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Knee Injury - Ligament Injury

knee ligament injury


There are four bones around the area of the knee joint: the femur (thigh bone), the tibia (the main shin bone), the fibula (the outer shin bone) and the patella (the knee cap). But the main movements of the knee joint are between the femur, the tibia and the patella. Articular cartilage (tough connective tissue) lines the ends of the tibia and femur and the back of the patella around the knee joint.

There are also four ligaments around the knee joint. A ligament is a tough strip of connective tissue that joins one bone to another bone around a joint. The knee joint ligaments help to stabilize and support the knee when it is moved into different positions.

Each ligament has a different job to do:

  • The anterior cruciate ligament (ACL) is one of the ligaments inside the knee joint. This ligament helps to stabilise the knee joint by controlling backward and forward movements of the knee. It stops the tibia bone from moving forwards in front of the femur.
  • The posterior cruciate ligament (PCL) is the other ligament inside the knee joint. The PCL helps to control the forward and backward movements of the knee.
  • The medial collateral ligament (MCL) is one of the ligaments on the outside of the knee joint. It runs between the femur and the tibia on the inner side of the knee. It helps to limit the amount that the knee moves from side to side.
  • The lateral collateral ligament (LCL) is the other main ligament on the outside the knee joint. It runs between the femur and the fibula on the outer side of the knee.  This ligament also helps to limit the amount the knee moves from side to side.

The knee joint is surrounded by a protective joint capsule.

What is a knee ligament injury?

The ligaments around the knee are strong. However, sometimes they can become injured. They may be sprained (stretched), or sometimes ruptured (torn). A ligament rupture can be partial (just some of the fibres that make up the ligament are torn) or complete (the ligament is torn through completely).
There are a number of different things that can cause injury to the ligaments in your knee:

  • You may have a direct blow to your knee or knock into something with your knee.
  • Your knee may be moved outside of its usual range of movement. For example, this can happen during a fall, if you land awkwardly during sport, or after a sudden movement.
  • ACL injury most often occurs during sports such as football, basketball, skiing and tennis. The injury often happens if you land on your leg and then quickly pivot or twist your knee in the opposite direction.
  • Injury to this PCL is not as common as an ACL injury. This is because the PCL is wider and stronger than the ACL. There are a number of ways that the PCL can become injured. For example, it may be injured during a car accident if the front of your bent knee hits the dashboard. It may also be injured from falling on to your bent knee.
  • Injuries to the MCL can happen in almost any sport and can affect people of all age groups. They often happen when your leg is stretched out in front of you and the outer side of your knee is knocked at the same time - for example, during a rugby or football tackle.
  • Injury to the LCL is less common than injury to the MCL. This is because your other leg usually protects against injury to the inner side of your knee. But, this ligament injury can sometimes happen if one leg is stretched out in front of you and doesn't have the other leg for protection - for example, during a rugby or football tackle.

What are the symptoms of a knee ligament injury?

Symptoms can include:

  • A popping sound.
  • Swelling of your knee..
  • Pain in your knee.
  • Tenderness around your knee on touching.
  • Not being able to use or move your knee normally.
  • A feeling that your knee is unstable or perhaps giving way if you try to stand on it.
  • Bruising around your knee can sometimes appear, although not always. It may take some time for bruising to develop.

How is a knee ligament injury diagnosed?

If you feel that you may have a knee ligament injury, you should see a doctor. If your doctor is concerned that you may have a more serious knee ligament injury, they may refer you for further tests such as an ultrasound scan or an MRI scan. Such tests should be able to show up any tears or rupture of your ligaments. Sometimes, an X-ray of your knee may be suggested.

What is the treatment for a knee ligament injury?

For the first 48-72 hours think of:

Paying the PRICE - Protect, Rest, Ice, Compression, Elevation; and
Do no HARM - No Heat, Alcohol, Running or Massage.

Medication

Paracetamol: Paracetamol is useful to ease pain. It is best to take paracetamol regularly, for a few days or so, rather than every now and then. An adult dose is two 500 mg tablets, four times a day.
Anti-inflammatory painkillers: these drugs are also called non-steroidal anti-inflammatory drugs (NSAIDs). They relieve pain and may also limit inflammation and swelling. There are many types and brands.
Rub-on (topical) anti-inflammatory painkillers: again, there are various types and brands. You can buy one containing ibuprofen, without a prescription, at pharmacies. Some studies suggest that they may be as good as tablets for treating sprains

Physiotherapy

This may be helpful after some knee ligament injuries. Physiotherapy may help to improve the range of movement in your injured knee. Exercises may also be suggested to help strengthen the muscles that support your knee joint.

Knee braces

Depending on the knee ligament injury that you have, your doctor may advise you to wear a special brace to support your knee while the damaged ligament heals. Knee braces usually have a hinge mechanism that allows some bending and extending movement of your knee joint but not movement of your knee from side to side.

Surgery

  • You are someone who does a lot of sport or you are a very active person and you have injured your ACL.
  • You have injured more than one knee ligament, or you have injured a knee ligament and have also injured another part of your knee.
  • You have ruptured your LCL.

If surgery is carried out to repair a torn ACL, your doctor will usually advise that you wait some weeks after your initial injury. The ACL ligament cannot simply be stitched back together. Instead, surgery to reconstruct, or rebuild, the ACL is usually carried out.

Usually tendons from within your own body or sometimes, tendons from someone else (a donor) may also be used to repair your ACL. The tendon is fixed in place inside your knee joint, using staples or screws. Once fixed in place, over time, a new ligament should grow over the tendon that has been used. Keyhole surgery is usually used to reconstruct your ACL.

There is currently some debate as to the best way to treat PCL injury - with surgery, or without surgery.

Surgery is not often needed for MCL injuries.

How long does a knee ligament injury take to heal?

This will depend on which knee ligament you have injured and also how severe your injury is. Also, if you have injured more than one ligament in your knee, recovery may take longer.

If you have surgery to repair your ACL, it usually takes around six months before your knee has recovered enough for you to return to your previous sporting activities.
If your PCL has been treated using surgery, it can take between 9 and 12 months before complete recovery.


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