Ligament structure
- type 1 collagen
- slower healing
Three phases of healing and time ranges
- Inflammation 0-72 hours (PROTECT)
- Proliferation 3-6 days (CONTROLLED LOADING)
- Remodeling 6wks to 1yr (INCREASE FUNCTION)
Function of ligaments
Connect bone to bone
Prevent excessive motion
Augment mechanical stability of joint
Guide joint motion
Motor control
Factors affecting healing
Age
Vascularity
Location of injury
Mechanical environment
Nutrition
Hormones
NSAIDs
Systemic health
Intra-articular ligaments vs extra-articular
- intra-articular ligaments take longer to heal than extra-articular due to decreased vascularization
Ligament injury grade I
Mild pain
Little or no swelling
Joint stiffness
No abnormal motion
Minimal bruising
Minimal loss of structural integrity
Minimal functional loss
Ligament injury grade II
Moderate to severe pain
Joint stiffness
Sig structural weakening with abnormal motion
Ligament injury grade III
Severe pain followed by little or no pain (nerve fibres torn)
Profuse swelling and bruising
Loss of structural integrity with abnormal motion
Clinical findings of a grade I ligament tear
- localized tenderness on palpation
- minimal inflammation
- normal range and end feel, might be painful
- little functional deficit
Clinical findings of a grade II ligament tear
- sig tenderness on palpation
- considerable inflammation
- increased joint play on ligament stress test, but definite end point
- moderate functional deficit
Clinical findings of a grade III ligament tear
- audible pop
- immediately painful unless nociceptors interrupted
- considerable swelling and bruising
- sig increased joint play on ligament stress test and no end point
- significant functional deficit
