Knee Ligament Injuries
Last updated date: 06-Jul-2023
Originally Written in English
Knee Ligament Injuries
Because the knee is a complex joint with numerous components, it is prone to a variety of ailments. Sprains, ligament tears, fractures, and dislocations are some of the most frequent knee ailments. Many knee injuries may be treated successfully with modest treatments like bracing and rehabilitation exercises. Other injuries may need surgery to repair.
Anatomy of the Knee joint
The knee is the body's biggest joint and one of the most vulnerable to injury. It is composed of four major structural components: bones, cartilage, ligaments, and tendons.
- Bones. The knee joint is made up of two bones: the thighbone (femur) and the shinbone (tibia). To give some protection, the kneecap (patella) rests in front of the joint.
- Articular cartilage. Articular cartilage covers the extremities of the femur and tibia, as well as the rear of the patella. As you bend or straighten your leg, this slick material allows your knee bones to move easily over one other.
- Meniscus. Between your femur and tibia, two wedge-shaped sections of meniscal cartilage operate as shock absorbers. The meniscus, unlike articular cartilage, is strong and springy to assist cushion and support the joint. When people speak about torn cartilage in the knee, they typically mean a torn meniscus.
- Ligaments. Ligaments link bones to one another. The four major ligaments in your knee operate like strong ropes to hold the bones together and stabilize your knee.
- Collateral ligaments. These are located on the inside and outside of your knee. The medial collateral ligament is located on the inside of your knee, whereas the lateral collateral ligament is located on the outside. They are in charge of your knee's side-to-side movement.
- Cruciate ligaments. These are located within your knee joint. They form an X by crossing each other, with the anterior cruciate ligament in front and the posterior cruciate ligament in rear. Your knee's forward and back mobility is controlled by the cruciate ligaments.
- Tendons. Tendons link muscles and bones. The quadriceps tendon links the front thigh muscles to the patella. In contrast, the patellar tendon connects the patella to the tibia.
What are Knee Ligament Injuries?
Knee ligaments are the strong, flexible bands of connective tissue that hold the knee together. Trauma, such as a vehicle collision, can result in knee ligament injury. Sports injuries might also cause them. A twisting knee injury in basketball or skiing is an example.
There are four primary ligaments in the knee. Ligaments are the connective tissue that holds bones together. They provide stability and strength to the joint. The four knee ligaments connect the femur (thighbone) to the shin bone (tibia). They are as follows:
- Anterior cruciate ligament (ACL). This ligament is in the center of the knee. It controls rotation and forward movement of the shin bone.
- Posterior cruciate ligament (PCL). This ligament is in the back of the knee. It controls backward movement of the shin bone.
- Medial collateral ligament (MCL). This ligament gives stability to the inner knee.
- Lateral collateral ligament (LCL). This ligament gives stability to the outer knee.
What causes knee ligament injuries?
1. Cruciate ligaments
The ACL is one of the most often damaged ligaments. During a quick twisting action, the ACL is frequently strained or torn. This is when the feet remain planted in one direction while the knees turn in the opposite direction. Slowing down when jogging or landing awkwardly from a leap might result in ACL injury. ACL injuries are more common in activities like skiing, basketball, and football.
The PCL is another often damaged ligament in the knee. A PCL injury, on the other hand, is frequently caused by a quick, direct hit, such as in a vehicle accident or during a football tackle.
2. Collateral ligaments
The MCL is more commonly damaged than the LCL. A hit to the outside of the knee frequently causes stretch and tear damage to the collateral ligaments. When playing hockey or football, this might happen.
3. Cruciate injury
A cruciate ligament injury is frequently painful. When an injury occurs, you may hear a popping sound. When you try to stand on it, your leg buckles. The knee expands as well. You are also unable to move your knee as normally as you would. You may also have discomfort along the joint and during walking.
The symptoms of a cruciate ligament damage may mimic those of other medical problems. Always consult your doctor for a diagnosis.
4. Collateral ligament injury
A collateral ligament damage also causes the knee to snap and buckle. It also causes discomfort and edema. Pain on the sides of the knee and swelling around the injury site are common symptoms. If you have an MCL injury, the discomfort will be on the inside of your knee. Pain on the outside of the knee may result from an LCL damage. The knee will also feel unstable, as though it would give way.
How are Knee Sprains and Tears Classified?
A healthcare provider will grade your injury by how severe it is and what symptoms you have:
- Grade 1: A grade 1 knee ligament damage is a modest sprain. The ligament is either overstretched or somewhat torn. A grade 1 knee strain causes little discomfort, swelling, or bruising. You can still put weight on the afflicted leg and bend the knee.
- Grade 2: A grade 2 knee sprain is a mild (partial) ligament rupture. Bruising, swelling, and discomfort are all symptoms. A grade 2 injury will make it difficult to place weight on the leg or bend the knee.
- Grade 3: A complete tear or rupture of the knee ligament is classified as a grade 3 injury. Grade 3 knee ligament injuries sometimes include more than one knee ligament. You will endure extreme bruising, swelling, and discomfort with this level of injuries. You will be unable to bear weight on your leg or bend your knee.
Common Knee Injuries
Sprains and rips of soft tissues (e.g., ligaments, meniscus), fractures, and dislocation are the most frequent knee injuries. In many situations, injuries to the knee involve more than one component.
The most frequent symptoms of knee damage are pain and swelling. Furthermore, the knee may snag or lock. Some knee injuries (for example, an ACL rupture) induce instability, or the sensation that your knee is giving way.
Anterior Cruciate Ligament (ACL) Injuries
During sports, the anterior cruciate ligament is frequently damaged. ACL injuries are more common in athletes who play cutting and pivoting sports like as soccer, football, and basketball. The ACL can be torn if you change direction quickly or land poorly following a jump.
Approximately half of all anterior cruciate ligament injuries occur in conjunction with injury to other components in the knee, such as articular cartilage, meniscus, or other ligaments.
What are the symptoms of an ACL injury?
When the ACL rips (ruptures), there is frequently a popping sound as well as pain and swelling in the knee within an hour. Patients often stumble for a week or more until things calm down.
People with an ACL injury can resume normal activities in around 20% of instances. However, most patients experience chronic symptoms such as knee instability (when the knee gives way, particularly while changing direction while walking or jogging) and recurring pain. Early therapy can help to avoid further injury to surrounding tissue each time the knee gives way. This includes cartilage damage, meniscal tears (which impact around 70% of ACL injury patients), and arthritis.
How is an ACL injury diagnosed?
Your consultant will talk with you about your symptoms and evaluate your knee to look for soreness, stiffness, edema, and other issues. He may also ask you to move your knee into various positions to examine your range of motion and joint function.
In most circumstances, they will schedule an X-ray to confirm the diagnosis. He will also arrange for you to get an MRI scan to determine the degree of the injury and any damage to the surrounding tissues.
How is an ACL injury treated?
- Non-surgical treatment consists of physiotherapy and supplementary support, such as a knee brace, when participating in sports. There are additional ACL preventive programs available to aid in recovery and the avoidance of future injuries.
- Surgery: If your knee often gives way during routine daily activities or prohibits you from participating in sports, your doctor may recommend ACL surgery. Traditionally, this operation required a year of recuperation; however, new approaches for treating ACL injuries pioneered have reduced this to four months. Along with your ligament surgery, you may be administered Activated Mesenchymal Pericyte Plasma injections (AMPP®).
Posterior Cruciate Ligament (PCL) Injuries
A hit to the front of the knee when the knee is bent frequently injures the posterior cruciate ligament. This is common in car accidents and sports-related contact. Posterior cruciate ligament injuries are usually partial rips that can heal on their own.
What are the symptoms of a PCL injury?
- Pain and swelling in the knee
- Difficulty walking
- Knee instability (feeling as if your knee may give way)
How is a PCL injury diagnosed?
The doctor will talk with you about your symptoms and assess your knee for soreness, stiffness, edema, and difficulty moving. In most circumstances, he will schedule an X-ray to confirm the diagnosis. He will also arrange for you to have an MRI scan to determine the extent of your injury and any damage to the surrounding area.
How is a PCL injury treated?
If the PCL is the only ligament injured, it may usually be treated without surgery by resting the knee, elevating it, and following a physiotherapy program; you may also be advised to wear a knee brace.
A novel approach for PCL surgery has been developed that involves strengthening the reconstruction with fiber tape (internal brace reconstruction). The orthopedic doctor has the most expertise in the world with this approach, which has transformed the outcomes of PCL surgery, and he is routinely asked to show it to other surgeons.
Collateral Ligament Injuries
Injuries to the collateral ligaments are usually caused by a force that pushes the knee sideways. These are often contact injuries.
- Injuries to the MCL are usually caused by a direct blow to the outside of the knee and are often sports-related.
- Blows to the inside of the knee that push the knee outwards may injure the lateral collateral ligament (LCL). Lateral collateral ligament tears occur less frequently than other knee injuries.
Medial collateral ligament (MCL) injuries
The MCL, one of the most often damaged ligaments, stabilizes the inside (medial) region of the knee and feels stiff while your leg is straight. It joins the thigh bone to the lower leg bone and prevents the knee from bending inwards. When the knee is knocked laterally, it is frequently hurt and, in certain situations, can be damaged alongside other ligaments in the knee.
What are the symptoms of an MCL injury?
- A popping sound when you are injured
- Pain, tenderness and swelling on the inner knee
- Feeling as if the knee is going to give way
- Locking or catching in the knee joint
How is an MCL injury diagnosed?
The doctor will talk with you about your symptoms and assess your knee for soreness, stiffness, edema, and difficulty moving. He will also do a 'Valgus' test, which involves bending your knee and applying pressure to the outside of it. In most circumstances, he will schedule an X-ray to confirm the diagnosis. He will also arrange for you to get an MRI scan to determine the degree of your injuries and any damage to the surrounding region.
How is an MCL injury treated?
This is determined by the severity of the ligament injury and whether additional ligaments are also impacted. If you have simply injured the MCL, you may generally treat it without surgery with a simple knee brace that holds the knee bent for 4-6 weeks. However, if the rip is severe or additional ligaments are involved, the doctor may recommend ligament surgery, which can include direct repair using the internal brace approach or ligament reconstruction.
Doctors advocate the Internal Brace repair approach using fiber tape for acute injuries and multi-ligament injuries. This helps to stabilize the joint and allows you to begin modest activity within a week following surgery.
- Acute meniscal tears are common in sports. Meniscus tears can occur as a result of twisting, cutting, turning, or being tackled.
- Meniscal tears can also be caused by arthritis or age. If the menisci have deteriorated with age, even an unpleasant twist when getting out of a chair may be enough to trigger a rip.
Stretching and tearing of the quadriceps and patellar tendons are possible. Although these tendons can be injured by anybody, tears are more likely in middle-aged adults who participate in running or jumping activities. Knee tendon injuries are commonly caused by falls, direct stress to the front of the knee, and landing awkwardly from a jump.
Multi-ligament knee injuries
A multi-ligament injury occurs when two or more ligaments are damaged at the same time. Most instances also include cartilage damage or a meniscal rupture, as well as knee instability. There is a larger danger of harm to the major blood arteries and nerves around your knee if you have a multi-ligament injury; this may necessitate multi-ligament surgery, which may entail more than one procedure to stabilize the knee and prevent future damage.
Treatment of Multi-ligament injuries
A comprehensive evaluation by an expert physician is required for anyone suspected of having a multiple ligament damage. Depending on the severity of the damage, the orthopedic surgeon may refer the patient to a vascular surgeon or a microsurgeon.
In contrast to single ligament tears, surgery for combined ligament tears is frequently performed shortly after the accident. Early surgery may be required to repair some of the torn ligaments, which become more difficult to mend as time goes on, or to address acute vascular problems. Arthrofibrosis can complicate acute surgery to repair numerous damaged ligaments (a scar forming in the joint causing stiffness). When treating numerous ligament injuries, more than one procedure may be necessary, such as two stages of ligament restoration or a second surgery to relieve scar tissue.
How can I prevent knee ligament injuries?
Not all knee injuries are avoidable. However, you may take precautions to protect your knee ligaments, particularly during exercise:
- Avoid sports that involve tackling, such as football and rugby.
- Exercise on level surfaces to decrease the chances you’ll twist a knee.
- Maintain a healthy weight to reduce pressure on the knees.
- Vary your exercise routine, combining weight training and aerobic activities (cardio).
- Warm up before you exercise, increase intensity gradually and stretch afterward.
- Wear shoes that fit well.
- Wear all appropriate safety equipment for any sports you play.
Knee ligaments link the bones and cartilage while also holding the knee joint together and supporting it. They are constructed from thick, rubbery connective tissue. The knee is supported and stabilized by four main ligaments, which can be damaged while participating in activities such as rugby, tennis, football, or skiing.