Knee Ligament Injury - Causes, Symptoms & Treatment
Medically Reviewed By : Dr Sravya MBBS, MS
Introduction:
Feeling like your knee has given out? Do you feel any discomfort while walking or experiencing a lot of pain followed by swelling in your knee? And have you heard any popping sound in your knee recently?
This might be because of knee ligament injury or ligament tear.
Before we explore this topic, let’s discuss some basics first!
What are knee ligaments?
Knee ligaments are the elastic bands of tough, flexible tissues that bones to each other. It holds our knees together by providing strength and stability to the joint.
There are four major knee ligaments and these ligaments connect our thighbone (femur– largest & strongest bone in our body) to the shin bone (tibia– second largest bone in our body).
The four major ligaments of knee joint includes:
- Anterior cruciate ligament (ACL)--it is placed in the centre of the knee, controls rotation of the tibia and its forward movement.
- Posterior cruciate ligament (PCL)--it is placed in the back of the knee which controls backward movement of tibia.
- Medial collateral ligament (MCL)-- it provides stability to the inner knee.
- Lateral collateral ligament (LCL)-- it provides stability to the outer knee.
You may be wondering what a cruciate is? ‘Cruciate’ literally means ‘cross-shaped’ and in medical terms, it means when the two ligaments form a shape of a cross.
What is a knee ligament injury?
Knee ligaments are tough and extremely strong but they can be torn or overstretched resulting in a tear or a sprain injury. So usually this happens when a joint is forced out of its usual position such as when there is a fall, a sudden twist or a blow to the body.
These ligament tears or injuries are so common, especially in athletes as they overstretch, change direction suddenly while playing sports like basketball, tennis, volleyball, football, etc.
How common are these ligament injuries?
ACL injuries are the most common ligament injuries in the knee and it is observed that in the United States around 1-2 lakhs of incidents are seen every year. It can happen to anybody at any age but women are four times more likely to have an ACL tear than men.
There are no proper findings why women are more prone to knee ligament injuries. Some think it’s because of their muscle strength, physical conditions, looser ligaments and differences in how women jump and land could also be one of the reasons.
What causes a knee ligament tear or injury?
- ACL tear: The anterior cruciate ligament (ACL) is one of the most often injured knee ligaments because this ligament is often overstretched or torn when there is a sudden twist of motion, changing the direction suddenly or awkward landing. It mostly happens when playing a sport like– football, basketball & skiing. ACL tears usually require surgery.
- PCL tear: The posterior cruciate ligament (PCL) is also a common knee ligament to be injured. PCL injury often happens when there’s a sudden, direct impact like in a car accident or colliding with someone else like, during a football tackle.
- MCL & LCL tear: Whereas, the collateral ligament injuries are usually caused by a blow to the knee from outside such as when playing sports like hockey or football.
- Ligament injuries also occur in the shoulder, elbow, wrist and neck.
Scale of severity:
- When you hurt your ligament, the doctor will grade your injury based on the severity on a one to three scale and they are:
- Grade 1: This is considered as a minor sprain where the ligament is slightly torn or overstretched. You will experience a mild pain and swelling so you will be able to bear weight on the injured leg and can also bend the knee.
- Grade 2: This is considered as a moderate pain where the ligament is partially torn resulting in some bruising, swelling and pain. You will find a little difficulty in bearing some weight on the injured leg or bending the knee.
- Grade 3: A grade 3 injury is confirmed when the ligament is completely ruptured or torn. You will experience severe bruising, swelling and pain. You can’t bend your knee or bear weight on the leg.
What does a knee ligament injury feel like?
- You might hear a snap or a popping sound when your knee injures.
- You may feel your knee has given out– means your leg becomes unstable while trying to stand on it.
- You may also observe that your knee has swollen within 24 hrs of the injury.
- You may feel a lot of pain which occurs suddenly.
- Discomfort while walking
- Tenderness
- Loss of range of motion– you can only move your body part to some extent.
- A feeling of looseness in the joint
How is a knee ligament injury diagnosed?
When you visit your doctor with any of the symptoms mentioned above and the first thing they will do is:
- They may ask about your medical history, any recent falls or traumas, etc.
- They will ask about your present symptoms and perform a physical exam in which they will examine all the structures of your injured knee and compare them with your non-injured knee.
Imaging tests:
Other tests which may confirm or rule out the condition are:
- X-rays: It shows whether the injury is associated with a broken bone.
- MRI scan: It gives better pictures of other soft tissues.
- Arthroscopy: It is used to detect the tumours and bone diseases, also to determine the cause of bone pain and inflammation.
Treatment for knee ligament injury:
The treatment for a knee ligament injury is based on:
- Age
- How severe your injury is
- How well you can tolerate medications, procedures and therapies
- Your medical history
- How long will it take to recover
A mild to moderate knee ligament injury can heal on its own but, to speed the healing process, you can do this:
You can follow the R.I.C.E principle–
‘R’ stands for rest: Avoid putting on so much weight as it can be painful to do so. You may need to use crutches for some time if necessary.
‘I’ stands for ice: Ice your knee for at least 20-30 minutes every 3-4 hours to reduce the pain and swelling. Do it regularly for 2-3 days or until the swelling is gone completely.
‘C’ stands for compression: Put an elastic bandage, straps or sleeves on your knee to reduce the swelling.
‘E’ stands for elevation: Raise your knee on a pillow when you are sitting or lying down.
- Medications include NSAIDs such as aspirin, ibuprofen will help reduce your pain and swelling.
- Stretching and strengthening exercises can help you in the therapy but, never stretch too much that it hurts.
- Your doctor may recommend physiotherapy because in most of the cases, this condition can be resolved with physiotherapy and other non-surgical treatment.
Is surgery required?
In most cases, collateral ligament tears don’t require surgery but, there can be a few exceptions.
If a cruciate ligament (ACL & PCL) is completely torn or overstretched, you are only left with one option which is reconstructive knee surgery. In this procedure, a surgeon will replace your torn ligament with tendons from other parts of your leg or a cadaver.
Deciding to have a surgery:
The decision to have a knee ligament surgery depends on the severity of your injury. Generally, knee surgery is considered when there’s more than one ligament injury and if it’s affecting your quality of life very badly.
If you think that your knee is stable & don’t have an active lifestyle, you may decide not to have a surgery but delaying surgery can cause more damage to your knee if it becomes unstable.
Your doctor will provide many options for you and suggest if you need a surgery or not once the swelling goes down and if the physiotherapy and rest has helped you reduce the symptoms.
Risks associated with the surgery:
- In most of the cases, reconstructive knee surgery fully restores the functioning of the knee, although your knee may not be the same as it was before the injury.
- If other structures are also damaged in your knee, it will be difficult to repair them fully.
- Just like other surgeries, knee surgery is also involved with some risks such as infection, a blood clot, knee pain associated with weakness and stiffness.
- Sometimes, the surgery may fail and your knee will still be unstable.
- Your surgeon will recommend further surgery but, studies have shown that subsequent surgeries may not show effect as the first time knee surgery.
How long does it take to recover from the surgery?\
Your surgeon or physiotherapist recommends a rehabilitation programme after the surgery. They will recommend some exercises like weight-bearing exercises, strengthening exercises & physical therapy which will start within the first week after the surgery.
You will be given crutches which will help you to move forward and you will also be provided with a cryo/cuff– it’s a device which provides cold therapy to your knee to help control the pain and swelling.
To recover from a knee ligament surgery it approximately takes 6 months but it may take 12 months to do your regular physical activities.
How can I prevent knee ligament injuries?
- You can’t prevent all the knee injuries but, you can take some precautions to keep your ligaments safer. They may include:
- Exercise on level surfaces to decrease the chances of getting your knee twisted.
- Wear appropriate shoes which fit well.
- Always warm-up before exercise.
- Wear appropriate safety equipment for the sport you play.
- Maintain a healthy weight to reduce the pressure on the knees
- Be careful while tackling while playing sports like football
- Do regular stretching and strengthening exercises.
Don’t get lost in your pain!
Just because ligament injuries will only temporarily stop you from doing what you love, doesn’t mean you can just bear the pain and ignore it! Remember, you are responsible for your own recovery and make choices accordingly such as, to go for a surgery or not, going for physical therapy, to use crutches, etc.
Neglecting something like this doesn’t get you anywhere. Only if you want your normal life back, you should take action immediately!
If you stick to your physical therapy and follow the instructions strictly given by the doctors, you can return to doing your favourite things as soon as possible.