Ligaments are bands of tough, elastic connective tissue that surround a joint to give support and limit the joint's movement.
When ligaments are damaged, the knee joint may become unstable. Ligament damage often happens from a sports injury. A torn ligament severely limits knee movement. This results in the inability to pivot, turn, or twist the leg. Surgery is a choice to repair a torn ligament if other medical treatment is not effective.
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There are 4 major ligaments in the knee.
The ligaments in the knee connect the femur (thighbone) to the tibia (shin bone), and include the following:
Three bones meet to form your knee joint: your thighbone (femur), shinbone (tibia), and kneecap (patella). Your kneecap sits in front of the joint to provide some protection.
Bones are connected to other bones by ligaments. There are four primary ligaments in your knee. They act like strong ropes to hold the bones together and keep your knee stable.
These are found on the sides of your knee. The medial collateral ligament is on the inside and the lateral collateral ligament is on the outside. They control the sideways motion of your knee and brace it against unusual movement.
These are found inside your knee joint. They cross each other to form an "X" with the anterior cruciate ligament in front and the posterior cruciate ligament in back. The cruciate ligaments control the back and forth motion of your knee.
The anterior cruciate ligament runs diagonally in the middle of the knee. It prevents the tibia from sliding out in front of the femur, as well as provides rotational stability to the knee.
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About half of all injuries to the anterior cruciate ligament occur along with damage to other structures in the knee, such as articular cartilage, meniscus, or other ligaments.
Injured ligaments are considered "sprains" and are graded on a severity scale.
Grade 1 Sprains. The ligament is mildly damaged in a Grade 1 Sprain. It has been slightly stretched, but is still able to help keep the knee joint stable.
Grade 2 Sprains. A Grade 2 Sprain stretches the ligament to the point where it becomes loose. This is often referred to as a partial tear of the ligament.
Grade 3 Sprains. This type of sprain is most commonly referred to as a complete tear of the ligament. The ligament has been split into two pieces, and the knee joint is unstable.
Partial tears of the anterior cruciate ligament are rare; most ACL injuries are complete or near complete tears.
The anterior cruciate ligament can be injured in several ways:
Several studies have shown that female athletes have a higher incidence of ACL injury than male athletes in certain sports. It has been proposed that this is due to differences in physical conditioning, muscular strength, and neuromuscular control. Other suggested causes include differences in pelvis and lower extremity (leg) alignment, increased looseness in ligaments, and the effects of estrogen on ligament properties.
When you injure your anterior cruciate ligament, you might hear a "popping" noise and you may feel your knee give out from under you. Other typical symptoms include:
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The posterior cruciate ligament (PCL) is a ligament within the knee. Ligaments are tough bands of tissue that connect bones.
The PCL -- similar to the anterior cruciate ligament (ACL) -- connects the thigh bone (femur) to your shin bone (tibia). Although it is larger and stronger than the ACL, the PCL can be torn.
Causes of PCL Injuries
PCL injuries are often due to a blow to the knee while it's bent. Common causes include:
Sports are a common cause of PCL injury. These injuries are especially common in:
What is an MCL injury?
An MCL injury is a sprain or tear to the medial collateral ligament. The MCL is a band of tissue on the inside of your knee. It connects your thigh bone to the bone of your lower leg. The MCL keeps the knee from bending inward.
You can hurt your MCL during activities that involve bending, twisting, or a quick change of direction. For example, the MCL can be injured in football or soccer when the outside of the knee is hit. This type of injury can also occur during skiing and in other sports with lots of stop-and-go movements, jumping, or weaving.
What are the symptoms?
You may have swelling, pain, and tenderness. Several hours after you've injured your knee, your pain may increase, and it might become harder to move your knee. You may notice some bruising.
How is an MCL injury diagnosed?
The doctor will examine you and ask questions about your past health. He or she will also ask how you injured your knee and about your symptoms at the time of injury.
Your doctor will check your range of movement, swelling, and tenderness.
You may have some tests, including an X-ray and an MRI.
What is the treatment?
Most MCL injuries can be treated at home with rest, ice, and anti-inflammatory medicine. Your doctor may suggest that you use crutches and wear a brace that protects but allows for some movement of your knee.
You may need to reduce your activity for a few weeks. But doing gentle movement as advised by your doctor will help you heal.
What is a lateral collateral ligament (LCL) injury?
The lateral collateral ligament (LCL) is the ligament located in the knee joint. Ligaments are thick, strong bands of tissue that connect bone to bone. The LCL runs along the outside of the knee joint, from the outside of the bottom of the thighbone (femur) to the top of the lower-leg bone (fibula). The LCL helps keep the knee joint stable, especially the outer aspect of the joint.
An injury to the LCL could include straining, spraining, and partially or completely tearing any part of that ligament. According to Orthogate, the LCL is one of the more commonly injured ligaments in the knee. Because of the location of the LCL, it’s common to injure the LCL along with other ligaments in the knee.
The main cause of LCL injuries is direct-force trauma to the inside of the knee. This puts pressure on the outside of the knee and causes the LCL to stretch or tear.
Symptoms of an LCL injury can be mild or severe, depending on the severity of the sprain or if it’s torn. If the ligament is mildly sprained, you may not have any symptoms at all. For a partial tear or complete tear of the ligament, your symptoms may include:
To diagnose an LCL injury, your doctor will examine your knee and look for swelling. They’ll also move your knee in various directions to determine where your pain is and how severe your symptoms are.
If your doctor believes you may have a torn ligament, you may undergo imaging tests like X-rays or MRI scans. These tests will allow your doctor to see the soft tissues inside the knee.
Very minor tears (sprains) may heal with non-surgical treatments and regenerative medicine therapy. But full ACL tears cannot be healed without surgery. If your activities do not involve making pivoting movements on the knee, physical therapy rehabilitation may be all you need but rehabilitation and recovery can happen within 3 months without surgical intervention. In some partial tears, surgery may be recommended.
A mild to moderate knee ligament injury may heal on its own, in time. To speed the healing, Avoid putting much weight on your knee if it's painful to do so. You may need to use crutches for a time.
You shouldn't walk on a torn ACL too soon after you've experienced an injury. It might make the injury more painful and cause further damage.
Ice your knee for 20 to 30 minutes every 3 to 4 hours to lessen the pain and swelling. Keep doing it for 2 to 3 days, or until the swelling is gone.
Compress your knee. Put an elastic bandage, straps, or sleeves on your knee to control swelling.
Raise your knee on a pillow when you're sitting or lying down.
Wear a knee brace to stabilize the knee and protect it from further injury.
Take anti-inflammatory painkillers. Nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, or naproxyn will help with pain and swelling. Follow the directions exactly. Talk with your doctor or pharmacist if you have any questions or feel that you still need them after 7 to 10 days.
Practice stretching and strengthening exercises if your doctor recommends them. Never stretch so much that it hurts. Ask your doctor to recommend a physical therapist for guidance.
The time is taken to heal mainly depends on the severity and location.
Grade I(mild) injuries just stretch the ligament causing a microscopic tear. They do not affect in the overall ability of your knee to support your weight. This type of injuries often heals within weeks. The collagen fibers take a maximum of six weeks to get matured. A complete rest from any physical activity, providing ice packs to the injury and applying some inflammatory medication may aid up the healing process. Physiotherapy like electric modalities, messaging and joint exercises may guide the ligaments to heal faster, preventing a further tear.
Grade II sprain occurs when your ligaments are partially torn and may provide you with mild to moderate instability in standing or walking. This injury may be healed by using any weight bearing brace or use of some supportive taping can be considered as an early treatment. This helps you to ease the pain preventing the stretching of the healing ligament. Joint exercises help to guide the ligament moving in same direction healing faster. It may last up to six months or even more.
Grade III injuries occur when the ligaments are completely torn and are separated from the bones. In this injury, your bones become most unstable and are a bit painful. You need to wear knee braces to protect the injury from weight-bearing stresses. It takes about a few months to retain to its original activities. Physiotherapy is highly recommended to be successful against such injuries. Seek professional advice in such cases.
The intensity and the time span required depends on the seriousness of the injury. In severe cases, one may need to go through physical therapies, bracing or may even need surgery. But the first step is to receive an examination regardless of any medication.
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