abusyortho

10+ Year Member
Dec 19, 2008
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Attending Physician
This is not a trick question but one meant to be read carefully.

Tearing a ligament causes pain.

But does a TORN ligament that's been in a pt for over a year (not counting for factors like more injury that could or could not result to swelling) actually _cause_ pain.

I know we have pain receptors; but one would think that wouldn't be an issue of a year old TORN ligament.

If so, how does it cause the pain once torn and knee is stable?
 

Bille11

ortho-surgeon
10+ Year Member
Aug 26, 2008
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Germany
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Resident [Any Field]
i'd guess that the knee seems to be objectively stable but actually is not in any movement. have you tried complex stability tests like pivot-shift? or does the patient recall unease during walk/giving way, which causes pain?
that may make the damaged knee with torn (cruciate?) ligament feel painful sometimes.

of course you have to remember chronic pain factors like minor cartilage defects which gets worse with time.
 

abusyortho

10+ Year Member
Dec 19, 2008
6
0
Status
Attending Physician
The pt just came back from skiing at St Moritz. His knee is stable - he even skied without a brace but as the videos showed, his knee was more "flexible" on R leg - but is complaining about pain. I'm aware of the neurovascular etc pain, but I'm still trying to figure out if this can actually _cause_ pain. I spoke to neurology the other day and they talked about the tearing, but past that, my friend couldn't comment confidently.

ACL verified torn 14 months ago via MRI.
 

Bille11

ortho-surgeon
10+ Year Member
Aug 26, 2008
3
0
Germany
Status
Resident [Any Field]
regarding your initial question: there is evidence that the ligament itself does not contain any pain receptors, which has been demonstrated in clinical studies and laboratory confirmed trials (including a really impressive experiment where they arthroscoped knees in local anaesthetic, irritated menisci, cartilage, ligaments, inner capsule and noted whether the proband felt pain or not during each action)

depending on disordered proprioception of a knee with torn ligament you'll find some kind of weird movement which probably causes pain on overstressed parts of that joint, related to minor cartilage defects, meniscus-lesions.

i'd suggest that the patient should have a diagnostic arthroscopy of the knee so the extent of damage can be specified (and cleaning of the joint/-structures can be done the same time). just keep in mind that mri is not an 100% reliable instrument for joint diagnostics.
 
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