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Knee pain and knee injuries are common, especially as the knee joint has to take rather a large amount of stress by holding the whole body weight and by strenuous exercise.
While ageing and being overweight increase the risk, a large number of knee injuries happen during sports activities such as football, rugby, skiing, tennis or squash. Most of these injuries are sprains, but ligaments can also tear partially or fully.
Torn knee ligaments might require surgery, while sprains can be treated in a number of ways. The most common solutions for knee pain and sprains are:
Ligaments are tough bands of tissue connecting bones, and can be found all over the body, including the neck, shoulders, wrists, knees, ankles and spine.
In the knee, there are four bones connected by four ligaments.
The four bones around the knee joint are the thighbone, the main shinbone, the outer shinbone and the kneecap. Cartilage connects the ends of the thighbone and the main shinbone to the kneecap, which reduces friction.
The four ligaments around the knee joint help to stabilise the knee while changing positions. These four ligaments are:
Most knee injuries affect the ACL, accounting for about 40 percent of all sports-related knee injuries.
A torn ACL can cause the knee to become unstable and limit the full range of movement. This means that some movements will become very difficult to perform. While not all torn ACLs need surgery, the delay of a necessary option might worsen the condition.
PCL injuries are less common than ACL injuries, as this ligament is stronger and wider. Symptoms of such an injury might not be immediately obvious, and pain might only be noticed some time after the incident.
MCL injuries do not usually require surgery and can be treated by resting and gentle exercises, which can help restoring muscle strength.
LCL injuries are rare, as the other leg provides some protection against injuries on the inner side of the knee.
In severe cases, surgery might be recommended although there is always some debate about the best treatment options. If surgery is suggested, procedures differ based on which ligament is affected.
Prior to the ACL/PCL surgery, patients usually wait for the swelling to go down and for the full range of movement to return, which could take up to three weeks.
This could be shortened by working with a physiotherapist, who will be able to give advice on stretching or low-impact exercises such as cycling or swimming. No sports with turning or jumping should be practiced during this time, however.
ACL and PCL ligaments cannot be stitched back together easily. The most common surgery method is to remove the remains of the ligament and replace them with a tendon from another part of the leg. The graft tissue can come from the patient directly (autograft) or from a donor (allograft).
The operation is usually conducted under general or spinal anaesthetics. During the operation, the surgeon first assesses the damage with an arthroscope and if/when torn knee ligaments are confirmed, removes the graft tissue. In some cases, synthetic graft tissue is used. This tissue is then cut to the right size and inserted through a special type of keyhole surgery, called arthroscopy. Following insertion it will be secured to the bone with stitches, screws or staples. When finished, the surgeon tests the movement range and stability of the knee before stitching up the incisions.
Torn LCLs and MCLs are usually addressed in two ways.
Due to the location of LCL and MCL - not being inside the knee joint - no keyhole surgery is necessary.
If the LCL/MCL was torn on the shinbone or the thighbone, the surgeon re-attaches it with stitches, screws and staples through a small incision. If the LCL/MCL was torn in the middle, the surgeon usually sews the two ends together.
In the majority of cases, ACL knee ligament surgery can fully restore the functioning of the knee. However, there might still be some swelling and pain involved, which could be due to other injuries to the knee. The recovery time usually takes around six months, but it might be up to a year before a patient is able to continue some sports.
For knee ligament surgery affecting PCL, initial recovery time is usually longer than in the case of ACL surgery - about nine to 12 months should be expected. The recovery time for a fully torn MCL is six to nine months on average, while patients with a partial tear might return to their everyday activities in three months.
Preventing torn knee ligaments can be difficult, as they can affect anyone and are rather unpredictable.
Exercise is generally recommended, as this helps strengthening the muscles supporting the knee joint, and could help avoiding injuries and knee ligament surgery. While practicing sports, warm-up is essential and wearing knee braces can help reduce the chances of an injury and support those who have previously experience a knee injury.