The Knee: Understanding Ligament Injuries (Part 2)

Kim’s Korner

Ligament injuries can happen to anyone but they are more common in those that play sports. Let’s firstly review exactly what a ligament is. Ligaments are short bands of fibrous tissue that connect bones together, increasing joint stability. Most ligament injuries can be as simple as a slight overstretch. However, in more serious cases, they can tear and cause damage to other structures surrounding the knee, for example, meniscus, cartilage and other ligaments.  Ligament injuries are graded according to their severity:

Grade I sprain: the ligament has been slightly sprained and is able to keep the knee stable;

Grade II sprain: the ligament is overstretched and becomes loose. This is often referred to as a partial tear.

Grade III sprain: a complete tear resulting in instability of the knee.

Ligaments of the Knee

Anterior Cruciate Ligament (ACL): This is in the middle of the knee, running diagonally from the front of the tibia to the back of the femur. It prevents the tibia (shin bone) from sliding forward on the femur, and also excessive rotation. It is a common knee injury, especially for those playing high intensity sports that involve jumping, sudden stops, quick changes in direction and pivoting (turning) with the foot firmly planted or a direct blow from an impact or a tackle, such as in football, tennis and basketball. The signs of injury are:

• Popping sound

• Swelling along the joint line

• Tenderness

• Instability

• Inability to fully bend the knee

• Difficulty walking, inability to bear weight with the feeling that the knee will give way

Posterior Cruciate Ligament (PCL): This works in tandem with the ACL and runs from the back of the tibia to the front of the femur. Together with the ACL, it forms a cross and prevents the tibia from moving backwards on the femur.  Injury to the PCL occurs less frequently than ACL injuries and is usually as a result of an impact below the knee, as in a car accident or a falling on the knee. The signs of injury are:

• Pain that can affect walking

• Swelling

• Instability—it may feel like it will give way, but rarely does

Medial Collateral Ligament (MCL): This runs on the inside of the knee; it limits rotation and prevents the inside of the knee opening up and the tibia moving inwards. Injuries usually occur when the foot is firmly planted and either twisting or a direct impact to the outside of the leg.  Depending on the severity of the injury the following symptoms may be present:

• Tenderness but no instability (grade I and II)

• Pain and swelling (grade II and III)

• Instability (grade III)

• Difficult bending knee (grade III)

Lateral Collateral Ligament (LCL): Located on the outside of the leg it limits rotation and prevents the outside of the knee opening up. Damage usually occurs after a direct blow to the inside of the knee. The signs of injury are:

• Swelling

• Stiffness or locking of the knee

• Tenderness on the outer aspect of the knee

• Instability

Treatment of all ligament injuries should focus on reducing pain and swelling, and improving stability.  At the first sign of a ligament injury you should follow the PRICE protocol: Protect the joint using support or a brace; Rest from any activity that causes pain or increases the risk of further damage; Ice to reduce swelling and pain; Compression to prevent swelling; Elevation to reduce swelling and pressure on the joint.

Grade I and grade II injuries can be managed conservatively and a physiotherapist will be

able to assess your injury and design a rehabilitation programme based on the findings of the assessment, focusing on strengthening and exercises to improve balance and proprioception. For grade III injuries and those that do not respond to rest and rehabilitation, surgery may be indicated. However, prevention is always better than cure, and a strengthening regime that targets the muscles of the lower leg should be incorporated into your training programme. For further advice consult a doctor or physiotherapist.

Kim Jackson is a UK-trained physiotherapist with over 20 years’ experience. She specializes in musculoskeletal pain and dysfunction, including back pain and sciatica, stroke and other neuro conditions plus sports physiotherapy, having worked with local, regional and international athletes and teams treating injuries and analyzing biomechanics to improve function and performance.  She is registered with the Allied Health Council and is a member of PASL.  She currently works at Bayside Therapy Services in Rodney Bay.