Knee Ligament Injuries
There are four major ligaments around the knee, the two collateral ligaments on the sides and the two cruciate ligaments in the middle of the knee. Twisting injuries to the knee during sports or other activities can damage these ligaments leading to partial or complete tears (ruptures).
Often there is immediate pain and swelling from the knee after the injury and in most cases further sport or activity is impossible. Some patients feel their knee give out and sometimes a pop or snap can be felt/heard. Either a single ligament can be damaged or a combination of two or more. In some cases the injury is associated with a cartilage injury of the knee.
Symptoms of Knee Ligament Injuries
The injury causes immediate pain and often causes early swelling of the knee. Sometimes it is difficult to walk after the injury. Many patients seek medical advice in an A&E department. Skilled clinical examination can sometimes pick up the injury at this stage but often the pain and swelling stops proper examination. X-rays are frequently done to exclude a broken bone and are usually normal.
Over a week or so, the pain and swelling improves but often the knee either feels weak or is prone to giving way. Patients often describe a “wobble” from the knee.
Treatment of Knee Ligament Injuries
Some ligament injuries heal on their own and only need a brace to protect them while they are healing. Physiotherapy can be useful once the knee is less painful to regain full movement in the knee and strengthen the knee to prevent further injury.
Some injuries, in particular a complete tear of the anterior cruciate ligament (ACL), do not heal even if surgically repaired. Whilst some patients can strengthen the muscles around the knee to compensate many will find that their knee still feels unstable with day-to-day activities and can give way with sports, risking further injury to the knee. In these cases, a reconstruction of the ACL should be considered. A piece of tissue is taken from elsewhere around the knee and put in place of the ligament. It is initially held in place with special devices but ultimately heals into the bone, replacing the ligament. The procedure is done under a general anaesthetic and takes about 90 minutes. One night in hospital is usually required and crutches may be required for the first 2-4 weeks. Intensive physiotherapy is required over several months thereafter with a view to returning to all sports at around 9 months following surgery. Many patients are able to playing sports at a similar level as prior to their injury.