Ligaments are tough bands of tissue that connect one bone to another bone. The ligaments of the knee function to stabilise the knee joint. There are two important groups of ligaments that hold the bones of the knee joint together, collateral ligaments and the cruciate ligament.
Cruciate ligaments, present inside the knee joint, control the back-and-forth motion of the knee. The cruciate ligament in the front of the knee is called anterior cruciate ligament or ACL and the cruciate ligament in the back of the knee is called posterior cruciate ligament or PCL.
Collateral ligaments are present on either side of the knee. They function to prevent the knee from moving too far during side-to-side motion. The collateral ligament on the inside is called the medial collateral ligament (MCL) and the collateral ligament on the outside is called the lateral collateral ligament (LCL).
The lateral meniscus is on the outside of the knee.
Meniscus injury can vary widely in size and severity. A meniscus can be split in half, ripped around its circumference in the shape of a C or left hanging by a thread to the knee joint. A barely noticeable tear may resurface years later, triggered by something as simple as tripping over a step.
The anterior cruciate ligament or ACL, is one of four major ligaments that make up the knee. Ligaments are in place to stabilize the femur (thigh bone), which sits just above the tibia (shin bone).
The ACL is critical to maintaining knee stability. People can tear their ACLs in a variety of ways. It can occur either from high impact sports like football, kabaddi, karate or due to motorcycle accidents or doing mundane things like walking down stairs or hopping out of bed. ACL injuries are very common among athletes of all ages and competitive levels. Approximately 200,000-300,000 ACL injuries are reported each year in the India.
Most ACL injuries are sports related injuries but can also occur during day to day activities, due to twisting of the knee. It can also occur with a sudden change of direction or a direct blow to the knee.
When you injure your ACL, you might hear a "popping" sound. You may experience Severe pain and inability to continue activity. Within the first two hours after injury, your knee will swell and you may feel as though the knee has given way. Subsequently as the swelling subsides in a week or two, feeling of instability or “giving way” with weight bearing is a common symptom.
Diagnosis of an ACL tear is made by knowing your symptoms, medical history, performing a physical examination of the knee, and performing other diagnostic tests such as X-rays, MRI scans, stress tests of the ligament and arthroscopy.
Treatment options include both non-surgical and surgical methods. Initial treatment consists of rest, ice, compression, and elevation (RICE protocol); all assist in controlling pain and swelling. If the overall stability of the knee is intact, doctor may recommend non-surgical methods. Physical therapy may be recommended to improve knee motion and strength. A knee brace may be needed to help immobilize your knee.
ACL reconstructions surgery is performed in young or otherwise active patients as well as in almost all patients who report instability with twisting or turning activities. For patients who experience an ACL tear and who have a meniscus tear, there is a much higher risk for the development of osteoarthritis in the future. Because of this, Dr. Savadekar will usually recommend a combined meniscus repair and ACL reconstruction to be performed.
One sign of an ACL tear is being able to limp away from the crash site only to be told by family doctor that nothing is broken. If a rider is in serious pain and has a visibly swollen knee that is very weak, it is quite possible that he or she suffered an ACL tear. Some other signs of a torn ACL include an inability to put weight on the injured leg without pain and an inability to stand or walk.
Pain and swelling are the first symptoms in the knee after the ACL injury. Pain is so severe that one may be unable to continue the ongoing activity. However isolated ACL injury(without associated meniscus or chondral injury) is not painful once swelling is reduced in a week or two. Instability or buckling sensation is the main symptom of an ACL injury.
ACL tears are one of the most common knee ligament injuries. The most common knee ligament injury is the MCL, which often tears and is able to heal on its own when it is isolated, hence often goes unnoticed. However, in general, most ACL tears do not heal and require surgery. Thus, it is the most commonly performed knee ligament surgery. The number of ACL tears seems has increased as the number of participants in sports has increased. This is especially in women athletes, with women’s kabaddi, women’s basketball, and women’s volleyball being very high risk sports for ACL tears.
An ACL tear does not heal because it does not have a good blood supply and it is located in the harsh intraarticular environment of the knee. The normal knee joint lining secretes enzymes which dissolve blood. This is beneficial to the knee itself so that it does not form a big blood clot inside the knee when one does have bleeding and the blood can be more easily resorbed over time. However, a blood clot is necessary for a ligament to heal. Thus, because of the enzymes that are created (plasmin) blood clots almost never form within the knee and this does not give the ACL a good chance to heal.
The anterior cruciate ligament is the main stabilizer to the knee in preventing the tibia from sliding forward on the femur. It is most effective as a knee stabilizer with the knee at about 20-30 degrees of knee flexion and this is where clinicians will generally check a knee to determine if the knee slips forward, which would be consistent with an ACL tear and clinical exam (the Lachman test). The ACL is also important to knee stability to ensure that the tibia does not internally rotate on the femur. This is a shifting that can occur when one has an ACL tear when they plant their foot, twist and turn, or pivot, and the knee can partially dislocate (sublux). This is the most disabling portion of an ACL tear.
The most common knee injury is to the medial aspect of the knee.
The medial collateral ligament, or MCL, extends from the end of the femur (thigh bone) to the top of the tibia (shin bone) and is on the inside of the knee joint. There are three main anatomic structures in the medial side of the knee, with the superficial medial collateral ligament being the largest and strongest. The other main structures are the posterior oblique and deep medial collateral ligaments. It is important to note that an MCL injury means that the entire medial knee structures are affected.
MCL can be hurt during activities that involve bending, twisting, or a quick change of direction. A large number of isolated medial ligament injuries are due to sporting injuries. An MCL injury can occur through stress against the outside of the knee that stretches or tears the medial knee structures. This injury can be caused through either contact or non-contact.
Patients with an MCL tear have symptoms such as knee pain, swelling, and locking or catching sensation in the knee during movement. Patients may also feel as though their knee may 'give out' suddenly or buckle.
Dr Savadekar will usually diagnose an MCL injury based on a physical examination of your knee. To determine looseness of the ligament, an MCL test may be performed by exerting pressure on the outside of your knee while your knee is bent to 25 degrees. In addition, other tests such as knee joint X-rays and MRI scan may be done.
Treatment options include non-surgical and surgical treatment. Non-surgical treatment consists of rest, ice, compression, and elevation (RICE protocol); all assist in controlling pain and swelling. A knee brace may be worn to help immobilize your knee. Use of crutches may be recommended to protect your knee and to keep you from putting weight on your knee while walking. Physical therapy exercises may be recommended to improve knee motion and strength.
Most often, surgery is not necessary for the treatment of an MCL tear. If needed usually repair of MCL tear is performed. However in old injuries MCL reconstruction may be necessary. In many cases, this injury cannot be prevented. Nonetheless, using proper techniques during sports or exercising can help prevent injury.
The ligament located on the back and middle of the knee is known as the posterior cruciate ligament, or the PCL. It is one of several ligaments that connect the femur (thighbone) to the tibia (shinbone). The posterior cruciate ligament is the strongest ligament of the knee and thus, it is injured less often accounting for about 3-37% of all knee injuries. PCL injuries are difficult to detect than other knee ligament injuries. Cartilage injuries, bone bruises, and ligament injuries often occur in combination with PCL injuries.
The PCL is usually injured by a direct impact, such as in an automobile accident when the bent knee forcefully strikes the dashboard. In sports, it can occur when an athlete falls to the ground with a bent knee. Twisting injury or overextending the knee can cause the PCL to tear.
Patients with PCL injuries usually experience knee pain and swelling immediately after the injury.
However, old PCL tears can cause:
Dr. Savadekar will assess signs of a torn PCL with a detailed clinical exam, x-rays, kneeling posterior knee stress x-rays, and almost always, an MRI scan to determine the extent of the injury and concurrent injuries to determine the recommended course of posterior cruciate ligament tear treatments. In general, many isolated PCL injury will heal over time; it is important to diagnose this particular ligament tear early to attempt to get them to heal in a stable position rather than in an elongated and nonfunctional position. While the results of an MRI scan are helpful for an acute injury evaluation, they are not very useful in the case of a chronic injury to evaluate for a PCL tear because they can show an intact posterior cruciate ligament, which may be unstable because it has healed in an elongated position. In this case, stress x-rays are required to diagnose the extent of the tear.
Non-surgical treatment consists of rest, ice, compression, and elevation (RICE protocol); all assist in controlling pain and swelling. Physical therapy may be recommended to improve knee motion and strength. A knee brace may be needed to help immobilize your knee. Crutches may be recommended to protect your knee and avoid bearing weight on your leg.
Generally, surgery is considered in patients with major ligament laxity or when there are other ligament injuries along with PCL injury. Surgery involves reconstructing the torn ligament using a tissue graft which is taken from another part of your body. Surgery is usually carried out with an arthroscope using small incisions. The major advantages of this technique include minimal postoperative pain, short hospital stay, and a fast recovery.
The PCL, or posterior cruciate ligament, is the strongest ligament in the whole knee. It sits in the center and back of the knee and prevents the knee from slipping backwards. It is most important for function on a bent knee, usually when the knee is bent to about 90 degrees.
A PCL injury occurs when the main ligament in the back of the knee, the PCL, is torn. Some times, even if PCL is not completely torn, it gets stretched so much that it is no longer functional. This most commonly occurs when somebody either hyperextends their knee or hits their knee against something when their knee is bent. This can be a dashboard injury in a motor vehicle accident, or it can be an athlete that falls down while playing a sport onto a bent knee.
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