Ligament Injuries
ACL – Anterior Cruciate Ligament
When you twist your knee or fall on it, you can tear a stabilizing ligament that connects your thighbone to the shinbone. An anterior cruciate ligament (ACL) unravels like a braided rope when it's torn and does not heal on its own. Fortunately, reconstruction surgery can help many people recover their full function after an ACL tear.
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ACL Tear
Ligaments are tough, non-stretchable fibers that hold your bones together. The cruciate ligaments in your knee joints crisscross to give you stability on your feet. People often tear the ACL by changing direction rapidly, slowing down from running or landing from a jump. Young people (age 15 to 25) who participate in basketball, soccer, football, and other sports that require pivoting are especially vulnerable. You might hear a popping noise when your ACL tears. Your knee gives out and soon begins to hurt and swell.
First treatment includes rest, ice compression and elevation (RICE) plus a brace to immobilize the knee, crutches and pain relievers. Get to your doctor right away to evaluate your condition.
Diagnosis
Your doctor may conduct physical tests and take X-Rays to determine the extent of damage to your ACL. Most of the time, you need reconstruction surgery. Your doctor replaces the damaged ACL with strong, healthy tissue taken from another area near your knee. A strip of tendon from under your kneecap (patellar tendon) or hamstring may be used. Your doctor threads the tissue through the inside of your knee joint and secures the ends to your thighbone and shinbone.
In rare cases in children when the ACL is torn cleanly from the bone it can be repaired. Less active people may be treated nonsurgically with a program of muscle strengthening.
Treatment
Successful ACL reconstruction surgery tightens your knee and restores its stability. It also helps you avoid further injury and get back to playing sports. After ACL reconstruction, you'll need to do rehabilitation exercises to gradually return your knee to full flexibility and stability. Building strength in your thigh and calf muscles helps support the reconstructed structure. You may need to use a knee brace for awhile and will probably have to stay out of sports for about one year after the surgery.
PCL – Posterior Cruciate Ligament
The knee can be thought of as having four ligaments holding it in place, one at each side to stop the bones sliding sideways and two crossing over in the middle to stop the bones sliding forward and backward. It is the latter two in the middle that are called the cruciate ligaments, the posterior (meaning back) stops the knee from bending back the wrong way.
Causes
The PCL is injured through hyperextension of the knee or bending it backwards. If you have jarred the knee, or had someone land on top of a straight leg then the posterior cruciate may be damaged. If you have injured the joint recently and there is a lot of swelling then you should see a physician immediately.
Treatment
In milder injuries, nonoperative rehabilitation and a brace are sufficient. For more severe injuries, reconstruction using a graft (like for an ACL injury) is warranted.
MCL – Medial Collateral Ligament
The medial collateral ligament (MCL) is one of four ligaments that are critical to the stability of the knee joint. A ligament is made of tough fibrous material and functions to control excessive motion by limiting joint mobility. The four major stabilizing ligaments of the knee are the anterior and posterior cruciate ligaments (ACL and PCL, respectively), and the medial and lateral collateral ligaments (MCL and LCL, respectively).
The MCL spans the distance from the end of the femur (thigh bone) to the top of the tibia (shin bone) and is on the inside of the knee joint. The medial collateral ligament resists widening of the inside of the joint, or prevents "opening-up" of the knee.
Causes
Because the MCL resists widening of the inside of the knee joint, the MCL is usually injured when the outside of the knee joint is struck. This action causes the outside of the knee to buckle, and the inside to widen. When the MCL is stretched too far, it is susceptible to tearing and injury. This is the injury seen by the action of "clipping" in a football game. An injury to the MCL may occur as an isolated injury, or it may be part of a complex injury to the knee. Other ligaments, most commonly the ACL, or the meniscus (cartilage), may be torn along with a MCL injury.
Symptoms of a MCL injury tend to correlate with the extent of the injury. MCL injuries are graded on a scale of I to III.
Grade I MCL Tear
This is an incomplete tear of the MCL. The tendon is still in continuity, and the symptoms are usually minimal. Patients usually complain of pain with pressure on the MCL, and may be able to return to their sport very quickly. Most athletes miss 2-4 weeks of play.
Grade II MCL Tear
Grade II injuries are also considered incomplete tears of the MCL. These patients may complain of instability when attempting to cut or pivot. The pain and swelling is more significant, and usually a period of 4-6 weeks of rest is necessary.
Grade III MCL Tear
A grade III injury is a complete tear of the MCL. Patients have significant pain and swelling, and often have difficulty bending the knee. Instability, or giving out, is a common finding with grade III MCL tears. A knee brace or a knee immobilizer is usually needed for comfort, and healing may take 6 weeks or longer.
Treatment
Treatment of a MCL injury rarely requires surgical intervention. Almost always, some simple treatment steps, along with rehabilitation, will allow patients to resume their previous level of activity. The time before an athlete is able to return to their sport corresponds to the grade of the injury.
Grade I MCL Tears
Grade I sprains of the MCL usually resolve within a few weeks. Treatment consists of:
• Resting from activity
• Icing the Injury
• Anti-inflammatory medications
Most patients with a grade I MCL tear will be able to return to sports within 1-2 weeks following their injury.
Grade II MCL Tears
When a grade II MCL sprain occurs, use of a hinged knee brace is common in early in early treatment. Athletes with a grade II injury can return to activity once they are not having pain over the MCL. Patients with a grade II injury often return to sports within 3 to 4 weeks after their injury.
Grade III MCL Tears
When a grade III injury occurs, patients usually wear a knee immobilizer and protect weight bearing (crutches) for the first week to 10 days following injury. Patients should remove the immobilizer several times a day to work on bending their knee. After that time, the patient can begin wearing a hinged knee brace, and can begin to increase their range of motion in the knee. They can apply more weight to the knee as pain allows.
Once the patient can flex the knee at least to 100 degrees, they may begin riding a stationary bicycle. The crutches can be discontinued once the patient is able to walk without limping. Jogging can begin once the patient has regained 60% of their quadricep strength (compared to the opposite side), and agility drills can begin one they have regained 80% of their strength. Complete rehab from a grade III MCL tear can take 3 to 4 months.
Is Surgery Ever Needed for a MCL Tear?
Some surgeons describe a so-called grade IV injury to the MCL. This is also called a medial column injury, and involves injury to more ligaments than just the MCL. Whether or not to repair the MCL, even in these settings, is controversial. Some doctors prefer to allow all MCL injuries to heal without surgery, and some prefer to repair these most significant injuries to the MCL. No significant difference has been demonstrated in these patients.
LCL - Lateral Collateral Ligament
The lateral collateral ligament (LCL) is one of the four knee ligaments. It spans the distance from the end of the femur (thigh bone) to the top of the fibula (thin, lateral, outer, longer leg bone) and is on the outside of the knee. The lateral collateral ligament resists widening of the outside of the joint. It is much less frequently injured than the MCL. Milder injuries are treated nonoperatively like MCL injuries with rest, ice, rehabilitation, and bracing with return to sports in 4-6 weeks. More severe injuries may require surgical repair or reconstruction. |
