What is a Ligament Injury?
A ligament is a soft tissue structure that joins a bone to a bone. A tendon, by contrast, joins a muscle to a bone. Ligament rupture occurs when excessive stress is applied to a joint. Stress can be applied through contact with a sporting opponent or object, or by “non-contact” such as forces applied to a knee when side-stepping or skiing. The knee possesses a number of ligaments and each may be completely or partially torn. The direction and magnitude of the force applied will determine which ligaments are ruptured and the severity of the tear. The most commonly injured ligaments of the knee are the medial collateral (MCL) and anterior cruciate (ACL). Multiple ligaments may be injured at once and meniscal tear can occur either acutely with the initial trauma or chronically in an unstable knee.
What are the Symptoms?
The symptoms depend on which ligament is torn. A pop may be felt at the time of injury. Immediate swelling is typically seen with an ACL tear. Pain will be present initially and with an MCL the pain is medial (inner side). Walking may be difficult initially due to pain and instability. Once the pain subsides instability may persist.
What is the Treatment?
MCL tear is often an isolated injury and in the majority of cases can be treated without surgery. Anti-inflammatory medication (NSAIDS), rest and physiotherapy +/- bracing depending of the grade of tear will be successful in the majority of cases.
ACL tear can often be treated non-surgically with physiotherapy and lifestyle modification in low demand patients or if there is a partial tear. Subsequent meniscal and cartilage damage is associated with the number of times your knee gives way and your level of activity. Jumping, side-stepping, and heavy manual labour increase your risk.
Younger, active people with ACL tears generally benefit from ligament reconstruction. Multi-ligament injuries are a more complex problem. An MCL injury at the time of an ACL is generally allowed to heal prior to the ACL reconstruction however injury to other ligaments may also require reconstruction. A meniscal tear can be treated at the time of ACL reconstruction.