American Spine Center

American Spine Center

Knee pain because of ligament injuries

Knee pain because of ligaments injuries

Many people especially athletes suffer from knee pain because of ligament injuries, and usually, these kinds of injuries limit their activities, careers, or in general their lifestyle.

But what are ligaments injuries?

To understand this you have to put a spotlight on the structure of the knee.

Structure of the knee

There are four bones around the area of the knee joint: the thigh bone (femur), the main shin bone

(Tibia), the outer shin bone (Fibula) and the kneecap (Patella).

The main movement of the knee joint is between the femur, the tibia, and the patella.

There is tough connective tissue (articular cartilage) that covers the ends of the tibia and femur and the back of the patella around the knee joint.

Why do we need cartilage in our knees?

The articular cartilage reduces friction between the bones of the knee joint and helps smooth movement between them.

Each knee joint also contains an inner and outer meniscus, which are thick rubbery pads of cartilage tissue. They are C-shaped and become thinner towards the middle of the joint.

Also, there are four ligaments around the knee joint. A ligament is a tough strip of connective tissue that joins one bone to another bone around a joint. These ligaments have a very important role in stabilizing and supporting the knee when it is moved into different positions.

Furthermore, each ligament has a different job to do:

  • At the inner side of the knee, there is the (so-called), medial collateral ligament. (MCL). It runs between the Femur and the Tibia on the inner side of the knee. It helps to protect and stabilize the knee joint against any forces on the side of the leg. Also helps in limiting the number of knee moves from side to side.
  • At the outer side of the knee, there is the (so-called), lateral collateral ligament. (LCL). It runs between the Femur and the Fibula. The function is to protect the knee joint against any forces on the side of the leg. Again this ligament does not allow too much movement of the knee from side to side.
  • Inside the knee joint, there are two ligaments. The first one is (the so-called), Anterior Cruciate Ligament (ACL). It runs diagonally connecting the front (anterior) of the Tibia to the back (posterior) of the Femur. This joint also helps to stabilize the knee joint by controlling backward and forward movements of the knee.
  • The second one is inside the knee is the (so-called) Posterior Cruciate Ligament (PCL). It also runs diagonally across the knee, it is also connecting the back (posterior) of the Tibia to the front (anterior) of the Femur. The ACL and the PCL cross each other inside the knee joint and some people call them the cross ligaments. (Cruciate means CROSS-SHAPED).

 

The knee joint is surrounded by a protective joint capsule. This is lined by a special membrane called the synovial membrane. Which produces the main lubricating fluid for the knee, the so-called Synovial fluid.

How does the ligament injury occur?

They may be stretched (sprained), or sometimes torn (ruptured). A ligament sprain happens when the fibers that make up the ligament are stretched and just a few fibers are torn. Most knee ligament injuries are sprains and not tears and they tend to settle down quickly.

  • If you have a direct blow to your knee
  • Knock into something with your knee
  • The knee may go beyond its usual range of movement. In some incidents during a fall, or landing during sports. Or even after a sudden movement.

The ligament of the inner side of the knee (medial collateral ligament, MCL), was injured.

It happens when your leg is stretched out in front of you and the outer side of your leg receives a blow at the same time. It happens in almost any sport. And happens in all age groups.

 

The ligaments inside the knee, the front ligament (anterior cruciate ligament, ACL), injury.

The injury happens if you land on your leg and then you twist your knee in the opposite direction quickly, where it is slightly bent. Just like what happens in basketball, football, and tennis. Because the muscles around a woman’s knee aren’t as strong as those around the man’s knee, in general women tend to have injuries to their ACL more frequently than men.

 

Inside the knee, rear ligament, (Posterior cruciate ligament, PCL) injury.

It may be injured during accidents, particularly car accidents. But how?

If the dashboard hits the front of your bent knee and your lower leg is forced backward.

It may also be injured from the front whilst it is stretched out in front of you with your foot on the ground. In a game of soccer for instance.

In the beginning, you may not notice any symptoms. However, you may notice that there is a pain that comes on when going up and down stairs or when starting a run.  Sometimes you may feel unstable when walking on uneven ground.

How does it feel when you injure your knee ligament?    

The symptoms depend on the severity of the injury rather than the ligament that is injured. The ligament that is completely torn may produce more in the way of symptoms than a ligament that is just sprained.

Symptoms may include:

  • Swelling of your knee. When a ligament is injured, there may be some bleeding inside your knee joint from the damaged ligament. Which may cause knee swelling. Minor ligament sprains may cause little in the way of swelling. However, torn ligaments may lead to a lot of knee swelling. Which may be produced very quickly.
  • Pain In the knee.
  • A popping sound or snapping feeling. Sometimes this could be felt if the ligament is completely torn.
  • Tenderness in the area around the knee on touching. This is maybe more generalized and severe if the ligament is torn.
  • In complete ligament tears, movement can be severely reduced; whereas, in more minor sprains you may have a relatively good amount of knee movement.
  • A bruising around your knee can sometimes be obvious, and not necessarily occurs at the time of the injury, it may take some time to develop clearly.
  • The feeling of instability of the knee. This may cause you to limp. Again it depends on how much your ligament is injured. You may be able to stand if you have just a minor sprain.

 

How is the knee ligament injury diagnosed?

In the first place, you have to see a doctor, your doctor has to know more about the injury by asking detailed questions about your symptoms and how you feel the pain, and where exactly you feel the pain. Also through physical examination, the doctor looks for signs of swelling in your knee.

They have special examination techniques and look for special signs specific to ligament injury.

For example, a drawer sign.

When the examiner, tries to do sliding of the knee joint forward and backward. Exactly, when he is trying to move the Tibia (the bigger leg bone) under applied stress. This sign when exiting (positive), backward or forward; means laxity or tear of the posterior/rear, or anterior/front cruciate ligament of the knee accordingly.

Radiology studies:

If your doctor suspects a more serious knee ligament injury, they may refer you for a special type of radiology examination called an Ultrasound Scan. Or a Magnetic Resonance Imaging (MRI) scan. By using these studies doctors may be able to recognize any tears or ruptures in the knee ligament.

Treatment of the knee ligament injury:

During the first few hours till the first few days, what should you do?  And what you should not do?

What to do:

  • Protect your knee from further injury.
  • Your knee needs to be in rest, for at least 2 days. But how to do so?
  • Use crutches.
  • Start some kind of exercises to help keep your knee joint moving and mobile, as soon as you can tolerate the exercises. Do not keep your injured knee immobile for too long.

 

  • Ask your doctor about the timing and the kind of exercises that fit your injury.
  • Apply some ICE for at least 10 to 30 minutes. Be informed that more than 30 minutes applying of cold will damage the skin. And less than 10 minutes would not be effective.
  • It is a good idea to use a bandage with compression to limit the swelling. Be noted that mild pressure is not uncomfortable or too tight and would not stop the blood flow to the joint.
  • Always try to use tubular knee support, and the pharmacist will help in choosing the right size.

And be advised also to remove the bandage after 48 hours. Because you need to allow for some movement of the joint. However, sometimes it may be needed to keep the bandage for a little more time to reduce the swelling of the joint.

 

  • It is a good idea to elevate the limb in a way, it will improve the joint swelling. Try to keep your foot on the injured side up on a chair, supported by a pillow under your knee.
  • Rehabilitation to get your knee back to normal.

What you should not do:

  • Heat (which does exactly the opposite of Ice on blood flow), should be avoided during the first 72 hours, however, after 72 hours heat may then be soothing.
  • Any vigorous kind of training, or exercise.
  • Massage may increase bleeding and swelling.
  • Alcoholic drinks. Which reduces the healing process, and increases bleeding.

Medical Therapy:

  • Paracetamol and codeine: for Paracetamol the adult dosing is two 500 mg tablets, four times a day. For a few days. If the pain is more severe, Codeine could be prescribed. Which is more powerful?  But has some side effects like constipation, and drowsiness.
  • Anti-inflammatory painkillers: are also called NSAIDs. They have two benefits, first to reduce pain. And second to reduce swelling. Some of them you can buy over the counter (no prescription is needed), for example: However, some needs a prescription.
  • These NSAIDS have some side effects like stomach pain, and bleeding from an ulcer. Some people with asthma, high blood pressure, kidney failure, and heart failure may not be able to use these medications.
  • Topical anti-inflammatory.

Physiotherapy:

Physiotherapy aims to increase the range of movement in your injured joint. If you are referred to surgery to repair a torn knee ligament, it is likely to be advised to see a physiotherapist first.

Knee braces:

Your doctor may advise you to wear a special brace to support your knee while the damaged ligament heals. This special brace allow some bending and extending movements but not allowing movement from side to side. However, a knee brace is not suitable for all patients, this will be decided by your doctor.

Surgery:

Some indications for the surgery after knee injury will be:

  • If the patient is an athlete.
  • If more than one ligament has been injured.
  • If you hurt another part of your knee, along with the knee ligament.
  • If the physiotherapy and the rehabilitation therapy did not work well.
  • If you have hurt the side ligament (lateral collateral).
  • In reality, surgery is most likely advised to repair the front inside ligament (anterior cruciate ligament).
  • The decision, to carry on surgery or not, depends on various factors like:
  • Was the physiotherapy effective or not?
  • How actively you are moving on a daily basis.
  • If you have any other medical condition.
  • If you have another medical injury in your knee.
  • After all, the decision to do the surgery may be discussed between you and your doctor.

 

How to protect yourself from ligament injury?

There are some facts to know about ligament injuries:

  • Warming up during a game or sports training time is very effective in preventing injuries.
  • Warming up for 5 to 10 minutes and gradually escalating the activity level, will increase the blood flow to your muscles, and help to loosen up your joint movement.
  • Wearing a knee brace is controversial.
  • Exercising regularly is recommended.
  • There are some groups of muscles that help to support your knee. Known as hamstring and quadriceps. It important to build –up the strength of these muscles to support your knee structures.

 

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