What are Knee Ligament Lesions?
The knee is the largest joint in the body and is vital for movement. The stability of the knee is provided by the lateral ligaments and the cruciate ligaments. The cruciate ligaments connect the thigh (femur) and tibia (shinbone) bones from the inside of the knee joint. These ligaments tightly connect these two bones like a short rope, providing the necessary stability when the knee is bent and straight. The one in the front is called the anterior cruciate ligament (ACL), and the one in the back is called the posterior cruciate ligament (PCL).
The lateral ligaments fix the femur and tibia bones by connecting them to each other from the inside and outside (the lateral ligament indirectly fixes the tibia by attaching to the fibula bone located on the outside back of the tibia). They prevent the knee joint from opening to either side. At the same time, they support the cruciate ligaments in fixing the rotational movements of these bones.
Anterior Cruciate Ligament (ACL) Injuries
The ACL prevents the tibia from sliding forward relative to the femur. It also prevents the tibia from rotating.
The anterior cruciate ligament can be injured in the following ways:
- Sudden change of direction, knee rotation
- Slowing down while running or sliding
- Landing after jumping
- Direct blow to the knee
Anterior Cruciate Ligament Injuries Symptoms
When your ACL is injured, you may not feel any pain right away. However, a snapping sound or loss of knee control is usually felt. Within 2-12 hours, the knee will swell and become painful when standing up. Applying ice and elevating the leg will reduce pain and swelling until you see an orthopedist.
If you walk with a torn anterior cruciate ligament, the knee cartilage may be damaged. Especially when the body is turned while the foot is fixed, the tibia remains fixed while the thigh bone (femur) rotates. This has a grinding-injuring effect on the cartilage.
Anterior Cruciate Ligament Diseases Diagnosis
The basic method of diagnosis and evaluation of ACL tears is examination. There are various examination tests. In particular, stability tests that make the decision for surgery are performed by examination.
In patients with these types of injuries, direct X-rays may be requested to detect other bone pathologies and MRI may be requested for intra-articular pathologies. In rare cases, arthroscopic examination may be required.
Anterior Cruciate Ligament Injuries Treatments
There are surgical and non-surgical treatment alternatives.
Non-Surgical Treatment;
- Partial tears
- Those with age or generally low physical activity
- In stability tests (such as pivot shift test), the overall stability is good.
Surgical treatment may not be required for the knees. It is recommended that such patients do regular exercises to develop their front and back thigh muscles (quadriceps and hamstrings) throughout their lives and use special knee pads during risky activities.
Anterior Cruciate Ligament Surgical Treatment
It is necessary for active patients with ACL tears who want to do sports. It is recommended for people who have occasional knee rotation and less activity to restore confidence in the knee and prevent cartilage damage.
In surgical treatment, a reconstruction appropriate to the original anatomy of the anterior cruciate ligament is usually achieved by using a tendon (or a part of it) around the knee arthroscopically. After ACL reconstruction surgery, a serious physical therapy and rehabilitation program is applied for approximately 3 months.
Posterior Cruciate Ligament (PCL) Injuries
The posterior cruciate ligament (PCL) is not injured as often as the ACL. PCL injuries are usually caused by excessive tension or pulling. The most common cause is a movement that bends the knee forward. This type of movement can occur with a false step, and it occurs more frequently in sports such as snowboarding, motorcycling, and football.
In PCL injury, there is a loss of knee stability. In particular, the tibia slides backwards relative to the femur. This movement can cause damage or thinning of the soft knee joint cartilage. This wear and tear can result in arthritis in the future.
Symptoms of a PCL injury are similar to those of an ACL tear, but signs of instability, such as rotation of the knee, are less common.
Most people with a PCL tear can return to normal activities without surgery after a good rehabilitation program. Surgery may be necessary for athletes who have a torn PCL with a piece of bone from the tibia or who cannot return to their pre-accident performance despite rehabilitation.
Collateral Ligament Injuries
Small incomplete tears in the medial collateral ligament (MCL) may not require surgical treatment. In this case, a bandage or one of the various knee brace options may be used, depending on your doctor's decision. In these cases, applying ice for 15-20 minutes 2-3 times a day, keeping the leg elevated, and resting will help the swelling and pain heal more quickly.
In the early days of lateral ligament injuries, swelling and pain in the knee can make it difficult to determine the severity of the injury through examination. In these cases, your doctor's suggestions for an examination under anesthesia or an MRI should be taken seriously.
In complete tears of the lateral collateral ligament (LCL) and medial collateral ligament, the fibers of the ligament do not heal strongly enough, which puts the stability of the knee at risk. Surgical treatment is preferred especially in young and active people who do sports. Surgery for new tears of the medial and lateral collateral ligaments is an easy procedure and the results are quite good. After surgical treatment, the knee needs a period of intensive physiotherapy to return to its former functions.
The deterioration of the stability of the knee resulting from inadequate treatment of knee lateral ligament injuries not only disrupts sports and high physical activity, but also causes the development of early calcification in the knee. In this case, reconstruction (re-creation) operations of the ligament are required. Although these operations are technically more difficult and have a longer recovery period than new tear operations, they give good results in good hands.
What are the knee ligaments and what are their functions?
There are four main ligaments in the knee joint:
- Anterior Cruciate Ligament (ACL): It connects the thigh bone (femur) and the shin bone (tibia), prevents the tibia from sliding forward, and controls the rotational movements of the knee.
- Posterior Cruciate Ligament (PCL): It prevents the tibia from sliding backwards and provides stability to the knee.
- Medial Collateral Ligament (MCL): It is located on the inner side of the knee joint and prevents the knee from opening inward.
- External Collateral Ligament (LCL): It is located on the outside of the knee joint and prevents the knee from opening outward.
How do knee ligament lesions occur?
Knee ligament lesions usually occur in the following situations:
- Sudden change of direction or stopping: Sudden movements, especially during sports activities.
- Direct blow to the string: Traffic accidents, falls, or blows to the knee during contact sports.
- Overstress: Straining the knee joint beyond its normal range of motion.
What are the symptoms of knee ligament lesions?
- Sudden snapping sensation or sound: A snapping sensation or sound may be heard in the knee at the time of injury.
- Swelling: Swelling in the knee may occur within a few hours after the injury.
- Pain: Pain is felt at the site of injury.
- Limited movement: Limited knee movements and weakness.
- Knee instability: A feeling of insecurity or emptiness in the knee.
How are knee ligament lesions diagnosed?
Diagnosis begins with the patient's history and physical examination. The doctor performs various tests to assess the stability of the knee. If necessary, magnetic resonance imaging (MRI) is used to examine the condition of the ligaments in detail.
What are the treatment options for knee ligament lesions?
Treatment depends on the severity of the injury, the patient's age, activity level, and overall health:
- Non-Surgical Treatment: For individuals with partial tears or low activity levels, rest, ice application, compression, elevation (RICE protocol), physical therapy, and knee brace use are recommended.
- Surgical Treatment: Ligament reconstruction can be performed with arthroscopic surgery in patients with complete tears, individuals who lead active lives, or patients who feel instability in the knee.
How can I protect myself from knee ligament injuries?
- Regular exercise: Doing exercises that strengthen the muscles around the knee.
- Warm up and stretch: Doing appropriate warm-up and stretching exercises before sports or physical activities.
- Choosing the right shoes: Wearing supportive shoes appropriate for the activity.
- Correct use of technique: Learning and applying correct techniques while doing sports.
Do knee ligament lesions heal completely?
With appropriate treatment and rehabilitation, many knee ligament injuries can heal completely. However, the recovery time depends on the severity of the injury and the treatment used. The rehabilitation process after surgical treatment is critical for a full recovery.
When can I return to sports after knee ligament lesions?
The time it takes to return to sports depends on the severity of the injury and the treatment applied. After surgical treatment, return to sports is usually possible within 6-12 months. However, approval from a doctor and physiotherapist is required for full recovery and stability of the knee.
What happens if knee ligament lesions are not treated?
Untreated knee ligament lesions can lead to chronic instability of the knee, which can lead to meniscus and cartilage damage, early joint degeneration, and osteoarthritis.
Which doctor should I see for knee ligament lesions?
For knee ligament injuries, it is recommended that you consult an orthopedic and traumatology specialist. These specialists are experienced in the diagnosis and treatment of knee injuries.
