Knee ligament sprains or tears are a common sports injury which means that you have injured one of the ligaments around the knee joint. These ligaments are critical to the stability of the knee joint and it’s ironic that the people who are most likely to suffer a torn ligament in knee injury are those with the most active lifestyles. The vast majority of these serious injuries occur among athletes, sportspersons, runners or those with a high degree of physical activity in their routines. A torn ligament in knee patients causes the person to suffer and they are forced to make alterations to their active lifestyle.
The knee is the largest joint in your body and one of the most complex hinge joint allowing you to sit, squat, walk or jump. Ligaments are strips of strong, elastic connective tissue that enclose a joint to provide support and limit the joint's movement. The ligaments within and around the knee hold the joint together and prevent it from giving way during turning and twisting activities. The knee ligaments connect your thighbone (femur) to your lower leg bones.
When your knee ligaments are damaged, it can leave the knee feeling unstable. This means that you won’t be able to pivot, twist or turn your leg like normal.
Since the knee joint relies just on these ligaments and surrounding muscles for stability, it is easily injured. The ligaments may be sprained (stretched), or sometimes ruptured (torn). Any direct blow to the knee or your knee may be moved beyond its usual range of movement, such as changing direction rapidly while running can injure a knee ligament.
The "sprains" are graded on a severity scale:
Grade 1 Sprains: stretching or slight tearing. The knee feels stable with mild tenderness, swelling, and stiffness
Grade 2 Sprains: also known as a partial tear of the ligament, this injury stretches the ligament to the point where it becomes loose. While the knee sometimes feels stable, the damaged areas are tender to the touch, and walking is painful.
Grade 3 Sprains: This type of sprain is most commonly referred to as a complete tear of the ligament with severe swelling and bruising. The knee joint is unstable and may feel "wobbly."
It is possible to injure one or more ligaments at the same time. These multiple ligament injuries can have serious complications and may even lead to amputation.
The main ligamentous injuries include trauma to the following:
The medial collateral ligament (MCL)
The lateral collateral ligament (LCL)
The anterior cruciate ligament (ACL)
The posterior cruciate ligament (PCL)
Surgery is considered when you have an unstable Knee that does not respond to nonsurgical treatment. Your orthopaedist may determine that your knee instability or ligament tears are severe enough to require surgery. The type of surgery is determined by kind of the injury to the ligaments. In some cases, ligaments can be strengthened or tightened again by inserting them back onto the bone in their anatomic position, by using a small anchor to affix the ligaments into the bone.
When the ligaments are too weakened or destroyed for repair surgery, your orthopaedist may suggest ligament reconstruction. Ligament reconstruction surgery involves harvesting a tendon from somewhere else in your body (autograft) which is used to replace your damaged ligament. Tendons grafts from the hamstring or the kneecap are usually used. The tendon is fixed in place inside your knee joint, using screws or surgical staples or by other means. Over time, after they are affixed, a new ligament should grow over the tendon that has been used.
ACL reconstructions: They have been performed for the last 30 years, and significant advances in surgical techniques have been made during this time. Now it is usually done using keyhole surgery (rather than a large incision) and a variety of different graft material can be used. The most popular method of reconstructing an ACL currently is the use of hamstring tendon, although alternatives include patella tendon, allograft tissue(from an organ donor) or synthetic material (e.g., active biosynthetic composite, LARS ligament etc).
PCL reconstruction: They may be treated with bracing and physiotherapy in a number of instances, but occasionally a grade 2 or grade 3 PCL injuries may need a surgical reconstruction.
Most isolated MCL or LCL injuries can be treated conservatively with bracing and physiotherapy, as the vast majority heal very well without surgery. MCL injuries can also occur in combination with ACL injuries and meniscal tears, which will need careful management. Grade 3 MCL or LCL tears may require surgery. Surgical treatment for isolated injuries of the medial collateral ligament MCL or LCL is a conflict-ridden topic. The treatment plan should be based partially on the patient's motivational factors and pre-injury level of activity. It is, therefore, significant to diagnose these as early as possible after the injury occurs.
Dr. Biren Nadkarni is a practicing Senior Orthopaedic and Joint Replacement Surgeon at the best orthopaedics hospital in Delhi, having almost two decades of rich and dynamic experience. He is currently working at Holy Family Hospital Sitaram Bhartia Institute of Science and Research as well as Cygnus orthocare hospital. Dr. Biren’s area of specialty includes the medical and surgical management of Knee and hip arthritis. He is the best knee specialist in India and very proficient in Adult Joint Reconstruction Procedures including knee reconstruction in delhi with a vast experience of performing around hundreds of Knee, Hip and Shoulder replacement as well as knee ligament surgery in his career.
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