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The knees can take a lot of punishment when athletes are running or playing sports, with four knee ligaments at risk of injury: the anterior cruciate ligament (ACL), the posterior cruciate ligament (PCL), the lateral collateral ligament (LCL) and the medial collateral ligament (MCL).
The ACL and PCL connect the thigh bone with the shin bone and injuries to these, particularly the ACL, commonly cause disability in the knee. Excess stress on the ligaments can cause them to overstretch or, in severe cases, to snap. ACL injuries are more common in women than men.
These are among the most common types of knee injury and account for a large proportion of all sports injuries. The anterior cruciate ligament can tear if the lower leg extends too far forwards or if the lower leg and knee are twisted. Basketball players, footballers, skiers, tennis players, gymnasts and other sports people are at risk of knee ligament injuries.Causes of knee ligament injuries
The most common causes of ACL and other knee ligament injuries are twisting the knee, an impact to the knee, extending the knee too far, suddenly stopping when running, landing badly from a jump, suddenly shifting the weight from one leg to the other and suddenly changing direction.
Sometimes an ACL injury can be difficult to diagnose; however, it is usually obvious to the person with the injury that something severe has happened. Sudden, severe pain is the first symptom most people will experience. There may be a loud snap or pop at the time of the knee injury and the knee will become swollen. The joint may feel loose and unstable, and the person will not be able to bear weight on it without causing an increase in pain.How common are knee injuries?
In sporting accidents, the knee is the most commonly injured joint. Around 11% of knee injuries are meniscal tears, with ligament injuries accounting for around 40%. Of these, 49% affect the anterior cruciate ligament and 29% the medial collateral ligament. ACL ruptures account for around 17,000 knee injuries in the UK each year.Diagnosis of knee ligament injuries
A thorough examination is needed to diagnose the injury. If bleeding has caused swelling of the knee, this may be drained through a needle. Other aids to diagnosis can include x-rays and magnetic resonance imaging (MRI) scans to determine the extent of the damage. Sometimes additional tests are undertaken.
If untreated at the time they occur, knee ligament injuries can continue to cause problems for months or even years and cause the knee to give way with certain movements, although mild injuries may heal on their own in time.
The initial treatment of knee ligament injuries to aid healing should be based on the RICE protocol:
Other measures you can take include stabilising the knee by wearing a knee brace. This will also help to guard against further injury. If the knee ligament injury remains painful, you can take non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or aspirin to help ease the pain and reduce the swelling. These should not generally be taken over a long period, however, as they can have side effects. If exercises to stretch and strengthen the joint have been recommended, you should practice these.
Surgery may be needed in the case of severe collateral ligament tears to reattach the ligament.Anterior and posterior cruciate ligament tears
Once the ACL or PCL has been stretched beyond its limit or completely torn, the damage cannot be repaired surgically and a reconstruction is needed. Tendons from other areas of the legs are used to replace the torn ligament. Most commonly, the tendons used are the patellar tendon or the hamstrings. Although surgical reconstruction techniques have improved greatly over recent years, not everyone with a knee ligament injury will choose to have such complicated surgery. If the joint is very painful or unstable, or if it is important to you to get back to the same level of activity, you may choose to go ahead with a reconstruction.
Some people are content to accept the risk of permanent instability and weakness in the leg and simply continue with strengthening exercises to optimise their recovery. This is something that should be discussed with the consultant surgeon.
How quickly you recover from a knee ligament injury depends on its severity and can vary with different people. A physiotherapist will supervise you throughout your recovery and you can expect it to be a minimum of six months before you are able to engage in your sport again. It can often take longer than this.
Although recovery can take a long time, there is no need to be inactive. As long as your doctor agrees, you could try a new activity that will not put strain on your knee, such as swimming.
You should not try to return to your former level of activity until your knee is not at all painful when you bend and straighten it or when you walk, jog or jump. Once your knee feels as strong as the uninjured one and there is no swelling, you will probably be ready to start engaging in your sport again. If you start too early, you risk causing permanent damage.
As with any surgical procedure, ACL surgery carries some minor risks such as blood clots, infection, pain and weakness. The functioning of the knee is fully restored in more than 80 per cent of cases; however, you may notice some differences from how it was prior to the injury. This could be due to other knee injuries that happened at the same time as the ACL injury, such as damage to the cartilage.
It is difficult to prevent knee ligament injuries, as they are usually caused by accidents; however, there are precautions you can take to lower the risk. Always warm up properly before physical activity and stretch afterwards. Regular stretching and strengthening exercises will help to keep your thigh muscles strong and less prone to injury. If you intend to change the intensity of your workout, do this slowly and give your body time to adjust rather than making abrupt changes.
Work is currently being carried out to ensure that athletes and sports people receive proper training and that safer sports equipment is used. Rates of sporting injury have been reduced in people who have participated in training programmes that improve strength, coordination, technique and awareness of the risk of injury. The use of protective equipment such as knee braces has also been shown to help reduce the incidence of injury, as has modifying rules to promote less aggressive and dangerous behaviour in sports such as rugby and American football.