The most common types of ligament injuries include:
ACL & PCL Ligaments
The Anterior Cruciate Ligament (ACL) is most often stretched or torn (or both) by a sudden twisting motion or hyperextended. The Posterior Cruciate Ligament (PCL) is most often injured in direct impact, such as a car accident or football tackle.
Symptoms: Injury to a cruciate ligament may not cause pain. Popping and buckling are common. An MRI will accurately detect a complete tear, but arthroscopy may be the only reliable means of detecting a partial one.
Treatment: For an incomplete tear, patients will benefit from bracing and physical therapy. For a complete tear, especially in athletes and active people, surgery is recommended, with reconstruction using allografts or autografts.
An ACL injury is a sports-related injury that occurs when the knee is forcefully twisted or hyperextended. An ACL tear usually occurs with an abrupt directional change with the foot fixed on the ground or when the deceleration force crosses the knee. Changing direction rapidly, stopping suddenly, slowing down while running, landing from a jump incorrectly, and direct contact or collision, such as a football tackle, can also cause injury to the ACL.
Posterior cruciate ligament (PCL), one of four major ligaments of the knee are situated at the back of the knee. It connects the thighbone (femur) to the shinbone (tibia). The PCL limits the backward motion of the shinbone.
PCL injuries are very rare and are difficult to detect than other knee ligament injuries. Cartilage injuries, bone bruises, and ligament injuries often occur in combination with PCL injuries.
Injuries to the PCL can be graded as I, II or III depending on the severity of injury.
- Grade I -- the ligament is mildly damaged and slightly stretched, but the knee joint is stable.
- Grade II-- there is partial tear of the ligament.
- Grade III-- there is complete tear of the ligament. The knee joint is unstable, and the ligament is divided into two halves making.
The PCL is usually injured by a direct impact, This can occur in sports when an athlete falls to the ground with a bent knee. The PCL can also tear with twisting or by overextending the knee.
Patients with PCL injuries usually experience knee pain and swelling immediately after the injury. There may also be instability in the knee joint, knee stiffness that causes limping, and difficulty in walking.
Diagnosis of a PCL tear is made based on a review of symptoms, medical history, and by performing a physical examination of the knee. Other diagnostic tests such as X-rays and MRI scan may be ordered. X-rays are useful to rule out avulsion fractures wherein the PCL tears off a piece of bone along with it. An MRI scan is done to help view the images of soft tissues better.
Treatment options may include non-surgical and surgical treatment. Non-surgical treatment consists of rest, ice, compression, and elevation (RICE protocol); which assist in controlling pain and swelling. Physical therapy may be recommended to improve knee motion and strength. A knee brace may be needed to help immobilize your knee.
Crutches may be recommended to protect the knee and avoid bearing weight on your leg.
Generally, surgery is considered in patients with dislocated knee and several torn ligaments including the PCL. Surgery involves reconstructing the torn ligament using a tissue graft which is taken from another part of your body, or another human donor. Surgery is usually carried out with an arthroscope using small incisions. The major advantages of arthroscopic surgery include minimal postoperative pain, short hospital stay, and a fast recovery. Arthroscopic surgery can often be done in an out-patient setting. Following PCL reconstruction, a physical therapy program will be started after surgery to facilitate healing and range of motion.
The MCL is the ligament that is located on the inner part of the knee joint. It runs from the thighbone (femur) to the top of the shinbone (tibia) and helps stabilize the knee. MCL injuries can result in a stretch, partial tear, or complete tear of the ligament. Injuries to the MCL commonly occur because of pressure or stress on the outside section of the knee. The Medial Collateral Ligament is more often injured than the Lateral Collateral Ligament. The cause is most often a blow to the outer side of the knee that stretches and tears the ligament on the inner side of the knee. Such blows occur frequently in contact sports.
When a collateral ligament is injured patients may experience
- A pop
- Sideways buckle
- Pain and swelling are common.
It is important to see a doctor if there is a popping noise or inability to move the knee because of severe pain. Knee instability is also a sign that a physician should be consulted.
The R.I.C.E. method of treatment can be initiated following the injury before seeing a doctor:
- Rest: Rest the knee, as more damage could result from pressure on the injury.
- Ice: Ice packs can be applied to the injured area to reduce swelling and pain. Never place ice directly over the skin. Ice should be wrapped in a towel and applied to the affected area for 15-20 minutes, four times a day for several days.
- Compression: Wrapping the knee with an elastic bandage or compression stocking can help minimize the swelling and support your knee.
- Elevation: Elevating the knee above the heart level will also help reduce swelling and pain.