Ligaments are fibrous dense regular connective tissues comprising of collagenous fibers. Ligament connects bone to other bones to form a joint. If ligaments are stretched, either by injury, excess strain on a joint, or by improper stretching techniques, the joint will become weaker, as the elongated ligaments are unable to properly support it. Because ligaments are so important in the stabilization of joints, they are also highly susceptible to injury.
Types of Ligaments
In anatomy, the term ligament is used to denote any of three types of structure. They are as follows.
Articular Ligaments - Articular ligaments include those found in the upper extremities, shoulder, lower extremities, pelvis, head, spinal column, pelvis and thorax. Articular ligaments are strong and also have a small amount of elasticity because their connective tissues consist of both collagen and elastic fibers. Articular ligaments stabilize joints and allow movement in only specific directions, which depend on the individual joint. Conditions that can directly or indirectly afflict the articular ligaments include strains, sprains, ligament tears, arthritis, dislocations, and trauma. Symptoms of these conditions include pain, swelling, restricted movement, painful movement and deformities.
Peritoneal Ligaments - Peritoneal ligaments are double-layered folds of peritoneum that attach one organ to another or to the abdominal wall or pelvis.The peritoneal ligaments include the broad ligament of the uterus, suspensory ligament of the ovary and the hepatoduodenal ligament. Conditions that can directly or indirectly afflict the peritoneal ligaments include anatomic defects, herniation and laceration. Symptoms of these conditions include pain and restricted movement.
Fetal Remnant Ligaments - Fetal remnant ligaments are a type of ligament that is the result of the closure of specific tube-like structures that develop in a fetus. After birth, these fetal tubes become cords that can be used by health care providers as anatomic locators. Fetal remnant ligaments include the medial umbilical ligaments, ligamentum arteriosum, ligamentum teres hepatis and the ligamentum venosum.
Causes of Ligament Injury
Ligament injury is usually caused by twisting injuries. For example, an ankle may be twisted or rotated during rapid pivoting in sports such as soccer and basketball, or by stepping off a curb or step. Sometimes a moderate or severe sprain causes problems even after the ligament has healed. A small nodule can develop in the affected ligament and cause constant friction in the joint, leading to chronic inflammation. The nerve that travels over the ligament may also be damaged, resulting in pain and tingling. Occasionally, the shock of a severe sprain causes blood vessels to spasm, reducing blood flow to the area. This condition is called reflex sympathetic dystrophy syndrome.
Symptoms of Ligament Injury
The severity and symptoms of a ligament injury depends on the degree of stretching or tearing of the ligaments. In a grade 1 ligament injury, the ligaments may stretch, but they don’t actually tear. Although the joint may not hurt or swell very much, a mild sprain can increase the risk of a repeat injury. With a grade 2 ligament injury, the ligament tears partially. Swelling and bruising are common, and use of the joint is usually painful and difficult. With a severe grade 3 ligament injury, a ligament tears completely, causing swelling and sometimes bleeding under the skin. As a result, the joint is unstable and unable to bear weight.
Diagnosis of Ligament Surgery
Often the diagnosis can be made on the basis of the physical exam alone, but you may need tests to rule out other causes and to determine the severity of the injury.
X-rays. X-rays may be needed to rule out a bone fracture. However, X-rays can't visualize soft tissues such as ligaments and tendons.
Magnetic Resonance Imaging (MRI). An MRI uses radio waves and a strong magnetic field to create images of both hard and soft tissues within your body.
Ultrasound. Using sound waves to visualize internal structures, ultrasound may be used to check for injuries in the ligaments.
Arthroscopy. During arthroscopy, your doctor inserts a narrow, fiber-optic viewing scope and other instruments through very small incisions which allows your doctor to directly see the damage and, in many cases, perform repairs at the same time.
The valgus stress test is performed on both arms and a positive test is indicated by pain on the affected arm to confirm UCL injury.
Surgery for Ligament Injury
Because connective tissue such as ligaments must withstand a great deal of stress in day to day activities and have a relatively low blood supply, injuries can take a very long time to heal, and sometimes require surgery. Many professional athletes have had multiple surgeries to ligaments over the course of their careers. Severe injury to ligaments can often require physical therapy. Even with surgery and physical therapy, injured ligaments tend to be less flexible, and more prone to repeat injury, so patients should be careful when engaging in strenuous activities that can put excess pressure on the injured ligaments.
Types of Ligament Surgery
There are numerous surgical procedures that may be used for the repair and reconstruction of injured ligaments. The surgery depends on the type of ligament injury. Following are some of the most commonly performed surgeries.
Anterior Cruciate Ligament (ACL) Surgery - The anterior cruciate ligament or ACL are tough bands of tissue that connect the ends of bones together, located in the center of the knee and are stretched between the femur and the tibia. The main role of this ligament is to keep the tibia from advancing in relationship to the femurin position and rotation. Once ruptured it looses its mechanical qualities, even if the fragments are brought together and sutured. A natural tendon taken from the knee itself must be used and is known as ligamentoplasty. The first approach would be to reduce inflammation and pain. The patient is advised rest along with suitable pain medications. Crutches would be used till he can walk without a limp. Once the pain is reduced, physiotherapy would be advised. A custom made ACL brace may be suggested which may help keep the knee from giving way during moderate activity.
Posterior Cruciate Ligament (PCL) Surgery - The posterior cruciate ligament, or PCL, is one of four ligaments important to the stability of the knee joint. The PCL is the ligament that prevents the tibia (shin bone) from sliding too far backwards. PCL helps to maintain the tibia in position below the femur (thigh bone). Treatment of PCL tears is controversial, and, unlike treatment of an ACL tear, there is little agreement as how best to proceed. Initial treatment of the pain and swelling consists of the use of crutches, ice, and elevation. Surgical reconstruction of the PCL is controversial, and usually only recommended for grade III PCL tears. Surgical PCL reconstruction is difficult in part because of the position of the PCL in the knee.
Lateral Collateral Ligament (LCL) Surgery - The lateral collateral ligament is a thin band of tissue running along the outside of the knee. It connects the thighbone (femur) to the fibula, which is the small bone of the lower leg that turns down the side of the knee and connects to the ankle. Like the medial collateral ligament, the lateral collateral ligament's main function is to keep the knee stable as it moves through its full arc of motion. Lateral collateral ligaments tears do not heal as well as medial collateral ligament tears do. Grade 3 lateral collateral ligament tears may require surgery. Lateral knee reconstruction is an open-knee procedure, and is not done arthroscopically.
Medial Collateral Ligament (MCL) Surgery - The Medial Collateral Ligament (MCL) connects the inner (medial) surfaces of the femur (thigh bone) and the tibia (shin bone). Its function is to resist forces applied from the outer surface of the knee and so prevent the medial (inner) portion of the joint from widening under stress. Injury to the MCL often occurs after an impact to the outside of the knee when the knee is slightly bent. The MCL on the inside of the knee becomes stretched and if the force is great enough, some or even all of the fibres will tear. The deep part of ligament is prone to becoming damaged first and this may lead to medial meniscal damage also.
Ulnar Collateral Ligament (UCL) Surgery - The ulnar collateral ligament complex (UCL) is located on the inside (or medial side) of the elbow (small finger side of the arm). It is composed of three bands or divisions, the anterior, posterior, and transverse bands. The UCL attaches on one side to the humerus (the bone of the upper arm) and on the other to the coronoid process of the ulna (a bone in the forearm). The treatment of a UCL injury can follow the path of receiving surgical treatment or opting to not receive surgical treatment. There are two types of surgical treatments used in dealing with a torn UCL: (1) Repair of the existing ligament or (2) replacement or reconstruction of the ligament. Non surgical treatment will primarily focus on strengthening the elbow joint to regain strength and stabilize the joint In the instance of choosing to not have the surgery, patients are instructed to follow the “Rest, ice, compression, elevation” method while using “Non-steroidal anti-inflammatory drug” to help alleviate pain and swelling. When the swelling has subsided, individual exercises or physical therapy may be prescribed to assist in the recovery process.
Ankle Ligament Repair/Reconstruction - This procedure is performed to address ankle instability. Patients will typically have a history of recurrent ankle sprains. Their physical exam will demonstrate increased looseness of the outside (lateral) ankle ligaments. This is often confirmed on x-rays with a stress view. This procedure is performed through an incision on the outside (lateral) of the ankle. The incision is opened up down to the ankle joint.
Benefits of Ligament Surgery
For most people, the benefits in terms of improved symptoms are much greater than the disadvantages. Surgery is highly reliable, with a greater than 95% chance of success of restoring normal stability. Studies have shown that greater than 90% of individuals are able to return to all forms of athletic and work activities. This includes sports such as football, soccer, basketball, and skiing as well as manual labor. Professional athletes with this type of surgery return to their previous level of competition in the great majority of cases. Using an allograft (in ACL surgery) for tendon will allow the patient to avoid donor site morbidity reduces surgical time, smaller incisions and availability of larger graft. Keyhole surgery is carried out with the use of specially designed instruments which are inserted through small incisions, with the added benefit that this less invasive work generally involves a shorter recovery time.
Risks of Ligament Surgery
Some of the common risks associated with any ligament surgery include infection, viral transmission, bleeding, numbness, instability, and stiffness. This is completely normal and should last a few weeks, gradually improving as your knee heals.
Ligament Surgery in India
Indian hospitals have pool of surgeons who specializes in orthopedic surgery. These hospitals have got infrastructure for the prevention, diagnosis, and treatment of disorders of the musculoskeletal system. Patients suffering from various problems related to orthopedics like Adult joint reconstruction and revision, Foot and ankle injuries, Sports injuries, Hand surgery, etc are treated with high-quality, cost-effective orthopedic care. Indian hospitals are similarly ranked to those in the U.S. according to the world health organization. The hospitals in India use the latest techniques which have revolutionized the success rate of all surgical procedures.
Cities in India offering Ligament Surgery at some of the best and top orthopedic surgery hospitals are as follows;
Cost of Ligament Surgery in India
People who travel to India for their medical and surgical needs can get almost immediate access to an endless list of quality, world-class affordable medical and surgical procedures at a highly attractive and low cost. Every hospital combines a unique multidisciplinary team approach with the world’s most advanced technologies and procedures to manage the full spectrum of surgical care that will limit pain, speed recovery and reduce hospital lengths, at the most reasonable price. Each patient's unique needs are considered from a holistic perspective and then a customized treatment plan is tailored to best meet the needs of each patient. This is done without an extra cost.
Some of the common countries from which patients travel to India for surgery are:
Located in South Asia, bordered by Pakistan, Nepal, China and Bangladesh, India is South Asia's largest, sovereign, democratic republic. India has an edge over other countries when it comes to offering comprehensive, cost-effective and timely medical care: it also offers an exotic, adventure-filled or cultural -if you wish array of destinations to discover and revel in for the travelers. Indian cities like Mumbai, Hyderabad, Goa, Bangalore, Nagpur, Kerala, Delhi, Pune, Jaipur, Chennai, Gurgaon, and Chandigarh offers best medical tourism service.
Mumbai - A city quite unlike any other in the whole of India, Mumbai (previously named Bombay) is an island city, being located on Salsette Island, alongside the Arabian Sea. With an appealing coastline, many of Mumbai's top resorts and tourist attractions lie around its main beaches, which include both Juhu Beach and also Girgaum Chowpatty Beach, where evening funfairs provide plenty of atmosphere.
Hyderabad - Hyderabad city is the capital city of the Indian state of Andhra Pradesh, in the region of Telangana. Hyderabad city is known for its rich history, food and its multi-lingual culture, both geographically and culturally. Founded in the year 1591 by fifth Qutb Shahi Ruler Muhammad Quli Qutb Shah. Now known as the historicold city, home to the Charminar, Falaknuma Palace, Chowmallah Palace and Makkah Masjid, it lies on the southern bank of the river.
Goa – Goa, a small enclave on the West Coast of India is one of the best holiday destinations in the World. Famous for its long stretch of beaches dotted with shacks, it is a favorite destination for the European tourists who flock to Goa during the winter months. Swaying palms, white sands and sparkling waters: the three essential elements that attract 2 million visitors annually to Goa’s balmy shores are plentiful in this tiny, glorious slice of India
Bangalore - Bangalore, the capital of the Karnataka, is fifth largest city in India. Few Cities in the World has the power to attract and motivate a casual visitor to move there permanently. Bangalore is one of those rare cities, which makes people who are new to the City to call themselves proud Bangaloreans. Bangalore, with a wonderful climate is already a Pensioner's Paradise.
Nagpur - Capital of the "land of oranges" and geographically at the virtual centre of India, Nagpur is endowed with rich forest resources and in itself is the second greenest city in India. The forests around Nagpur are full of best quality teak plantations. Shopping in Nagpur may turn out to be a pleasant experience for the discerning shopper. Nagpur is designed specifically for its many tourists and families to avoid any small annoyances.
Kerala - The Land Kerala is a dramatic, narrow, leaf-shaped strip of land, flanked by the formidable Western Ghats on the east, and the Arabian Sea on the west. A land of unabashed wealth, its people are amongst the most progressive and literate of the Indian populace. This tropical spice garden has lured the Arabs, Chinese and Europeans for many centuries. Christianity and Judaism entered the subcontinent through the legendary white sand beaches of Kerala.
Delhi - Delhi the capital of India main point of arrival for overseas visitors, and the major transport hub. Delhi is just not a city but it is a book that narrates the history of India. The city was built and destroyed seven times and has been witness to the various events, which has brought India through the history books.
Pune - The city of Pune is situated in Maharashtra and is said to be the cultural capital of the state. Located at a distance of approximately 120 km from Mumbai, the city is one of major tourist destinations in India. The rich history, architecture and culture of the city makes it a must visit destination for the tourist coming to India.
Jaipur – The city of Jaipur, painted in pink, grasp the appreciation of every visitor. One can see that hoary charm still alive in the avenues of Jaipur. Jaipur offers World Class Medical Facilities, comparable with any of the western countries. It has state of the art Hospitals and the best qualified doctors.
Chennai – The Gateway to South India, Chennai is famous for its sandy beaches, parks and historic landmarks. With a very distinct culture, the people of Chennai have a special interest in music, dance and all other art forms of South India. Capital of the state of Tamil Nadu, Chennai has embraced both the new and the old with ease
Gurgaon – Gurgaon, the commercial capital of Haryana, is one of the most sought after destination for MNCs, Corporate, residents and Investors as it offers world class standard of living and globally comparable business address in the form of IT parks and Business Centers and along with that very prominent medical hub.
Chandigarh - Chandigarh is the best-planned city in India, with architecture which is world-renowned, and a quality of life, which is unparalleled. Chandigarh is a rare epitome of modernization co-existing with nature's preservation. It is here that the trees and plants are as much a part of the construction plans as the buildings and the roads.
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