Knee

Ligament Injuries

The knee is a vital joint in the body, and its function relies on the stability provided by a network of ligaments. Ligaments act as strong connective tissues that secure the bones of the knee together, ensuring joint stability. Ligaments in the knee include the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL).

Injuries to these ligaments are common and can have a significant impact on mobility and quality of life. Understanding the different types of ligament injuries, their symptoms, and treatment options is essential for proper management.

Types of Ligament Injuries

Knee ligament injuries are classified into three grades based on their severity:

  • Grade I (Mild): The ligament is slightly stretched, with no instability in the knee joint.
  • Grade II (Moderate): The ligament is partially torn, causing joint looseness and instability.
  • Grade III (Severe): The ligament is completely torn or detached from the bone, resulting in knee instability.

Common Ligament Injuries

PCL Rupture

The Posterior Cruciate Ligament (PCL) is one of the four major ligaments in the knee, responsible for preventing the tibia from moving too far backward in relation to the femur. PCL injuries are typically caused by direct impact, such as falling onto a bent knee, sports accidents, or motor vehicle collisions. While less common than ACL injuries, PCL ruptures can cause significant knee instability and, if untreated, may lead to chronic knee problems such as instability and arthritis.

MCL Rupture

The Medial Collateral Ligament (MCL) is located on the inner side of the knee and helps to stabilise the knee, controlling sideways movement. MCL injuries are typically caused by external forces that push the knee inward, often during activities such as football, rugby, soccer, or skiing. MCL tears can range from mild to severe and may result in knee instability and pain.

LCL and ACL Injuries

Lateral Collateral Ligament (LCL) and Anterior Cruciate Ligament (ACL) injuries are typically caused by sudden twists, impacts, or changes in direction. ACL injuries, in particular, are highly prevalent in athletes and individuals involved in sports requiring pivoting movements.


Symptoms of Ligament Injuries

The symptoms of ligament injuries vary depending on the location and severity, but common signs include:

  • Pain: Immediate pain is felt in the affected knee, which may worsen with movement.
  • Swelling: Swelling around the knee joint occurs shortly after the injury, often with bruising.
  • Instability: A feeling that the knee is “giving way” or unable to support weight.
  • Difficulty bearing weight: Walking or standing may become difficult due to pain and instability.

For more severe ligament injuries, visible deformities may occur, particularly in the case of a displaced fracture or major ligament tears.


Diagnosis of Ligament Injuries

Diagnosis begins with a thorough physical examination to assess the knee's stability, range of motion, and any visible deformities. During this exam, Dr. Ryan du Sart will evaluate for signs of ligament instability, such as increased laxity in comparison to the uninjured knee.

Imaging tests are crucial for confirming the diagnosis and identifying the extent of the injury:

  • X-rays: Used to rule out fractures or dislocations.
  • MRI: The gold standard for diagnosing ligament injuries, providing detailed images of the ligaments, tendons, and surrounding tissues.


Treatment Options for Ligament Injuries

The treatment approach for knee ligament injuries depends on the type, location, and severity of the injury.


Non-Surgical Treatment

Non-surgical treatment is often appropriate for mild to moderate ligament injuries, especially when the knee remains stable and functional.

Treatment typically includes:

  • Rest and Activity Modification: Avoiding weight-bearing activity and limiting movement to allow the ligament to heal.
  • R.I.C.E. Protocol: Rest, Ice, Compression, and Elevation to reduce swelling and manage pain.
  • Bracing: A knee brace may be used to provide stability and prevent further stress on the injured ligament.
  • Physiotherapy: A targeted rehabilitation program is essential for restoring strength, mobility, and stability to the knee.


Surgical Treatment

Surgical intervention is usually considered for more severe injuries or when non-surgical treatments have failed. Depending on the type of ligament injury, surgical options may include:

  • ACL/PCL Reconstruction: A tendon graft, typically harvested from the hamstrings, patellar tendon, or quadriceps tendon, is used to reconstruct the torn ACL or PCL. Surgical reconstruction aims to restore stability and reduce the risk of future knee injuries. Find out more about ACL Reconstruction.
  • MCL Repair or Reconstruction: In cases of severe MCL tears, surgery may be necessary to repair or reconstruct the ligament.
  • Internal Fixation: Displaced fractures or severe ligament tears may require the use of screws, plates, or other fixation devices to realign and stabilise the knee.


Recovery and Rehabilitation

Recovery from ligament injuries, especially after surgery, requires a structured rehabilitation plan. Following surgery, patients can expect:

  • Initial Immobilisation: The knee will be immobilised to prevent further injury, usually with a brace or splint for 4-6 weeks.
  • Physical Therapy: A structured rehabilitation program is essential for restoring strength, flexibility, and range of motion in the knee.
  • Gradual Return to Activity: Weight-bearing activities can be resumed progressively, with full recovery expected in 3-6 months, depending on the severity of the injury and the type of surgery.


Preventing Future Ligament Injuries

While not all ligament injuries can be prevented, certain measures can reduce the risk of re-injury:

  • Strengthening Exercises: Strengthening the muscles surrounding the knee joint, particularly the quadriceps, hamstrings, and calf muscles, can improve knee stability and reduce the likelihood of future ligament injuries.
  • Proper Footwear: Wearing shoes that provide adequate support and cushioning can reduce stress on the knee during sports and physical activities.
  • Balance and Proprioception Training: Exercises to improve balance and body awareness can help prevent falls and missteps that lead to ligament injuries.


Why Choose Dr. Ryan du Sart?

Dr. Ryan du Sart is a fellowship-trained orthopaedic surgeon with extensive experience in diagnosing and treating ligament injuries, including ACL, PCL, and MCL tears. With a patient-first approach, Dr. du Sart provides comprehensive care tailored to the individual needs of each patient, from initial diagnosis to rehabilitation.


Book a Consultation

If you’ve experienced ligament injuries, and wanting to know more information, if surgery is required or your next steps, book a consultation with Dr. Ryan du Sart today.

Phone: (08) 9779 9767
Email: admin@ryandusart.com.au

Clinic Locations:

6 Higgins Street, South Bunbury, WA 6230

20 Prince Street, Busselton, WA 6280



References:

  1. Beynnon, B. D., et al., “Anterior Cruciate Ligament Injury: Mechanisms, Risk Factors, and Prevention.” American Journal of Sports Medicine, 2014.
  2. Jayanthi, N., et al., “Risk Factors for Knee Ligament Injuries in Sports.” Current Sports Medicine Reports, 2017.
  3. Webb, S. et al., "PCL Injuries: Treatment Options and Outcomes." British Journal of Sports Medicine, 2018.
  4. Mariani, P. et al., “Rehabilitation After ACL Surgery: A Literature Review.” Knee Surgery, Sports Traumatology, Arthroscopy, 2019.
  5. Lehman, G. et al., “Knee Ligament Injuries: Non-surgical versus Surgical Management.” Journal of Orthopaedic and Sports Physical Therapy, 2015.
  6. Woolf, A.D., et al., "Prevention of Ligament Injuries: Role of Strengthening and Conditioning." Sports Health Journal, 2017.