What is ligament injuries?
A ligament are important stabilisers in the joint and are made of collagen fibres organised into a thick band of tissue in which they connect one bone to another. The knee joint has four main ligaments, two are located inside the knee joint (the anterior and posterior cruciate ligaments) and the others are located outside the joint (the medial and lateral collateral ligaments). Ligament injuries can occur when they are suddenly stretched. Depending on the number of collagen fibres damaged, it may result in a partial ligament injury (called a Grade 1 or 2 sprain or tear) or complete ligament rupture (Grade 3).
What causes a knee ligament injury?
The most common and serious knee ligament injuries include:
- Anterior cruciate ligament (ACL) injuries – this injury occurs during cutting or twisting movements, sudden stopping, or incorrect landing from a jump and commonly occurs in sports. Although this is less common, the ACL can also be injured by a tackle or a collision with another team member. ACL injuries commonly happen when the athlete’s foot is in contact with the ground and their knee is suddenly forced backwards, or when the knee is slightly bent and collapses inwards. Young females and people with a family history of ACL injures have a higher risk of sustaining a ACL injury. Australia has the highest occurring ACL injuries in the world.
- Medial collateral ligament (MCL) injuries – The MCL is damaged when the lower leg (tibia) is stretched outwards, causing the knee ligaments on the inner aspect of the knee to tear. This injury usually occurs during an awkward landing, a tackle or fall over another player, during skiing or when a foot or ski gets caught therefore causing the knee to collapse inwards.
- Posterior cruciate ligament (PCL) injuries are not as common at ACL and MCL injuries, these occur during a fall onto a very bent knee, or via the knee hyperextending if a player lands against the front of the knee, forcing the shin backwards relative to the thigh bone.
How do I know if I need have a knee ligament injury?
Symptoms vary depending on the severity of the injury, you may have sustained a ACL knee ligament injury if you have had a ‘pop’ or a crack at the time of the injury, this may also be very painful. In some occurrence, pain may settle quickly allowing you to stand, walk and even run without any associated pain. The knee may swell up, stay generally painful or feel restricted to fully bend and straighten. If you have sustained a MCL injury you may experience tenderness on the inner aspect of the knee, slight swelling and restriction of movement, all of which vary in intensity depending on the severity of the ligament injury. If you have sustained a posterior cruciate injury, you may experience widespread knee pain (worse at the back of the knee and calf), minimum swelling unless other structures are damaged as well.
Your physiotherapist, GP or surgeon will be able to examine your knee to determine what type of knee ligament injury you have sustained. Imaging may be required.
How can physiotherapy help with knee ligament injuries?
Your physiotherapist will be able to help you with a knee ligament injury by:
- Giving you advise on how to manage your condition.
- Prescribing physical rehabilitation program – it will be considered sporting goals, occupational requirements and knee function. This will allow your physiotherapist to decide whether surgery may be your best option. Your physiotherapist can help you pre & post operation
- For ACL Injuries – the treatment will involve reconstructing the damaged ligament, usually with the person’s own hamstring or knee-cap tendon, or training the surrounding muscles to try and ‘stabilise’ the knee joint.
- For MCL Injuries – It may be recommended that you use a brace to protect the ligament whilst it heals. Small painless knee movements exercises will be shown to you by your physiotherapist to help regain knee motion, and strengthening exercises for the quadriceps, hamstrings and hip muscles will help to support the knee. Taping may also be used for a early return to sports which may take up to 6 weeks.
- For posterior cruciate injuries – it will be recommended that you use a brace for 4 – 6 weeks (depending on the severity of the injury). Gentle pain-free knee movement exercises and a physical rehabilitation program.
What can I do at home?
It is important that you complete the exercises prescribed to you by your physiotherapist to allow your knee ligament injury to heal. A rehabilitation program should also be completed before and after surgery to allow you to return to your required activity as quickly as possible. It is important that you take the recovery advice given to you by your physiotherapist or surgeon and ensure you rest and ice your knee, in addition to taking care with twisting movements that may stretch your healing ligament.
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Reference: Australian Physiotherapy Association 2019, Your Body, viewed 19 November 2019, < https://australian.physio/>.