Ligament Injuries Click to View Products for Ligament Instability   ACL The anterior cruciate ligament (ACL) (Fig. 1) is the most commonly injured ligament of the knee. The ligament is most commonly injured during athletic activity. The ACL controls how far forward the tibia moves in relation to the femur.   The ACL may not be the only ligament injured when the knee is twisted violently, such as in a clipping injury in football. It is not uncommon to see the medial collateral ligament (MCL), the medial meniscus and the ACL injured.	Fig. 1
Symptoms Include: Popping sound at the time of injury. Pain and swelling which inhibit movement and range of motion. The feeling of “giving way”. Numbness or tingling.
Treatment: Non-surgical treatment   ACL can be treated with RICE R: Rest means keeping off the injured knee as much as possible. Crutches enable the patient to move about when necessary without placing weight on the injury. A cast or splint may be applied to the knee for support and severe sprains occasionally require a hard cast. I: Icing, cold therapy to stimulate blood flow and relieve the pain associated with inflammation. Cold therapy should be applied several times over the course of the day. C: Compression means supporting the knee with a firmly (not tightly) wrapped elastic bandage, compression stocking, or gel wrap. If swelling causes the bandage to become tight, it should be loosened immediately. E: Elevating the knee minimizes bruising and swelling. This should be done as often as possible during the first 48 hours. Bracing: Braces can be either a knee immobilizer or a hinged knee brace to limit motion and protect the injury. Functional braces may be used where surgery is not indicated or chosen as an optional treatment.   Rehabilitation: Quadriceps and hamstring strengthening once the swelling has subsided. Nonsteroidal anti-inflammatory medications (NSAIDs) such as Ibuprofen, Motrin, Naprosyn and Celebrex may be used to decrease knee pain. Be sure to talk to your doctor before starting these medications. Surgical treatment Reconstructive surgery to replace the torn ACL.
MCL The medial collateral ligament originates from the end of the femur to the top of the tibia and is on the inside of the knee joint (Fig.1). The medial collateral ligament resists opening of the inside of the joint. The MCL is usually injured when the outside of the knee joint is struck.
MCL injuries are graded on a scale of I to III: Grade I MCL Tear: An incomplete tear of the MCL. The tendon is still in continuity, and the symptoms are usually minimal. Patients usually complain of pain with pressure on the MCL, and may be able to return to their sport very quickly. Most athletes miss 1-2 weeks of play. Grade II MCL Tear: Grade II injuries are also considered incomplete tears of the MCL. These patients may complain of instability when attempting to cut or pivot. The pain and swelling is more significant, and usually a period of 3-4 weeks of rest is necessary. Grade III MCL Tear: Grade III injury is a complete tear of the MCL. Patients have significant pain and swelling, and often have difficulty bending the knee. Instability, or giving out, is a common finding with grade III MCL tears. A knee brace or a knee immobilizer is usually needed for comfort, and healing may take 6 weeks or longer.
Symptoms Include: Pain directly over the ligament. Swelling and bruising on the inner side of the knee. Instability or “giving way”.
Treatment: Grade I sprains of the MCL usually resolve within a few weeks. Treatment consists of cold therapy and antiinflammatory medication. When a grade II MCL sprain occurs, use of a hinged knee brace is common in early treatment in addition to cold therapy and antiinflammatory medication. When a grade III injury occurs, patients usually wear a knee immobilizer and protect weight-bearing (crutches) for the first week to 10 days following injury. Patients should remove the immobilizer several times a day to work on bending their knee. After that time, the patient can begin wearing a hinged knee brace, and can begin to increase their range of motion in the knee. They can apply more weight to the knee as pain allows.
	PCL The posterior cruciate ligament (PCL) Fig 2 is far less likely to be injured than other ligaments in the knee. This thick durable ligament controls how far backward the tibia can move in relation to the tibia. Symptoms Include: Popping sound at the time of injury. Pain and swelling which inhibit movement and range of motion. The feeling of “giving way”.
Fig. 2
Treatment: Non-surgical treatment   PCL can be treated with RICE R: Rest means keeping off the injured knee as much as possible. Crutches enable the patient to move about when necessary without placing weight on the injury. A cast or splint may be applied to the knee for support and severe sprains occasionally require a hard cast. I: Icing, cold therapy to stimulate blood flow and relieve the pain associated with inflammation. Cold therapy should be applied several times over the course of the day. C: Compression means supporting the knee with a firmly (not tightly) wrapped elastic bandage, compression stocking, or gel wrap. If swelling causes the bandage to become tight, it should be loosened immediately. E: Elevating the knee minimizes bruising and swelling. This should be done as often as possible during the first 48 hours. Bracing Braces can be either a knee immobilizer or a hinged knee brace to limit motion and protect the injury. Functional braces may be used where surgery is not indicated or chosen as an optional treatment. Rehabilitation: Quadriceps and hamstring strengthening once the swelling has subsided.
Surgical treatment Surgical intervention for posterior cruciate ligament injuries is far less successful than that of the anterior cruciate ligament. The position of the ligament makes surgery difficult and is usually only attempted when other structures within the knee are involved.
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