Knee Ligament Injuries
Ligaments are like strong ropes that help connect bones together and provide stability to joints. In the knee, there are four main ligaments. On the inner aspect of the knee is the medial collateral ligament (MCL) and on the outer aspect of the knee is the lateral collateral ligament (LCL). The other two main ligaments are found in the centre of the knee. These paired ligaments are called the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL). The MCL and the LCL work together with ACL and the PCL to keep the knee joint stable during movement. The MCL and LCL provide support at the inner and outer aspects of the knee while the ACL and the PCL lend support at the centre of the knee.
Types of Ligament Injuries:
The above ligaments of the knee can get damaged with injury, from a simple sprain to a total tear. The severity of the injury can be assessed by checking how much abnormal movement is there at the joint. A small tear may allow 5 mm of excess movement and a complete tear may allow gross abnormal movement.
The symptoms are pain and swelling from the injury. But when the person tries to weight bear or walk then the knee may feel ‘wobbly’ – instability- and you may feel like your knee is giving way or it is locking
You may feel or hear a popping or snapping sensation at the time of the injury. You may also find that you cannot stand properly on the affected leg or put your full weight on it.
Along with ligaments there may be damage to cartilage cushions of the knee joint. There may not be any pain if you injure the cartilage of the knee, but you may have some pain or discomfort from the swelling that follows an injury. Pain may be on the inside or outside of the knee joint depending on which part of the cartilage got damaged.
You may injure your knee ligament if:
- It receives an impact or is moved beyond its usual range of movement, for example if you have a fall or land awkwardly
- During sports that combines running, jumping and stopping with quick changes of direction, such as football
- Your knees hit the dashboard in a car accident - posterior cruciate ligament damage is sometimes called the 'dashboard injury' as this is often how it occurs
Gentle examination often helps but it may not be possible to fully examine in acute injuries due to severe pain. But in chronic injuries it is possible to come to a conclusion after the examination. X rays and MRI scans help further to diagnose more complicated or severe injuries.
The treatment you receive will depend on what damage you have done and how bad the damage is. In acute injury it is always – Rest, Ice application, elevation and immobilisation. In chronic injury– Stretching and strengthening physiotherapy and splinting.
In some situations, you may need to have surgery to repair the ligaments. This is likely to be the case if you have torn lateral collateral ligament, ACL especially in active people and there is a torn cartilage. Most medial collateral ligaments heal well with splinting but may rarely need repair. If there are more than two ligaments torn then it is best to repair them both. If PCL injuries remain chronically painful not responding to physiotherapy, need surgery.