At some point in our lives most of us will have had an injury or pain associated with the knee. The knee is one of the largest and most complex joint in the body with ligaments that provide stability to the joint. Today we will cover the main ligaments of the knee and injuries that can happen to them. We will also cover treatment options on how to best treat and recover from a ligament injury. The knee consists of 4 ligaments which are:
ACL – Anterior cruciate ligament (Front of the Knee)
PCL – Posterior cruciate ligament (Back of the Knee)
MCL – medial collateral ligament (Inner side of the Knee)
LCL – Lateral collateral ligament (outer side of the Knee)
The knee is one of the largest and most complex joints in the body. The ligaments provide stability to the knee joint. The ACL or anterior cruciate ligament prevents the femur (the thighbone which is the longest and strongest bone in the body) from sliding back onto the tibia or the tibia from sliding forward on the femur. The femur is a very strong bone that requires a lot of force to break with motor vehicle accidents the most likely cause of a femur fracture. The PCL or posterior cruciate ligament prevents the femur from sliding forward on the tibia or the tibia sliding backward on the femur. The MCL or medial collateral ligament and the LCL or lateral collateral ligaments prevents the femur from sliding side to side.
The ligaments of the knee are short bands of flexible but tough fibrous bands of connective tissue that connect two bones or cartilages or holds together a joint. Injuries to the knee are quite common with all four ligament injuries being fairly common.
Direct impact trauma or a blow to the knee where a blow to the lateral or outside of the knee will cause damage to the Medial Collateral Ligament. A direct blow behind the knee would cause damage to the ACL or anterior cruciate ligament.
The ACL ligament is often injured by athletes in high demand sports such as basketball, football and soccer where the high speed direction changes or landing incorrectly from a jump can often damage the ACL ligament.
The PCL ligament is an injury that often occurs from a direct hit or blow in contact related sports such as football.
The MCL ligament and LCL ligament are most often injured in sports where high speed directional changes are made or direct impact to the side of the knee.
Knee injuries are quite common and often classified into three stages which represent the degree of injury or sprain to the knee ligaments.
A mild sprain where there is a minor stretch or tear to the ligament is often classified as a mild or 1st degree sprain. With this type of sprain there is no instability on the relaxed knee. A person with this mild sprain can continue with activity but may have some discomfort. A mild sprain usually will heal over time in about 2 to 4 weeks.
A moderate or 2nd degree sprain is a sprain where ligaments fibre tears occur. The degree of tear can be variable from several fibres to many fibres. There is a snapping sound at the time of injury and the joint gives way. The joint becomes hypermobile (excessive joint play) and the person will have difficulty continuing with the activity due to pain. The knee will fee unstable and painful.
A 3rd degree sprain or severe sprain is where there is either a complete rupture of the ligament itself or where there is an avulsion fracture (where the bony attachment of the ligament is torn of while the ligament remains intact). There is a snapping sound and the joint gives way. With this injury there will be significant instability and the person cannot continue the activity due to the pain and hypermobility. The joint can have severe bruising and swelling and it may be difficult or impossible to put weight on the knee.
Depending on the severity of the sprain many home remedies may be all that is required. For minor sprains of the knee usually 2 to 4 weeks will likely heal the injury. For milder knee sprains some the things we can do at home are to follow the R.I.C.E. method. Give the knee time to heal and apply ice to the area several times a day for up to 20 minutes at a time. Compression socks can help to reduce swelling in the knee and elevating the knee will also help.
A severe sprain may need medical intervention. If you experience a popping noise in the knee or if the knee feels very unstable and gives out when the injury occurs you should seek treatment options. Other things to keep an eye on are if you begin limping due to pain, the knee begins to swell near the injury or intense pain. If the sprain is so severe you may need surgery especially in a grade 3 sprain. This typically involves reattaching the torn ligament.
For milder stage 1 or 2 injuries we would treat the initial or acute stage by reducing the inflammation and any associated swelling and pain which can result in fewer adhesions forming within the joint and helps to maintain proper range of motion of the knee.
Strengthening programs to specific muscles of the knee to help stabilize the structure around the knee and to allow the ligaments time to heel.
Physiotherapy may include modalities such as an IFC or Ultrasound to help reduce inflammation swelling and pain. In many cases where the knee is unstable we would often recommend a knee brace which helps support the knee. A knee brace is often covered by your extended health insurance. A good knee brace won’t cost much more than $200-$250,and these braces are usually sufficient to cover most knee sprains.
For more information on Knee Ligament injuries or how to treat them contact Dynamic Physiotherapy & Sports Injury Clinic Inc. at 905-273-5433 or via our website. Appointments can be scheduled on our site directly!
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