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Knee Ligament Injuries

Ligaments are thick bands of connective tissue that connects bone to bone. Their purpose is to give joints stability and prevent excessive movement in their respective directions.

The knee joint has a complexity of ligaments, tendons and other soft tissue that blend together to give the knee it's unique characteristics. Though there are other ligaments in the knee, such as the patella-femoral ligaments, the knee joint has four major ligaments.

  • Anterior cruciate ligament.
  • Posterior cruciate ligament
  • Medial collateral ligament (Inside border the knee)
  • Lateral collateral ligament (Outside border the knee)

These ligaments can often get injured through high force trauma that forces these structures to stretch beyond their capacity (beyond what they can do). This is common in the sporting population when twisting, landing awkwardly or being tackled from an awkward angle. These injuries are commonly classified dependant on the severity of disruption (damage).

Grade 1: This refers to a mild sprain or "over stretch". Very little, if any of the ligament fibres tear, pain is low and the ligament still functions as normal. This often does not require much treatment other than a period of rest and tends to settle within a couple of weeks.

Grade 2: This refers to a more moderate tear where more of the ligament fibres are damaged. There is often ligament laxity and so feeling of instability is common. Bruising, swelling and pain can all be seen at the site of injury. Often these are treated conservatively (non-operatively) with a period of rest and rehabilitation over the course of 6-12 weeks.

Grade 3: This refers to when most to all of the ligament fibres have been torn. There is often considerable swelling, difficulty to weight bear/instability and bruising. Pain is normally severe, however when all fibres are torn it is not uncommon for people to have no pain at all. These injuries commonly require surgical intervention.

While mostly all ligament injuries will be managed the same in the hyper acute stage below, do not self assess where you are expecting anything other than a grade 1/slight strain. Please seek a medical assessment to ensure accurate diagnosis and prevent delays in appropriate management. Not all ligaments will be treated the same.

Injury management

Early management phase

  • Protect (Knee support/crutches if necessary)
  • Relative rest - Can continue pain free exercise/activity but limit painful activity. (Cycling etc often ok).
  • Ice
  • Compression - Compression garments/stockings can often help with swelling
  • Elevation

Early activation of your quadricep muscle (Squeezing your thigh) is recommended if this can be done pain free after a few days post injury.

Sub-acute phase

Following the above management it is recommended to follow an individual and structured rehabilitation programme prior to returning to activity. Specific exercises and appropriate times scales should be decided based on individual injury site, severity and goals. Return to play criteria should be discussed with the therapist and met prior to the resumption of sports. An general example of return to sports can be found here (Link in progress) however it is recommended to seek medical advice for your specific injury. To contact us, click here.

Unsure how to return to your activity? This may help: Return to sport


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