{"id":5767,"date":"2019-12-16T07:41:56","date_gmt":"2019-12-16T07:41:56","guid":{"rendered":"https:\/\/jurmed.ro\/pacienti\/?p=5767"},"modified":"2019-12-16T07:42:58","modified_gmt":"2019-12-16T07:42:58","slug":"leziunile-ligamentelor-colaterale-ale-genunchiului","status":"publish","type":"post","link":"https:\/\/jurmed.ro\/pacienti\/leziunile-ligamentelor-colaterale-ale-genunchiului\/","title":{"rendered":"Leziunile ligamentelor colaterale ale genunchiului"},"content":{"rendered":"
\"\"<\/a>
Dr<\/em>. Alin Popescu \u00a0 medic primar\u00a0 medicin\u0103 sportiv\u0103 www.dralinpopescu.ro<\/strong><\/em><\/figcaption><\/figure>\n

Ligamentele colaterale sunt structuri ale genunchiului lezate frecvent. Afectarea lor presupune exercitarea unei for\u021be importante, precum o c\u0103z\u0103tur\u0103 la schi sau un impact direct la nivelul p\u0103r\u021bii laterale a piciorului. Exist\u0103 dou\u0103 ligamente colaterale, unul de fiecare parte a genunchiului, care limiteaz\u0103 mi\u0219c\u0103rile laterale la acest nivel. Ligamentul colateral medial ( LCM ) se afl\u0103 pe partea intern\u0103 a genunchiului, vecin cu genunchiul al\u0103turat, iar ligamentul colateral lateral ( LCL ) pe partea opus\u0103, \u00een exterior. Ligamentele colaterale, al\u0103turi de ligamentul \u00eencruci\u0219at posterior, nu permit tibiei s\u0103 se deplaseze posterior pe femur. Ligamentul colateral medial reduce rota\u021bia tibiei pe femur. Dac\u0103 o for\u021b\u0103 puternic\u0103 determin\u0103 \u00eentinderea acestor ligamente, ele se pot rupe. Ruptura poate s\u0103 apar\u0103 \u00een regiunea de mijloc sau la oricare dintre capete, acolo unde se fixeaz\u0103 la nivelul osului. Dac\u0103 impactul este foarte puternic, pot s\u0103 apar\u0103 leziuni \u0219i la nivelul altor structuri ale genunchiului. Cea mai frecvent\u0103 combina\u021bie este ruptura LCM \u0219i cea a ligamentului \u00eencruci\u0219at anterior. Rupturile LCM sunt mai frecvente dec\u00e2t cele ale ligamentului lateral, dar o ruptur\u0103 a LCL are mai mari \u0219anse de a cauza instabilitatea genunchiului. Explica\u021bia este dat\u0103 de faptul c\u0103 suprafa\u021ba superioar\u0103 a tibiei prezint\u0103 o depresiune \u00een vecin\u0103tatea LCM \u0219i este neted\u0103 \u00een vecin\u0103tatea LCL, favoriz\u00e2nd alunec\u0103rile \u0219i gener\u00e2nd \u00een consecin\u021b\u0103 instabilitate.<\/p>\n

Cauzele leziunilor ligamentelor colaterale.<\/u> Leziunile la acest nivel apar \u00een timpul desf\u0103\u0219ur\u0103rii activit\u0103\u021bilor sportive, precum schiatul sau fotbalul, atunci c\u00e2nd mi\u0219carea gambei este for\u021bat\u0103 spre una dintre cele dou\u0103 p\u0103r\u021bi: medial, spre cel\u0103lalt genunchi, sau lateral. O lovitur\u0103 aplicat\u0103 \u00een por\u021biunea extern\u0103 a genunchiului \u00een timp ce talpa este fixat\u0103 la sol poate genera ruperea LCM. Alunec\u00e2nd pe ghea\u021b\u0103, piciorul se deplaseaz\u0103 spre exterior. Greutatea corpului genereaz\u0103 o for\u021b\u0103 neobi\u0219nuit\u0103 care se transmite spre interiorul genunchiului \u0219i poate rupe LCM.<\/p>\n

Simptome.<\/u> O for\u021b\u0103 suficient de puternic\u0103 s\u0103 rup\u0103 unul dintre ligamentele colaterale lezeaz\u0103 \u0219i \u021besuturile moi din jurul genunchiului, care devin tumefiate sau s\u00e2ngerez\u0103. Se poate produce hemoragie \u0219i \u00een interiorul articula\u021biei. Genunchiul doare mai ales c\u00e2nd se las\u0103 greutate pe piciorul \u00een cauz\u0103.<\/p>\n

Afectarea cronic\u0103, pe termen lung, senza\u021bia de instabilitate datorat\u0103 unei leziuni mai vechi a ligamentelor, este o problem\u0103 frecvent \u00eent\u00e2lnit\u0103. Dac\u0103 ligamentul afectat se vindec\u0103, dar nu \u00een totalitate, un anumit grad de instabilitate va fi resim\u021bit \u00een continuare.<\/p>\n

Diagnostic.<\/u> Examinarea clinic\u0103 ini\u021bial\u0103 indic\u0103 de obicei structurile lezate. \u00cen anumite cazuri, durerea intens\u0103 sau contractura muscular\u0103 \u00eengreunez\u0103 examinarea genunchiului. De aceea, doctorul poate indica o perioad\u0103 de repaus cu genunchiul imobilizat \u00een ortez\u0103, urmate de o reexaminare \u00een 5-7 zile. Exist\u0103 anumite teste care indic\u0103 lezarea ligamentelor colaterale. La aplicarea unei for\u021be de lateralitate de c\u0103tre medic, o mi\u0219care prea mare de-a lungul liniei articulare \u00eentre tibie \u0219i femur indic\u0103 o leziune a ligamentului colateral. Durerea la nivelul liniei articulare, f\u0103r\u0103 o deplasare lateral\u0103 semnificativ\u0103, poate fi semn al unei leziuni mai u\u0219oare. Radiografia e util\u0103 pentru a exclude orice leziune osoas\u0103. RMN se indic\u0103 dac\u0103 exist\u0103 suspiciunea unor leziuni multiple, inclusiv afectarea ligamentului \u00eencruci\u0219at anterior sau menisc.<\/p>\n

Tratament.<\/u> Nechirurgical \u2013 Scopul ini\u021bial al tratamentului este reducerea durerii \u0219i a inflama\u021biei. Repausul, medica\u021bia antiinflamatorie, un bandaj compresiv aplicat timp de c\u00e2teva s\u0103pt\u0103m\u00e2ni \u00een func\u021bie de gravitatea leziunii \u0219i eventual utilizarea unor c\u00e2rje pentru a evita solicitarea membrului afectat, sunt utile acestui scop. Terapia fizical\u0103, const\u00e2nd \u00een ghea\u021b\u0103, aplicat\u0103 precoce dup\u0103 momentul accident\u0103rii, stimulare electric\u0103 \u0219i repaus cu piciorul ridicat deasupra nivelului inimii este extrem de util\u0103 \u00een completarea schemei de tratament.<\/p>\n

Chirurgical \u2013 Persoanele care \u00een ciuda tratamentului aplicat continu\u0103 s\u0103 aib\u0103 perioade de instabilitate \u0219i tumefac\u021bie sau leziunile multiple la nivelul genunchiului necesit\u0103 tratament chirurgical. Repararea chirurgical\u0103 a ligamentului lezat presupune \u00een primul r\u00e2nd o incizie la nivelul pielii. Dac\u0103 ligamentul a fost smuls din inser\u021bia sa la nivelul osului, va fi reata\u0219at prin suturi puternice sau cu ajutorul unor c\u00e2rlige speciale numite ancore. Rupturile din zona mijlocie ligamentar\u0103 se repar\u0103 prin apropierea \u0219i coaserea capetelor. Reconstruc\u021bia ligamentar\u0103 indicat\u0103 \u00een caz de instabilitate sau tumefiere cronic\u0103 a genunchiului, const\u0103 \u00een \u00eent\u0103rirea ligamentului afectat sau \u00eenlocuirea acestuia cu o gref\u0103 de tendon. C\u00e2nd ligamentul este grav afectat \u0219i devine imperios necesar\u0103 \u00eenlocuirea lui, se poate apela la dou\u0103 metode: tendonul mu\u0219chiului semitendinos propriu sau folosirea de \u021besut de la un donator.<\/p>\n

Recuperarea.<\/u> Nechirurgical\u0103 \u2013 leziunile minore se recupereaz\u0103 \u00een 4-6 s\u0103pt\u0103m\u00e2ni, rupturile moderate \u00een aproximativ 2 luni, iar rupturile severe necesit\u0103 circa 3 luni pentru vindecare. Dac\u0103 simptomele persist\u0103 mai mult de 3 luni, bolnavul necesit\u0103 interven\u021bie chirurgical\u0103. Postchirurgical \u2013 pacien\u021bii sunt sf\u0103tui\u021bi s\u0103 respecte recomand\u0103rile \u00een ceea ce prive\u0219te greutatea care trebuie plasat\u0103 pe picior \u00een timpul mersului sau \u00een cazul adopt\u0103rii pozi\u021biei verticale. P\u00e2n\u0103 la \u0219ase s\u0103pt\u0103m\u00e2ni dup\u0103 interven\u021bie, indica\u021bia este de a menaja piciorul respectiv. Bicicleta sta\u021bionar\u0103, stretchingul u\u0219or sau presiunea u\u0219oar\u0103 aplicat\u0103 la nivelul articula\u021biei de c\u0103tre specialist pot fi efectuate precoce, ajut\u00e2nd la rec\u00e2\u0219tigarea amplitudinii de mi\u0219care. Aceste exerci\u021bii sunt utile \u0219 pentru \u00eent\u0103rirea mu\u0219chiului cvadriceps, situat pe fa\u021ba anterioar\u0103 a coapsei.<\/p>\n","protected":false},"excerpt":{"rendered":"

Ligamentele colaterale sunt structuri ale genunchiului lezate frecvent. Afectarea lor presupune exercitarea unei for\u021be importante, precum o c\u0103z\u0103tur\u0103 la schi sau un impact direct la nivelul p\u0103r\u021bii laterale a piciorului. […]<\/p>\n","protected":false},"author":9,"featured_media":5704,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[67,472],"tags":[],"class_list":["post-5767","post","type-post","status-publish","format-standard","has-post-thumbnail","category-articole","category-ortopedie"],"yoast_head":"\nLeziunile ligamentelor colaterale ale genunchiului<\/title>\n<meta name=\"description\" content=\"Leziunile ligamentelor colaterale ale genunchiului Autor: Dr. Alin Popescu medic primar medicin\u0103 sportiv\u0103 www.dralinpopescu.ro\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/jurmed.ro\/pacienti\/leziunile-ligamentelor-colaterale-ale-genunchiului\/\" \/>\n<meta property=\"og:locale\" content=\"ro_RO\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Leziunile ligamentelor colaterale ale genunchiului\" \/>\n<meta property=\"og:description\" content=\"Leziunile ligamentelor colaterale ale genunchiului Autor: Dr. Alin Popescu medic primar medicin\u0103 sportiv\u0103 www.dralinpopescu.ro\" \/>\n<meta property=\"og:url\" content=\"https:\/\/jurmed.ro\/pacienti\/leziunile-ligamentelor-colaterale-ale-genunchiului\/\" \/>\n<meta property=\"og:site_name\" content=\"Jurmed - 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