Tendons and ligaments are dense fibrous connective tissue structures composed of collagen fibres. Tendons connect skeletal muscles to bones and enable movement whereas ligaments connect bone to bone and help to stabilize the joints.
Collagen fibres in a tendon are parallel to allow elasticity while collagen fibres in a ligament are in a crossed pattern to allow stability and support.
Tendons and ligaments are prone to injury if overstretched. The joints of the knees, elbows, ankles and shoulders are most commonly affected. It is common for these injuries to occur while playing sports and is thus commonly seen in players and athletes.
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If you have had a bad fall, have twisted your knee or lifted a heavy object and you have pain, swelling and difficult movement of the injured area, this may be tendon or ligament tear.
A sprain is stretching / tearing in a ligament and a strain is caused by stretch/tear in a tendon or muscle itself.
The movement in the area of injury will be limited and painful.
The damaged area will have numbness or tingling sensation. There will be swelling/inflammation and bruising over the affected area.
Tendon and/or ligament repair surgery is required when natural healing process is not effective or when affected individuals are not able to return to normal activities and pain, swelling, difficult movement and discomfort persist even after adequate rest, ice & compression therapy, elevation, medications and physical therapy have been given.
Surgery is required when there is joint misalignment and instability leading to deformity and disability.
Blood tests and other diagnostic tests are required before the surgery.
The surgery is performed by an orthopaedic surgeon who is trained to treat problems of the bones and joints.
You will be asked to temporarily discontinue any medications you may be taking that increase the risk of bleeding.
You will be asked to be on fasting 8-10 hours prior to the surgery.
In a tendon repair surgery, incision(s) are made on the skin over the injured area and torn ends of the tendons are sewed together, incision is closed, sutures or surgical staples are given and the area is covered with a sterile dressing. If the tendons are not healthy enough to be reconnected, then a tendon graft from another part of the body may be required. The surgery may be performed under regional or general aesthesia.
In Ligament repair or reconstruction surgery, the ligament is replaced with a graft of the healthy tendon which may be taken from the person himself (auto graft) or from a donor (allograft).
When suturing is done to perform repair it is called as primary repair and when a graft is used, it is called as secondary repair.
In case of a minor injury, it may take a few days to a few weeks for complete recovery. However if injury is severe and surgery is required, it may take a few months to regain mobility and functionality.
The affected area may be supported by splint or cast till complete healing takes place. When doctor’s advice on medications and precautions are followed and physical therapy is done as prescribed, the patient will be able to use the affected joint after the healing is complete.
Risk and Complication
There is risk of bleeding, infection, clot formation and continued laxity or stiffness of the joint post surgery.
There may be limited range of motion and pain even after surgery.
Other risks associated with specific medical conditions must be discussed with the surgeon prior to the surgery.
Mild injuries can be treated by:
Adequate rest: not lifting heavy objects from or putting weight on injured area. Ice therapy: putting ice bag on the injured area to ease pain and swelling. Compression therapy: wrapping the injured area in an elastic bandage. Elevation: placing a pillow below the injured area to prevent fluid collection. The above therapy is very helpful in the first one to three days of the injury.
Medications are given to relieve pain and certain exercises are prescribed by physiotherapists to help the patients to get back to normal activities at a safe pace.
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