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Start your extensive look at ligaments

Ligaments are made of fibrous connective tissue and provide stability to the skeleton by connecting one bone to another bone. They are holding joints in place, preventing from dislocating or injuries and allowing movement such as twisting, jumping, or side-to-side motion. The knee joint is an example of strong ligament connections. Good ligaments are necessary to practice healthy sporting activity without problems and to have a good normal life.

What happens when a ligament is injured?

When extreme motion is applied to a joint, such as twist, fall or another high-impact event, the ligament can be damaged or totally torn. A damaged ligament results in joint instability, reduced articular performance and high risk to develop osteoarthritis or degenerative changes. Persons with damaged ligaments feel pain, swelling, and discomfort. The activities of daily and professional life could be severely limited by these accidents.

What are the treatment options to restore function?

Low grades injuries can heal using a non-surgical treatment, such as a combination of bracing, physical therapy, heat therapy or medication. The healing can take weeks to months. Severe or complete ligament injuries need surgery to restore a natural articulation: the reconstruction or the reinforcement is necessary and  autograft, allograft or a synthetic ligament could be used during surgery. The surgical is mandatory to restore a functional articulation, reduce pain, restore circulation, prevent arthritis, and strengthen the surrounding area to support the tissue.

The treatment choice will depend on factors such as your age, your activity level, and the severity of your injury and will be recommended by your orthopaedic surgeon. Tears of any grade require attentive care. Should you suspect a torn ligament, ask for medical advice.

What are the different surgical reconstruction options?
  • Autograft: tissue is obtained from another part of the patient’s own body, for example: patellar tendon, hamstring tendon, quadriceps tendon, fascia lata.
  • Allograft: obtained from a donated tissue such as a cadaver
  • Synthetic/artificial graft: artificially produced and designed to mimic the anatomic ligament fibres
  • Hybrid reinforcement: autograft or allograft reinforced with a synthetic/artificial graft
What is an artificial ligament?

An artificial ligament seeks to mimic the native ligament and is made out of a biocompatible material, functioning in vivo without systemic response in the body. Also, mechanical performances of artificial ligaments can be characterized by abrasion resistance or rotational fatigue limitation. The implantation of an artificial ligament is a very specialized technique, performed in centers of excellence, recommended for athletes and patients requiring high performance.

Runner on starting blocks

text-decoration-info-ligament-longLigaments are slower to heal than other types of soft tissue due to a low vascularity

text-decoration-info-ligamentLigaments connect bones to other bones, helping to stabilize the joints

Artificial ligaments mimic the anatomical properties of the natural ligament

Acromion-clavicular ligament Humeral-clavicular ligament Coraco-clavicular ligament Trapezoid ligament Conoid ligament

SHOULDER

The acromioclavicular joint (ACJ) is a fundamental structure for the stability of the clavicle and of the scapula. Two strong ligaments guarantee its solidity (conoid, trapezoid ligaments) and the capsule. Injury of the acromioclavicular joint (ACJ) happens when falling sideways on the shoulder, typical of cyclists, or in strong contrasts as in rugby.

What happens when the ACJ is torn?
As the result of a fall or collision, the acromioclavicular joint and surrounding structure can be damaged. The shoulder blade (scapula) is forced downwards, and the clavicle (collarbone) appears prominent. The symptoms are pain, limited motion in the shoulder, swelling, bruising or tenderness at the top of the shoulder.

I am about to undergo a LARS surgery, how does it work?
When experiencing a severe ACJ dislocation/injury, the ligament repair is carried out under general anaesthesia. To stabilize your clavicule, the LARS is looped around your clavicle and the coracoid process from the shoulder blade. After restoring the relationship between your clavicula and scapula, the LARS ligament passes through both bones, giving you extreme stability; like a loop it wraps around both bony structures, restoring the anatomy. The new ligament is stabilized by two screws. The procedure will leave you with a little scar of 5 cm running along the top of your shoulder.

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More than 150 000 LARS ligaments have been implanted

KNEE

The knee joint is stabilized by four ligaments: the anterior and posterior cruciate ligaments (ACL and PCL), the medial collateral ligament (MCL) and the lateral collateral (LCL). Injuries to the ACL and PCL are the most common sports-related injuries, particularly in skiing, basketball, football but also hockey and all contact sports.  Without cruciate ligaments, the quality of your knee decreases.

What happens when the ACL/PCL is torn?
The ACL controls rotation and forward movement of the tibia, while PCL controls its backward movement. When one of these ligaments is injured, people will be unable to jump and land on the knee, accelerate, and then change directions or rapidly pivot on the knee. Being smaller and weaker than the PCL, the ACL is more likely to sustain a complete tear. A damaged ligament results in joint instability, reduced articular performance and high risk to develop osteoarthritis or degenerative changes. The reconstruction of the cruciate ligaments is essential for the return to active life.

Refer to the patient leaflet for additional information and patient rehabilitation.

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Medial collateral ligament Lateral collateral ligament Anterior cruciate ligament Posterior cruciate ligament

Artificial ligaments are biocompatible

Plantar fascia ligament Posterior inferior talofibular ligament Calcaneofibular ligament Anterior talofibular ligament Anterior inferior talofibular ligament Posterior talofibular ligament

FOOT and ANKLE

Ankle ligaments are found throughout your foot, ankle and lower leg. They are short and very strong and is composed of three main ligament complex. The lateral ligament complex is the most injured (lateral ankle sprain). These injuries are typical of sports such as football or athletics, but also of simple falls during everyday life

What happens when the lateral ankle ligament is torn?
Most ankle ligament injuries are caused when the foot twists inwards. The symptoms are pain, swelling and recurrent sprains reduce the capacity of the ligament to properly heal, resulting in long-term ankle instability.

I am about to undergo a LARS surgery, how does it work?
A skin incision is made 4 to 5 cm long. A vertical tunnel is drilled from the tip of the malleolus and emerging from the fibula. By a micro-skin incision, located 2 to 3 cm higher than the previous skin incision, a second tunnel is drilled. The LARS is pulled into the tunnel and fixed using a screw. The suture is made using resorbable threads.

Refer to the patient leaflet for additional information and patient rehabilitation.

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Medically reviewed by Dr Matteo Izzo, Switzerland