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Knee Ligament Injury

Knee ligament damage is often caused by knee trauma. We look at the signs of a knee ligament injury and how it can be treated.

The knee is the largest and strongest joint in the body. Due to its location in the body and the demands placed upon it by normal daily life, the knee joint is a common place to feel pain or suffer injury. The basic function of the joint is to allow movement of the leg in a front to back direction.

A torn ligament in knee occurs when an excessive strain is placed across the knee, overloading the supporting ligament. This often results in knee damage and pain.

Ligaments are strong, fibrous bands of connective tissue that run through the joints of the body. They connect two adjacent bones and provide strength and stability to a joint.

The knee has four main ligaments:     

  • The anterior cruciate ligament (ACL) helps to prevent the knee from over-rotating and helps to limit forward movement of the shinbone (tibia) on the thigh bone (femur).      
  • The posterior cruciate ligament (PCL) helps to prevent the knee from over-rotating and helps to limit backwards movement of the shinbone on the thigh bone.      
  • The medial collateral ligament (MCL) supports the inner side of the knee.        
  • The lateral collateral ligament (LCL) supports the outer side of the knee.

Knee ligament damage is mostly caused by trauma to the knee. This trauma commonly occurs with some sporting activities that require rapid changes of direction, such as football, rugby, netball, or if during contact, such as being tackled in football.

Of the four ligaments, ACL is the most common knee ligament injury. The ACL can be damaged by twisting the knee in the wrong direction. This can typically occur when the feet remain planted but the legs twist, resulting in a complete tear of the ACL. Sports, such as skiing and football, commonly see a higher occurrence of ACL injuries.

The second most common knee ligament injury is damage to the PCL. A PCL injury is much less common than a torn ACL because it requires direct impact to the knee. This back of knee ligament can occur during some sports, such as being tackled while playing football, although it is much more likely to result from a road traffic accident (RTA).

The remaining two ligaments (MCL and LCL) are much less likely to be damaged and are much rare injuries. However, these ligaments can become stretched or torn, particularly if the outside of the knee receives a blow.

It is possible that during a high-impact blow to the knee that multiple ligament knee may injuries occur.

A knee ligament tear can be reliably diagnosed by your doctor or physiotherapist. During your consultation, the orthopaedic surgeon will take a look at the history of your condition and by conducting a physical examination.

The examination will look at specific movements of the knee, using a set of tests designed to stress each ligament. X-rays or other scans may be requested to exclude any associated fracture or cartilage injury or to plan surgery if needed.

Torn ligament in the knee symptoms may vary depending on which ligament has been affected.

For a cruciate ligament tear, pain and a rapid onset of swelling are the most common symptoms at the time of the injury. You may also hear the sound of a pop that comes from the knee. This occurs in around 70% of these cases. Pain may increase with a bent knee and pressure is applied to the joint.

If you experience any knee swelling it is recommended to seek the advice of a suitably qualified clinician to obtain appropriate clinical guidance.

The location and extent of pain and swelling will depend on the ligament injured and the severity of the injury. Pain medication and an ice pack may give some pain relief while medical attention for the injury is sought.

Following the injury, the pain and swelling should begin to reduce. The main symptoms now are usually stiffness and weakness to the knee joint. It is vital that early and regular movements and rehabilitative exercises are taken to reduce stiffness and maintain power.

Some individuals may experience ongoing knee joint instability, giving way and pain. It is very difficult to predict who may experience these symptoms as there is little correlation between the severity of knee ligament injury and ongoing knee instability.

Sticking to a supervised knee joint strengthening and co-ordination rehabilitation routine will significantly reduce the chances of developing ongoing knee pain and instability

Initial treatment will focus on the knee ligament pain. The acute phase management is aimed at reducing swelling and alleviating pain to allow rehabilitation to commence as early as possible following injury.

To handle the pain, it’s advisable to follow the MICE procedure, which stands for Movement, Ice, Compression and Elevation. The following self-help videos explain how to safely follow a MICE routine after an injury:

Ongoing management of a torn ligament requires a supervised rehabilitation program of exercises to ensure the knee restores its full range of motion. This is to ensure that appropriate grading of strengthening and coordination exercises are undertaken.

The knee ligament injury treatment exercises below are a guide to the type of rehabilitation indicated. The exercises will help to reduce the knee ligament injury recovery time. In significant ligament injuries it is important to seek professional advice to ensure the correct exercises are being performed at the right stage of rehabilitation.

These regular knee pain exercises will enhance muscular strength, flexibility and range of motion across the knee joints:

Standing quads stretch with posterior tilt

In each exercise, perform the five stretches for 30 seconds each. This exercise should be performed twice a day.

Inner Range Quadriceps (IRQ) with weight

In each exercise, perform three sets of 10 reps each. This exercise should be performed three to four times a week.

Side lying abduction

In each exercise, perform three sets of 10 reps each. This exercise should be performed three to four times a week.

Surgery is rarely required as part of collateral ligament knee injury treatment, which normally respond well to rehabilitation

For sports injuries with a torn ligament, ACL reconstruction is an effective option if instability or a ‘giving way’ of the knee continues in spite of undergoing a supervised rehabilitation regime.

Specialists Offering Knee Ligament Injury

Mr Nitin Modi

Consultant Orthopaedic Surgeon

MBBS, MS Orthopaedics FRCS (T&O), MS Orthopaedics, MRCS, FCPS Orthopaedics, Diploma Orthopaedics

BMI St Edmunds Hospital

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Mr Drummond Mansbridge

Consultant Orthopaedic and Trauma Surgeon

MBChB(Glasg), FRCS(Glasg), FRCS(Trauma and Orthopaedics)

BMI Ross Hall Hospital

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Mr Iain Adam Findlay

Consultant Orthopaedic Surgeon

MBChB, BSc(Hons), FRCS (Tr&Orth).

BMI The Winterbourne Hospital

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Mr Bhupinder Singh Mann

Consultant Orthopaedic Surgeon

BSc, MBBS, MRCS, FRCS, (Tr. & Orth.)

BMI The Chiltern Hospital 1 more BMI The Shelburne Hospital

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Professor Sanjiv Jari

Consultant Knee, Lower Limb and Orthopaedic Sports Medicine Surgeon

BSc (Hons), MBChB, FRCS(Eng), FRCS(Tr&Orth), Orthopaedic Sports Medicine Fellowship(USA), CCST (Tr.& Orth) , Certificate of Completion of Surgical Training

BMI The Alexandra Hospital

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Mr Sanjiv Manjure

Consultant Orthopaedic Surgeon

MBBS, MS, McH, FRCS, FRCS(Orth)

BMI The Manor Hospital

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