Knee Ligament Injury
Article by H.Giebeler, M.Batch
Knee Ligament Injury
Knee Ligament Tear – Knee Ligament Strain – Knee Ligament Rupture
What is a Knee Ligament?
A ligament is a short band of tough fibrous connective tissue composed mainly of long, stringy collagen molecules. Knee ligaments connect bones to other bones in and around your knee joint. They do not connect muscles to bones; that is the function of tendons. Knee ligaments limit the amount of mobility of your knee joint or prevent specific movements altogether.
Major Knee Ligaments
- ACL: Anterior Cruciate Ligament
- PCL: Posterior Cruciate Ligament
- MCL: Medial Collateral Ligament
- LCL: Lateral Collateral Ligament
- Coronary Ligament
What Causes Knee Ligament Injuries?
You can injure a knee ligament through a sharp change in direction, landing wrong from a jump, or the most common a blunt force hit to the knee, such as in a football tackle. The incident usually needs to happen at speed. Muscle weakness or incoordination predispose you to a knee ligament sprain or tear. Overstretching your knee ligaments will result in a torn knee ligament. Your knee physiotherapist or doctor will determine your knee ligament injury’s severity and recommend the appropriate treatment.
Knee Ligament Pain
Did you know that more severe knee ligament injuries may be less painful than milder knee ligament injuries? Why?
Symptoms & Severity of Knee Ligament Injuries?
The severity and symptoms of a ligament sprain depend on the degree of stretching or tearing of the ligament.
In a mild, grade I sprain, the ligaments may stretch, but they don’t tear. Although the joint may not hurt or swell very much, a mild sprain can increase the risk of a repeat injury.
With a moderate, grade II sprain, the knee ligament tears partially. Swelling and bruising are common, and the use of the joint is usually painful and challenging.
With a severe, grade III sprain, your ligament tears completely, causing swelling and sometimes bleeding under the skin. As a result, the joint is unstable and unable to bear weight. Often there will be no pain following a grade III tear as all of the pain fibres are torn at the time of injury.
How Do You Know If Your Knee Injury Is Serious?
While it is always best to seek the professional advice of a highly skilled practitioner trained in knee injuries such as your doctor or physiotherapist, here are seven signs that could indicate a severe knee injury.
- Obvious deformity. You may have a fracture or dislocation.
- You heard a “pop” or “snap”.
- You’ve experienced swelling
- Greater than normal movement
- Less than usual movement, e.g. can’t straighten
- You are unable to weight-bear on your leg
- Your knee “gives way” or “buckles”.
If you experience any of these symptoms, please seek prompt medical assessment.
Knee Ligament Injury Recovery Time
Treatment of a ligament injury varies depending on its location and severity.
Grade I sprains usually heal within a few weeks. Maximal ligament strength will occur after six weeks when the collagen fibres have matured. Resting from painful activity, icing the injury, and some anti-inflammatory medications are useful. Physiotherapy will help to hasten the healing process via electrical modalities, massage, strengthening and joint exercises to guide the direction that the ligament fibres heal. Better aligned scar tissue helps to prevent a future tear.
When a grade II sprain occurs, use of a weight-bearing brace or some supportive taping is a conventional early treatment. This protection helps to ease the pain and avoid stretching of the healing ligament. After a grade II injury, you can usually return to activity once the joint is stable, and you are no longer having pain. Healing may take up to six weeks. Physiotherapy helps to hasten the healing process via electrical modalities, massage, strengthening and joint exercises to guide the direction that the ligament fibres heal. Well-aligned scar tissue helps to prevent a future tear and quickly return you to your pre-injury status.
When a grade III injury occurs, you usually wear a hinged knee brace to protect the damage from weight-bearing stresses. The aim is to allow for ligament healing and gradually return to normal activities. These injuries are most successfully treated via physiotherapy and may not return to their full level of activity for 3 to 4 months. We strongly recommend that you seek professional advice in these cases.
Please seek the advice of your trusted knee physiotherapist or a doctor with a particular interest in knee injuries. Their help will determine the best treatment for your knee ligament injury.
Common Causes - Knee Pain
Knee pain can have many origins from local injury, referred pain, biomechanical issues and systemic issues. While knee pain can appear simple to the untrained eye, a thorough assessment is often required to ascertain the origin of your symptoms. The good news is that once a definitive diagnosis is determined, most knee pain quickly resolves with the correct treatment and rehabilitation.
Knee Ligament Injuries
- Knee Ligament Injuries
- ACL Injury
- PCL Injury
- MCL Sprain
- LCL Sprain
- Posterolateral Corner Injury
- Superior Tibiofibular Joint Sprain
Knee Meniscus Injuries
Kneecap Pain
- Chondromalacia Patella
- Fat Pad Syndrome
- Patella Dislocation
- Patellofemoral Pain Syndrome
- Osgood Schlatter’s Disease
- Sinding Larsen Johansson Syndrome
Knee Arthritis
Knee Tendon Injuries
Muscle Injuries
- Corked Thigh
- Thigh Muscle Strain
- Hamstring Strain
- ITB Syndrome
- Popliteus Syndrome
- Muscle Strain (Muscle Pain)
- Cramps
- DOMS – Delayed Onset Muscle Soreness
Knee Bursitis
Children’s Knee Conditions
Other Knee-Related Conditions
- Runner’s Knee
- Plica Syndrome
- Fibromyalgia
- Stress Fracture
- Overuse Injuries
- Restless Legs Syndrome
- Sciatica
Knee Surgery
For specific information regarding your knee pain, please seek the assistance of a healthcare professional with a particular interest in knee condition, such as your physiotherapist.
What is Physiotherapy Treatment?
Physiotherapists help people affected by illness, injury or disability through exercise, manual joint therapy, soft tissue techniques education and advice. Physiotherapists maintain physical health, allow patients to manage pain and prevent disease for people of all ages. Physiotherapists help encourage pain-relief, injury recovery, enabling people to stay playing a sport, working or performing daily living activities while assisting them to remain functionally independent.
There is a multitude of different physiotherapy treatment approaches.
Acute & Sub-Acute Injury Management
Hands-On Physiotherapy Techniques
Your physiotherapist's training includes hands-on physiotherapy techniques such as:
- Joint Mobilisation (gentle joint gliding techniques)
- Joint Manipulation
- Physiotherapy Instrument Mobilisation (PIM)
- Minimal Energy Techniques (METs)
- Massage
- Soft Tissue Techniques
Your physiotherapist has skilled training. Physiotherapy techniques have expanded over the past few decades. They have researched, upskilled and educated themselves in a spectrum of allied health skills. These skills include techniques shared with other healthcare practitioners. Professions include exercise physiologists, remedial massage therapists, osteopaths, acupuncturists, kinesiologists, chiropractors and occupational therapists, to name a few.
Physiotherapy Taping
Your physiotherapist is a highly skilled professional who utilises strapping and taping techniques to prevent and assist injuries or pain relief and function.
Alternatively, your physiotherapist may recommend a supportive brace.
Acupuncture and Dry Needling
Many physiotherapists have acquired additional training in acupuncture and dry needling to assist pain relief and muscle function.
Physiotherapy Exercises
Physiotherapists have been trained in the use of exercise therapy to strengthen your muscles and improve your function. Physiotherapy exercises use evidence-based protocols where possible as an effective way that you can solve or prevent pain and injury. Your physiotherapist is highly-skilled in the prescription of the "best exercises" for you and the most appropriate "exercise dose" for you, depending on your rehabilitation status. Your physiotherapist will incorporate essential components of pilates, yoga and exercise physiology to provide you with the best result. They may even use Real-Time Ultrasound Physiotherapy so that you can watch your muscles contract on a screen as you correctly retrain them.
- Muscle Stretching
- Core Exercises
- Strengthening Exercises
- Neurodynamics
- Balance Exercises
- Proprioception Exercises
- Real-Time Ultrasound Physiotherapy
- Swiss Ball Exercises
Biomechanical Analysis
Biomechanical assessment, observation and diagnostic skills are paramount to the best treatment. Your physiotherapist is a highly skilled health professional. They possess superb diagnostic skills to detect and ultimately avoid musculoskeletal and sports injuries. Poor technique or posture is one of the most common sources of a repeat injury.
Hydrotherapy
Aquatic water exercises are an effective method to provide low bodyweight exercises.
Sports Physiotherapy
Sports physio requires an extra level of knowledge and physiotherapy to assist injury recovery, prevent injury and improve performance. For the best advice, consult a Sports Physiotherapist.
Vestibular Physiotherapy
Women's Health
Women's Health Physiotherapy is a particular interest group of therapies.
Workplace Physiotherapy
Not only can your physiotherapist assist you in sport, but they can also help you at work. Ergonomics looks at the best postures and workstation set up for your body at work or home. Whether it be lifting technique improvement, education programs or workstation setups, your physiotherapist can help you.
Electrotherapy
Plus Much More
Your physiotherapist is a highly skilled body mechanic. A physiotherapist has particular interests in certain injuries or specific conditions. For advice regarding your problem, please contact your PhysioWorks team.
ACL Tear
An ACL (Anterior Cruciate Ligament) tear most often occurs during sporting activities when an athlete suddenly pivots, causing excessive rotational forces on the ligament. Individuals who experience ACL tears describe a feeling of the joint giving out, or buckling. You'll commonly hear a "pop."Signs You May Have Sustained an ACL Tear:
- Sudden giving way of the knee
- Hearing a 'pop' at the time of injury
- Sudden swelling of the knee joint
- Pain in the knee when walking
How is an ACL Tear Diagnosed?
A well trained Sports Physiotherapist, Sports Physician or Orthopaedic Surgeon will generally be able to confirm the diagnosis of an ACL tear within the clinic and from your injury history. An MRI scan can confirm your ACL tear and identify other knee injuries that may have occurred when your ACL was ruptured. These accessory injuries commonly include meniscal tears, bone bruising and collateral ligament injuries. Confirmation of an ACL tear is essential since the treatment differs from a common knee ligament strain or a meniscus tear.What to do if have a Ruptured ACL?
Please be guided by your trusted healthcare practitioner for an ACL tear. Successful rehabilitation options vary depending on your age, activity level and extent of the injury. For specific advice, please consult your physiotherapist, knee surgeon or doctor.Why are ACL Tears Such a Big Problem?
When an ACL injury occurs, the knee becomes less stable. The ACL injury is a problem because this instability can make sudden, pivoting movements difficult, and it may make the knee more prone to developing arthritis and cartilage tears. If your knee is unstable, a common complaint of a sensation that the knee will 'give out' from under them. When this giving way sensation is because of an ACL injury, the knee joint is sliding too much. Joint sliding can be a problem because each episode of instability (the 'giving way' sensation) can cause damage to the knee cartilage. Therefore an ACL injury makes patients more prone to developing arthritis and meniscus tears. Athletes often have particular difficulty once they have sustained an ACL injury. Many sports require a functioning ACL to perform common manoeuvres such as cutting, pivoting, and sudden turns. These high demand sports include, but are not limited to:- Football
- Soccer
- Basketball
- Skiing
- Gymnastics
- Hockey (Ice and Field)
- Wrestling
- Lacrosse
- Rugby
ACL Tear? Things to Consider.
Patients who suspect they have an ACL tear should seek a professional assessment by their physiotherapist or sports doctor. An ACL tear may be misdiagnosed immediately after the injury because of associated pain and swelling. There may also be muscle spasm that contributes to making the knee challenging to examine. Therefore, it may not be possible to conclusively determine the presence of an ACL tear soon after the injury. If an ACL tear is suspected, you will return for a follow-up evaluation with your orthopaedic surgeon.How Does Your Physiotherapist Make the Diagnosis of an ACL Tear?
The presence of a suspected ACL tear occurs whenever a patient has an injury to their knee. In the clinic, knee instability assessment occurs via specific manoeuvers performed by your physiotherapist or doctor. These manoeuvers test the function of the ligament to determine if an ACL tear is present. The most commonly used tests to determine the presence of an ACL tear include the Lachman Test and the Pivot Shift Test.What are Other Tests Recommended to Diagnose an ACL Tear?
A complete examination of the knee is also necessary to determine if other injuries may have occurred that could be causing your symptoms. Your physiotherapist or doctor will also evaluate X-rays of the knee to assess for any possible fractures, and an MRI may evaluate ligament or cartilage damage. However, MRI studies may not be needed to diagnose an ACL tear. The physical examination and history are just as good as an MRI in diagnosing an ACL tear. Many patients are concerned when their doctor or physiotherapist does not order an MRI. While the MRI may be necessary in some cases, it is not required to diagnose most ACL tears, if there are laxity and a predisposing mechanism of injury.What to do if have a Ruptured ACL?
We recommend professional guidance for an ACL tear. Successful rehabilitation options vary depending on your age, activity level and extent of the injury.
What is the Main Function of the ACL in Your Knee?
The Anterior Cruciate Ligament (ACL) is the primary forward slide restraint of the shin bone (tibia). The anatomy of the knee joint is critical to understanding this relationship. Mostly, the femur (thigh bone) sits on top of the tibia (shin bone), and the knee joint allows movement at the junction of these bones. Without ligaments to stabilise the knee, the joint would be unstable and prone to dislocation. The ACL prevents the tibia from sliding too far forward. The ACL also contributes stability to other joint movements, including the angulation and rotation at the knee joint. The ACL performs these functions by attaching to the femur on one end to the tibia at the other. The other major ligaments of the knee are the posterior cruciate ligament (PCL), and the medial and lateral collateral ligaments (MCL and LCL, respectively).ACL Surgery
The decision as to whether or not to operate on an ACL tear is dependent on several factors. Some patients who experience ACL tears can resume normal daily activities without surgical reconstruction of this ligament. There are some important factors to consider in deciding as to whether or not operative treatment of an ACL tear is needed. These factors include the age of the patient, the activity level of the patient (both recreational and occupational), the expectations of the patient, the ability and willingness of the patient to undertake postoperative rehabilitation. Plus, the degree of instability of the joint, and any other associated injuries to the knee (e.g. other ligamentous or meniscal problems).What is the Surgical Treatment for ACL Reconstruction?
ACL reconstruction is usually not performed until several weeks after the injury. Studies have shown improved results when ACL reconstruction surgery is delayed several weeks from the time of injury. This time allows the inflamed and irritated knee to cool down. Swelling decreases, inflammation subsides, and range of motion improves. Resolution of swelling and stiffness before ACL reconstruction surgery improves the postoperative function of the joint.Can the ACL be Repaired?
ACL reconstruction surgery is common, and improperly, referred to as an ACL repair. Unfortunately, a torn ACL cannot be "repaired." Rather, the torn ligament's replacement is healthy graft tissue. It is not possible to repair the torn ACL by simply reconnecting the torn ends.How is the ACL Reconstruction Performed?
The surgical procedure for an ACL reconstruction is variable but commonly involves using a segment of another larger ligament or tendon to replace the damaged ACL. The graft options for ACL reconstruction include: Hamstring Tendons Patellar Ligament Peroneus longus tendon Allograft (Donor Tissue) The ACL reconstruction surgery lasts about 1 1/2 to 2 hours, depending on the graft choice and any other work that may need to be done in the knee joint. Your physiotherapist will coordinate your postoperative rehabilitation and guidance.What to do if have a Ruptured ACL?
We highly recommend professional medical for an ACL tear. Successful rehabilitation options vary depending on your age, activity level and extent of the injury.ACL Reconstruction Rehabilitation
Post-operative rehabilitation is probably the least emphasized and most crucial aspect of care for a torn ACL. Whether or not a patient is diligent about their therapy determines how well their knee will perform after ACL reconstruction. Most patients experience a full recovery and resume their previous lifestyle, including professional athletes. However, some patients complain of pain, stiffness and limited motion in the joint for months or years following ACL reconstruction surgery.
The best outcome is when your physiotherapist guides your rehabilitation in ACL Reconstructions.