfort when walking, medical examination is not necessarily required. The severity of the tenderness is, however, not always a measure of the extent of the injury. In cases of more pronounced tenderness or pain, medical examination is required to ensure the diagnosis and treatment. Acute medical attention is necessary in cases of pronounced pain or sensory disturbance, as the bleeding can occasionally cause the pressure in the muscle compartment to increase so greatly that the blood supply and nerves can be damaged (acute compartment syndrom). The diagnosis is usually made following normal medical examination, however, if there is any doubt concerning the diagnosis, ultrasound scanning can be performed, as this is the most suitable examination to ensure the diagnosis (Ultrasonic image). The larger the bleeding as assessed by ultrasound scanning, the longer the period needed to heal the injury.

Treatment: The treatment primarily consists of relief and rehabilitation as with muscle rupture in the anterior thigh. In cases of large accumulated bleeding the blood accumulation can be drained under ultrasound guidance. If the bleeding is located medial (M vastus mediale) or lateral on the thigh (M vastus lateralis), the rehabilitation will usually go more quickly. If the bleeding is located in the centre of the front thigh muscle (M vastus intermedius or M rectus femoris), a longer period of rehabilitation must be expected as sudden jumping or kicking will comprise a risk of a muscle rupture in the damaged anterior thigh muscle. Some advise caution with massage to reduce the risk of myositis ossificans (formation of bony bars within the muscle). Treatment with ultrasound has generally no convincing effect.

Rehabilitation of children and adolescents: INSTRUCTION

Complications: If steady progress is not experienced, you should be medically (re)examined to ensure that the diagnosis is correct or whether complications for muscle ruptures have arisen (article).

Thigh bone fracture

Thigh

Diagnosis: THIGH BONE FRACTURE
(FRACTURA)


Anatomy: The femur is the only bone in the thigh. Innumerable muscles are attached to the bone.

  1. Caput femoris
  2. Collum femoris
  3. Trochanter minor
  4. Trochanter major

THIGH BONE FROM THE FRONT

Cause: Fracture of the thigh bone occurs most commonly following a heavy blow or twist. By far the majority of fractures occur in the middle section of the thigh bone. A fracture of the femoral neck (article) and stress fractures are very seldom seen in children (article).

Symptoms: Pain and swelling. It will most often be impossible for the patient to support himself on the leg due to pain.

Examination: X-ray examination will usually reveal the fracture. Since many stress fractures are not visible early in the course, x-ray examination can be repeated after a few weeks. Scintigraphy, CT, MRI and ultrasound scans can often diagnose stress fractures far earlier than x-rays (Ultrasonic image). The occurrence of stress fractures in the thigh bone is very rare in children, but much more frequent in adults (see thigh stress fracture in SportNetDoc adults).

Treatment: The treatment primarily comprises relief (article). Only in special cases is surgery necessary (article).

Rehabilitation of children and adolescents: The rehabilitation is completely dependant on the severity of the fracture and the treatment. All rehabilitation should therefore be performed in close cooperation with the doctor controlling the treatment. A period of at least two months is usually recommended before full participation in sport can be permitted.

Complications: The great majority of cases heal without complication or after-effects following non-operative treatment. Complications are more frequently seen following surgical treatment of the fracture (article). A shortening of the leg can be seen following a thigh bone fracture (article) and problems in the healing process where in some cases a false joint is formed (pseudoarthrosis), which requires surgical treatment.

Inflammation of the kneecap ligament fastening on the kneecap (Sinding-Larsen)

Knee

Diagnosis: INFLAMMATION OF THE KNEE CAP LIGAMENT FASTENING ON THE KNEE CAP (SINDING-LARSEN)


Anatomy: The large anterior thigh muscle (musculus quadriceps femoris) consists of four muscles (M vastus lateralis, M vastus medialis, M vastus intermedius & M rectus femoris). All the muscles fasten on the upper edge of the knee cap. The knee cap ligament (ligamentum patellae) connects the lower edge of the knee cap with the front part of the shin bone (tuberositas tibiae). The function of the knee cap ligament is therefore, when the knee is stretched, to transfer the power the large thigh muscle produces.

 

  1. M. rectus femoris
  2. M. vastus medialis
  3. Retinaculum patellae mediale
  4. Retinaculum patellae mediale
  5. Tuberositas tibiae
  6. Lig. Patellae
  7. Retinaculum patellae laterale
  8. M. vastus lateralis

KNEE FROM THE FRONT

Cause: Repeated uniform loads on the knee cap ligament (jumping, kicking) causes microscopic ruptures at the knee cap ligament fastening on the lower edge of the knee cap. As the load often continues despite tenderness, which in the early stages diminishes after warm-up, a chronic inflammation gradually occurs in the ligament. In some cases, the symptoms will arise at the ligament fastening on the lower edge of the knee cap (Photo)

Symptoms: Jumping and similar activity will initially cause tenderness at the lower edge of the knee cap. The pain diminishes during the first weeks/months after warm-up. If the sport activity continues the pain will increase, resulting in the activity eventually becoming impossible.

Acute treatment: Click here.

Examination: The diagnosis is often made following a normal medical examination, however, if there is any doubt surrounding the diagnosis an ultrasound scan should be performed which will be able to reveal a fraying out (fragmentation) of the bone at the apex of the knee cap (aseptic necrosis of the bone) (article).

Treatment: The treatment consists of relief from the pain inducing activity (jumping, kicking) as soon as possible after the onset of symptoms. The injury can in some cases heal within a few weeks if the treatment is instigated quickly. A rehabilitation period of several months must be anticipated if the pain has been in evidence for some months. Emphasis is put on stretching of the anterior thigh muscle. Ice treatment can be repeated every time tenderness is provoked during the rehabilitation period at the apex of the knee cap.

Rehabilitation of children and adolescents: INSTRUCTION

Bandage: Some patients have the opinion that the application of tape or bandage around the shin bone directly under the knee cap can relieve the discomfort (tape-description).

Complications: In case of lack of progress it should be considered whether the diagnosis is correct or whether complications have arisen. Special consideration should be given to:

Special: Since there is a risk that the injury can cause permanent disability, the injury should be reported to your insurance company.

Osgood-Schlatter desease

Knee

Diagnosis: OSGOOD-SCHLATTER DISEASE


Anatomy: The large anterior thigh muscle (musculus quadriceps femoris) consists of four muscles (m vastus lateralis, m vastus medialis, m vastus intermedius & m rectus femoris). All the muscles fasten on the upper edge of the knee cap. The knee cap ligament (ligamentum patellae) connects the lower edge of the knee cap with the front part of the shin bone (tuberositas tibiae), where children and adolescents have a growth zone. The function of the knee cap ligament is therefore, when the knee is stretched, to transfer the power the large thigh muscle produces.
 

  1. M. rectus femoris
  2. M. vastus medialis
  3. Retinaculum patellae mediale
  4. Retinaculum patellae mediale
  5. Tuberositas tibiae
  6. Lig. Patellae
  7. Retinaculum patellae laterale
  8. M. vastus lateralis

KNEE FROM THE FRONT


(Photo)
Cause: Repeated uniform loads on the knee cap (jumping, kicking) cause an over-load conditioned inflammation with a fragmentation of the bone at the knee cap ligaments fastening on the growth zone at the upper front part of the shin bone (tuberositas tibiae). The mechanism behind development of Osgood-Schlatter disease is the same in adults as for jumper’s knee. Osgood-Schlatter disease is one of the most common sports injuries in children and adolescents.

Symptoms: Slowly insetting tenderness at the upper, front part of the shin bone (tuberositas tibiae) during and after the sports activity. If the discomfort has a long duration, the bone fastening on the shin bone will become more prominent and can become so large that kneeling will be a problem. It is especially boys in the 10-16 age group that have the symptoms, and the condition is very common and can be seen in almost all boys’ football teams. The symptoms will diminish at around age 17 when the growth zone on the shinbone closes.

Acute treatment: Click here.

Examination: The diagnosis can usually be made with certainty under a normal medical examination, revealing localised tenderness on the knee cap fastening on the upper, front part of the shin bone. If there is any doubt surrounding the diagnosis an ultrasound scan can be performed to identify the changes (ultrasonic image), however, this is seldom necessary in uncomplicated cases (article).

Treatment: The treatment comprises relief from the pain inducing activity (jumping, kicking). The injury can in some cases heal within a few weeks if the treatment is instigated quickly whereas a rehabilitation period of several months must be anticipated if the pain has been in evidence for some months. Emphasis is placed on stretching of the anterior thigh muscle. Ice treatment can be repeated every time tenderness is provoked in the knee cap ligament fastening during the rehabilitation period. If during the rehabilitation period pain is experienced when walking, medicinal treatment in the form of rheumatic medicine (NSAID) in gel form can be considered. Injection of corticosteroid should not be considered in the treatment (article). The sports activity can be cautiously resumed when the pain has diminished. Relapses will often occur, which should be followed as soon as possible with a period of relief. During the relief period it will usually be sufficient to abstain from the most stressful exercises (jumping), whilst many other training exercises can be performed without discomfort. In the majority of cases it will be therefore be possible to participate in at least a part of the sports activity (for example as goal-keeper).

Rehabilitation of children and adolescents: INSTRUCTION

Bandage: Some patients have the opinion that the application of tape or bandage around the shin bone directly under the knee cap can relieve the discomfort (tape-description).

Complications: In case of lack of progress it should be considered whether the diagnosis is correct or whether complications have arisen. Special consideration should be given to:

  • meniscus lesion
  • cartilage damage (osteochondral lesions)
  • bone membrane tear (periosteal avulsion)
  • tendinitis
  • bursitis
  • inflamed mucous fold (plica synovialis)

A tearing of the knee-cap tendon from the fastening on the shinbone has only been described in very rare cases. The torn part of the bone (on which the knee cap tendon is fastened) can be fixed to the shinbone again under surgical operation (article).

Special: Shock absorbing shoes or insoles will reduce the load on the knee.

Meniscus lesion

Knee

 

Diagnosis: MENISCUS LESION


Anatomy: The bones in the knee joint comprise the thigh bone (femur), shin bone (tibia) and the knee cap (patella). The articular surfaces on the thigh bone, shin bone and the knee cap are covered with a few mm thick cartilage coating which serves to reduce the strain on the articular surfaces. There is a ring-formed cartilage disk (meniscus) internally and externally in the joint. The knee joint is strengthened by a joint capsule which is in turn strengthened on the sides by an outer and an inner collateral ligament (ligamentum collaterale laterale (LCL) and ligamentum collaterale mediale (MCL)). The internal meniscus is attached to the inner collateral ligament, whereas the external meniscus is not attached to the outer collateral ligament.
 

  1. Ligamentum cruciatum posterius
  2. Ligamentum collaterale mediale/tibiale
  3. Meniscus medialis
  4. Insertio anterior menisci medialis
  5. Ligamentum transversum genus
  6. Tibiae
  7. Fibulae
  8. Ligamentum cruciatum anterius
  9. Ligamentum collaterale laterale/fibulare
  10. Meniscus lateralis
  11. Femur

KNEE JOINT FROM THE FRONT

 

  1. Ligamentum transversum genus
  2. Meniscus lateralis
  3. Meniscus medialis
  4. Insertio anterior menisci

KNEE JOINT FROM ABOVE

Cause: Meniscus lesions often occur when the knee is stretched at the same time as rotating. The meniscus will consequently be squeezed between the thigh bone and the shin bone. The inner meniscus is more often damaged than the external. Meniscus injuries in children is very rare (article-1)(article-2)

Symptoms: Pain along the joint line when applying pressure and when rotating the knee. The pain often occurs suddenly when performing certain movements, and can be accompanied by swelling of the knee. In some instances the knee can lock due to a splinter from the meniscus becoming jammed. In other cases, a small and tender outpouching of fluid can be sensed at the joint line (meniscus cyst). Prolonged discomfort will often cause the thigh muscle to diminish.

Acute treatment: Click here.

Examination: A medical examination is always necessary if there is any suspicion of injury within the knee joint. A normal clinical examination is often not sufficient. The doctor can perform various knee tests (meniscus test), however, there is typically tenderness along the joint line which is aggravated when rotating the knee joint. It is often necessary to perform an arthroscopy (telescopic examination of the joint), MR-scan or ultrasound scan to make the diagnosis (article) (ultrasonic image).

Treatment: In uncertain cases the treatment comprises relief and rehabilitation of the knee. If the discomfort does not slowly diminish, if there are instances of “locking” or if it is clear that the meniscus lesion is large (e.g. assessed from an ultrasound scan), surgery should be considered. Under an operation, it can be attempted to sew the torn piece of meniscus back (which will require a considerably longer rehabilitation period, but will probably in the long term reduce the risk of degenerative arthritis in the knee) (article). The torn piece of meniscus is usually removed, but in rare cases the whole meniscus is taken out. Caution is often exercised when recommending removal of the meniscus in children and adolescents, as this can often give prolonged discomfort (article).

Rehabilitation of children and adolescents: INSTRUCTION

Following an operation, exerting load on the knee can commence as soon as the pain and swelling in the knee has diminished. In the best cases, full activity is possible after a period of a few weeks. In uncomplicated cases, it should be possible to resume a full level of sports activity during the course of a month. Rehabilitation must not be allowed to cause increased swelling (or pain) in the knee.

Complications: If insufficient progress is made prior to an operation it must be considered if the diagnosis is correct. Supplementary examinations will often be required (X-ray, ultrasound or MR scan). In particular the following should be considered:

Following an arthroscopy, fluid accumulation in the joint (traumatic arthritis/synovitis) should be considered, and infection in the scar or knee joint, which will always require medical attention as soon as possible.

Special: Since there is a risk that the injury can cause permanent disability, the injury should be reported to your insurance company.

 

Luxation of the knee cap

Knee

Diagnosis: LUXATION OF THE KNEE CAP
(SUB-)LUXATIO PATELLAE)


Anatomy: The large anterior thigh muscle (musculus quadriceps femoris) consists of four muscles (M vastus lateralis, M vastus medialis, M vastus intermedius & M rectus femoris). All the muscles fasten on the upper edge of the knee cap. The knee cap ligament (ligamentum patellae) connects the lower edge of the knee cap with the front part of the shin bone (tuberositas tibiae). The knee cap is held in place by the structures that fasten on the knee cap, especially the anterior thigh muscle, joint capsule and several ligaments (retiaculum patellae mediale & retiaculum patellae laterale) as well as the knee cap ligament.

  1. Tendo m. adductoris magni
  2. Retinaculum patellae mediale
  3. Meniscus medialis
  4. Ligamentum collaterale mediale/tibiale
  5. Bursa anserina
  6. Bursa subtendinea m. sartori
  7. Ligamentum patellae
  8. Patella

KNEE FROM THE FRONT

Cause: Luxation of the knee cap can occur following a blow on the knee, but more often after a sudden and violent knee movement, where the knee is twisted and stretched at the same time. This can cause the knee cap to be displaced to the external side of the knee, whereby the ligaments holding the knee cap will rupture. The knee cap will often impact with the thigh bone, producing the risk of cartilage damage in the knee: cartilage damage in the joint (osteokondrale lesion), cartilage damage on the knee cap (chondromalacia patellae).

Symptoms: Sudden insetting severe pain that renders continued sports activity impossible. The knee cap can become completely displaced to the external side of the knee in some cases, and the knee will consequently be locked in a flexed position (total luxation) until the knee cap suddenly slips into place again allowing the knee to be stretched once more. In other cases, the knee cap will only be partially displaced to the external side of the knee (subluxatio patellae).

Acute treatment: Click here.

Examination: The diagnosis can be difficult if the knee cap is in its correct position, and anyone with suspicions of displacement of the knee cap should always seek medical attention to ensure the diagnosis and correct treatment. The examination will typically provoke severe pain when the knee cap is pressed outwards (lateral) whilst the knee is flexed (Apprehension test). The knee cap will often be able to be pressed further out on an injured knee than a healthy one. An MR scan will be able to reveal more information regarding the cartilage condition in the knee after a partial or total luxation of the knee cap (article).

Treatment: Partial luxation should primarily be treated with relief and rehabilitation. There is no general consensus of opinion regarding treatment of total luxation of the knee cap, some recommend surgery whilst others advocate relief and rehabilitation (article 1), (article 2). Surgery should however be considered with repeated (total or partial) luxation.

Rehabilitation of children and adolescents: INSTRUCTION

Rehabilitation of non-operated, partial luxation of the knee cap (subluxatio patellae).

Bandage: Tape and bandaging has no documented preventive effect subsequent to previous total or partial luxation of the knee cap (article), however experience has shown that this is utilised to a large degree, (tape-description).

Complications: In case of lack of progress it should be considered whether the diagnosis is correct. Special consideration should be given to:

Inner collateral ligament rupture

Knee

Diagnosis: INNER COLLATERAL LIGAMENT RUPTURE
(RUPTURA COLLATERALE LIGAMENTUM MEDIALE/TIBIALE)


Anatomy: The bones in the knee joint comprise the thigh bone (femur), shin bone (tibia) and the knee cap (patella). There is furthermore a small joint between the shin bone and the calf bone (fibula). The knee joint is strengthened by a joint capsule which is in turn strengthened on the sides by an outer and an inner collateral ligament (ligamentum collaterale laterale (LCL) and ligamentum collaterale mediale (MCL)). Inside the knee there are two ligaments, the anterior and posterior cruciate ligaments (ligamentum cruciatum anterius (ACL) and ligamentum cruciatum posterius (PCL).
 

  1. Ligamentum cruciatum posterius
  2. Ligamentum collaterale mediale/tibiale
  3. Meniscus medialis
  4. Insertio anterior menisci medialis
  5. Ligamentum transversum genus
  6. Tibiae
  7. Fibulae
  8. Ligamentum cruciatum anterius
  9. Ligamentum collaterale laterale/fibulare
  10. Meniscus lateralis
  11. Femur

KNEE FROM THE FRONT

 

  1. Tendo m. adductoris magni
  2. Retinaculum patellae mediale
  3. Meniscus medialis
  4. Ligamentum collaterale mediale/tibiale
  5. Bursa anserina
  6. Bursa subtendinea m. sartori
  7. Ligamentum patellae
  8. Patella

KNEE FROM THE FRONT

Cause: When the shin bone is pressed outwards in relation to the thigh bone the inner side-ligament is stretched. If the load becomes sufficiently powerful (as is the case when the load is sudden, so that the thigh muscles do not have time to tighten and stabilize the joint) the ligament can rupture.

Symptoms: Sudden pain on the inside of the knee. Occasionally a snap is felt when the ligament ruptures. In severe cases the athlete complains about a sense of looseness in the knee.

Acute treatment: Click here.

Examination: If a total or partial rupture of the ligaments in the knee is suspected, you should seek medical attention for a diagnosis. An x-ray examination is recommended as many ligament injuries in children and adolescents can be accompanied by damage to the bone at the point of attachment of the ligaments (article). The doctor can perform various knee tests (internal side-instability-test), to examine the stability of the knee. If the knee is stable the injury is called a “sprain” of the inner side-ligament. If the knee is loose the injury is called a “rupture” of the ligament. The diagnosis is usually made from a normal medical examination. If there are any doubts surrounding the diagnosis, an ultrasound scan can be performed which will reveal the rupture and the bleeding along the ligaments (Ultrasonic image) .

Treatment: The treatment of a partial or total rupture of the inner side-ligament involves relief and rehabilitation. If the knee is markedly loose, you can, for a short period, use a support splint (Don Joy). Surgical treatment previously considered has today largely been abandoned in uncomplicated ruptures of the inner side-ligament (article-1)(article-2). (However if the rupture of the inner side-ligament is combined with other ligament ruptures, many would recommend surgery).

Rehabilitation of children and adolescents: INSTRUCTION

Bandage: Hinge bandages can be used initially (Don Joy). Tape treatment of ligament ruptures in the knee have no sure effect.

Complications: If smooth progress is not achieved, it should be considered whether the diagnosis is correct or whether complications have arisen. Supplementary examinations (X-ray, ultrasound, MR scan or arthroscopy) will often be required. The following should be considered:

An inflammation by the ligament fastening is sometimes seen later in the course of the injury, and in some cases bursitis at the ligament fastening is seen (article).

Special: Since there is a risk that the injury can cause permanent disability, the injury should be reported to your insurance company.

Outer collateral ligament rupture

Knee

Diagnosis: OUTER COLLATERAL LIGAMENT RUPTURE
(RUPTURA LIGAMENTUM COLLATERALE LATERALE/FIBULARE)


Anatomy: The bones in the knee joint comprise the thigh bone (femur), shin bone (tibia) and the kneecap (patella). There is furthermore a small joint between the shin bone and the calf bone (fibula). The knee joint is strengthened by a joint capsule which is in turn strengthened on the sides by an outer and an inner collateral ligament (ligamentum collaterale laterale (LCL) and ligamentum collaterale mediale (MCL)). Inside the knee there are two ligaments, the anterior and posterior cruciate ligaments (ligamentum cruciatum anterius (ACL) and ligamentum cruciatum posterius (PCL)).
 

  1. Ligamentum cruciatum posterius
  2. Ligamentum collaterale mediale/tibiale
  3. Meniscus medialis
  4. Insertio anterior menisci medialis
  5. Ligamentum transversum genus
  6. Tibiae
  7. Fibulae
  8. Ligamentum cruciatum anterius
  9. Ligamentum collaterale laterale/fibulare
  10. Meniscus lateralis
  11. Femur

KNEE FROM THE FRONT

 

  1. M. gastrocnemius
  2. Caput fibulae
  3. B. subtendinea m. bicipitis femoris inferior
  4. M. biceps femoris
  5. Ligamentum collaterale laterale/fibulare
  6. M. plantaris

OUTER LOWER LEG

Cause: When the shin bone is pressed inwards in relation to the thigh bone the outer side-ligament is stretched. If the load becomes sufficiently powerful (as is the case when the load is sudden, so that the thigh muscles do not have time to tighten and stabilize the joint) the ligament can rupture.

Symptoms: Sudden pain on the outside of the knee. Occasionally a snap is felt when the ligament ruptures. In severe cases the athlete complains about a sense of looseness in the knee

Acute treatment: Click here.

Examination: If a total or partial rupture of the ligaments in the knee is suspected, you should seek medical attention for a diagnosis. An x-ray examination is recommended as many ligament injuries in children and adolescents can be accompanied by damage to the bone at the point of attachment of the ligaments (article). The doctor can perform various knee tests to examine the stability of the knee (external side-instability-test). If the knee is stable the injury is called a “sprain” of the outer side-ligament. If the knee is loose the injury is called a “rupture” of the ligament. The diagnosis is usually made from a normal medical examination. If there are any doubts surrounding the diagnosis, an ultrasoundexamination scan can be performed which will reveal the rupture and the bleeding along the ligaments (Ultrasonic image)

Treatment: The treatment of a partial or total rupture of the outer side-ligament involves relief and rehabilitation (article). If the knee is markedly loose, you can, for a short period, use a support splint (Don Joy). With pronounced sideways looseness surgery can be considered (article). (However if the rupture of the outer side-ligament is combined with other ligament ruptures, as is often the case, surgery is recommended).

Rehabilitation of children and adolescents: INSTRUCTION

Bandage: Hinge bandages can be used initially (Don Joy). Tape treatment of ligament ruptures in the knee have no sure effect.

Complications: If smooth progress is not achieved, it should be considered whether the diagnosis is correct or whether complications have arisen. Supplementary examinations (X-ray, ultrasound, MR scan or arthroscopy) will often be required. The following should be considered:

An inflammation by the ligament fastening is sometimes seen later in the course of the injury, and in some cases bursitis at the ligament fastening is seen (article).

Special: Since there is a risk that the injury can cause permanent disability, the injury should be reported to your insurance company.