Dr. Hemendra Kumar Agrawal
Dr. Hemendra Kumar Agrawal
Sports & Joints Orthopedic surgeon
MBBS MS(ortho) DNB( ortho) MNAMS
Sports Arthroscopy & Arthroplasty Fellowship

The knees can take a lot of punishment while playing sports or running, often resulting in knee ligament injuries. Around a fifth of knee injuries from playing sport affect the anterior cruciate ligament or ACL. A torn ACL can be painful and debilitating, but can often be treated successfully.

Anatomy of a knee injury

Ligaments are tough bands of tissue that connect the bones in your body. Two important ligaments in the knee, the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL), connect the thigh bone with the bones of the lower leg. But too much stress on these ligaments can cause them to stretch too far – or even snap.

ACL and other ligament injuries can be caused by:

  • Twisting your knee or Getting hit on the knee.
  • Extending the knee too far.
  • Jumping and landing on a flexed (bent) knee.
  • Stopping suddenly when running.
  • Suddenly shifting weight from one leg to the other.

These injuries are common in footballers, basketball players, skiers, gymnasts and other sports people.

There are four ligaments in the knee that are prone to injury.

  • Mentioned above, the anterior cruciate ligament(ACL) is one of the two major ligaments in the knee. It connects the thigh bone to the shin bone. ACL injuries are a common cause of disability in the knee and are more common in women than men.
  • The posterior cruciate ligament(PCL) is the second major ligament in the knee connecting the thigh bone to the shin bone.
  • The lateral collateral ligament(LCL) connects the thigh bone to the fibula; the smaller bone on the outside of the lower leg.
  • The medial collateral ligament(MCL) connects the thigh bone to the inside of the shin bone.

How can I prevent a knee ligament injury?

Knee ligament injuries are hard to prevent, since they’re usually the result of an accident. But taking some precautions might lower your risks. You should:

  • Keep your thigh muscles strong with regular stretching and strengthening.
  • Warm up before physical activity.
  • Stretch afterphysical activity.
  • Never abruptly increase the intensity of your workout. Make changes slowly

What does a knee ligament injury feel like?

An ACL injury – or other ligament injury – is occasionally hard to diagnose clinically. However, sometimes the person will know immediately that something is severely wrong, because of the pain, limitation of movement and rapid swelling that follow a ruptured internal ligament. Symptoms of a knee ligament injury are:

  • Pain, often sudden and severe.
  • A loud pop or snap during the injury.
  • Swelling & a feeling of looseness in the joint.
  • Inability to put weight on the joint without pain.

If they’re not treated at the time, ACL and other types of ligament injuries may continue to give trouble months or years later, causing the knee to give out when you twist or pivot.

If you have an acute injury severe enough to rupture your ACL, you will probably be taken straight to an emergency department. If the symptoms are not so severe and you go to your doctor, you will quickly be referred to an orthopaedic surgeon if an ACL injury is suspected. To diagnose an ACL or other ligament injury, you will need a thorough examination. You may also need X-rays, and an MRI (Magnetic Resonance Imaging) scan, as this can identify the structures inside the knee and clearly show the extent of the damage. Other tests may also be necessary.

What’s the treatment for a knee ligament injury?

A mild-to-moderate knee ligament injury may heal on its own given time. You will be referred to the sports orthopaedic surgeon  for supervised management, and to speed the healing you can take measures of your own. For example, you can:

  • Rest the knee.Avoid putting excess weight on it. You may need to use crutches for a time.
  • Ice your kneeto reduce pain and swelling. Do it for 20-30 minutes every three to four hours for two to three days, or until the pain and swelling is gone.
  • Compress your knee.Use an elastic bandage, straps or sleeves on your knee to control swelling.
  • Elevate your kneeon a pillow when you’re sitting or lying down.
  • Wear a knee braceto stabilise the knee and protect it from further injury.
  • Take anti-inflammatory painkillers. Non-steroidal anti-inflammatory drugs ( NSAIDs), like etoricoxibor ibuprofen, will help with pain and swelling. However, these drugs can have side-effects and should only be used with doctors prescription/
  • Practise stretchingand strengthening exercises if they are recommended.

For severe collateral ligament tears, you may need surgery to attach the ligament back to the bone if it was pulled away, or to the other part of the ligament if it was torn in the middle.

Unfortunately, the cruciate ligaments – the ACL and PCL – cannot be repaired. Once they are completely torn or stretched beyond their limit, the damage is irreparable. The only option is a reconstruction. In the UK, about 17,000 ACL ruptures occur each year, according to the NHS; and due to the extensive work carried out on them, techniques have improved over the past 15 years. To reconstruct the ACL, tendons are taken from other parts of your leg to replace the torn ligament. The most usual sites used to supply the new tendon are the patellar tendon (this goes from below the knee-cap to the top of the tibia) or the hamstrings, powerful tendons at the back of your thigh.

A ligament reconstruction for an ACL or PCL injury is nowdays done arthroscopically with minimal incisons. Arthroscopic ligament reconstruction help in better recovery and painless physiotherapy to patient. People who have pain or  instability in their knees may choose to have it. So might professional sports people or devoted amateurs – who really want to return to their previous level of activity will need to discuss the options with your consultant sports orthopaedic surgeon.

When will I feel better after a knee ligament injury?

Recovery time depends on how severe your knee ligament injury is. People also heal at different rates. You will need intensive input from a physiotherapist under the supervision of your sports surgeon who can supervise the various stages of your recovery. It will take at least six months before you are able to return to sport, and often longer. While you recover – if your doctor agrees – you could take up a new activity that won’t hurt your knee. For instance, runners could try swimming.

Whatever you do, don’t rush things. Don’t try to return to your old level of physical activity until:

  • You feel no pain when you bend or straighten your knee.
  • You feel no pain in your knee when you walk, jog, sprint or jump.
  • Your knee is no longer swollen.
  • Your knee feels as strong as your uninjured knee.

If you start using your knee before it’s healed, you could cause permanent damage and disabilities.

So prevention of knee injuries is always better,however early diagnosis & treatment by sports orthopaedic surgeon will help in better and speedy recovery.

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