Treatment of Ligament Injuries of the Knee Joint

Introduction

Ligaments are tough bands composed of elastic connective tissue that wrap a joint to support and limit the movement of the joint. When these ligaments get damaged, the knee joint can lose its stability. Damage to the ligament may often occur from an injury during sports. A torn ligament has the potential to severely limit different knee movements. This eventually results in the inability of the knee to pivot, turn, and twist the leg. Surgical correction is a treatment modality to repair a torn ligament in case other management plans are ineffective. There are four chief ligaments in the knee. These ligaments connect the femur or the thigh bone to the tibia or the shin bone.

What Are the Constituents of Knee Joint?

The knee joint consists of three main bony components and a series of ligaments, cartilage, blood, nerve, and muscle supply. The components are classified as follows.

Bony Components:

The bony component includes the following:

• The thigh bone or femur.

• The shin bone or tibia.

• The kneecap or patella.

Ligaments:

The ligaments include the following:

• Anterior Cruciate Ligament: Is located in the center of the knee and controls rotation and forward movement of the tibia (shin bone).

• Posterior Cruciate Ligament: Is located in the back of the knee and controls the tibia's backward movement (shin bone).

• Medial Collateral Ligament: Gives stability to the inner knee.

• Lateral Collateral Ligament: Gives stability to the outer knee.

Cartilages:

The cartilages include the following:

• The medial meniscus.

• The lateral meniscus.

It is outlined by a layer of a fluid-filled membrane called the synovial membrane.

1. Muscles.

2. Blood vessels.

3. Nerves.

What Happens in Case of a Ligament Injury?

The anterior cruciate ligament is the most prone among all the knee ligaments to be injured. The ACL may be stretched or torn during a sudden twisting motion. Sports injuries during skiing, basketball, or football are more at risk for ligament damage. The posterior cruciate ligament may get injured in cases where a sudden, direct impact occurs, such as in vehicular accidents, football tackles, or other contact sports.

How Does a Cruciate Ligament Injury Feel?

A cruciate ligament injury usually does not result in pain. Instead, a popping sound may be heard just as the damage occurs, followed by the buckling of the leg when trying to stand on it, and consequently swelling. However, symptoms differ amongst individuals. The symptoms may mimic other conditions or medical problems, and consultation with a doctor for a definitive diagnosis is essential.

How Are Collateral Ligaments Prone to Being Injured?

The medial collateral ligament is more prone to injury or damage than the lateral collateral ligament. Stretch and tear injuries to these ligaments are usually caused by blows to the outer or lateral side of the knee when playing rough sports such as hockey or football.

How Does a Collateral Ligament Injury Feel Like?

Unlike cruciate ligament injuries, an injury to the collateral ligament causes the knee to pop and buckle and causes pain and swelling at the affected site. The symptoms may mimic other conditions or medical problems, and physician consultation for a definitive diagnosis is fundamental.

How Are Knee Ligament Injuries Diagnosed?

Recording the complete medical history and physical examination of a patient is of vital importance, along with diagnostic procedures and imaging techniques enlisted as follows;

• X-Rays: It is a helpful diagnostic tool since they provide a clear image of dense tissues in the body, including bones and thick ligaments.

• Magnetic Resonance Imaging (MRI): MRI is another diagnostic tool since it can reveal any abnormality in the ligaments, such as chronic thickening and increased ossification.

• Arthroscopy: Arthroscopy is a minimally-invasive surgical, diagnostic, and treatment procedure used for joint conditions that use a small, lighted, optic tube inserted into the joint through a small incision made in the joint to access the joint cavity. Images taken from inside the joint are projected onto a screen to evaluate any degenerative or arthritic changes in the joint, bone diseases, and tumors and to determine the cause of bone pain and inflammation.

How Are Knee Ligament Injuries Treated?

The doctor determines the treatment modalities for a knee ligament injury based on the following criteria;

• Age of the patient.

• Overall health status and medical history of the patient.

• The extent and nature of the injury.

• Reactions to specific medications, certain procedures, and therapies.

• Probable postoperative recovery phase period.

• Opinion or preference of the patient.

Treatments may include the following;

• Medications such as Ibuprofen.

• Muscle-strengthening exercises.

• Protective knee brace (for use during exercise).

• Ice pack application (to reduce swelling).

• Surgery.

Postoperative Rehabilitation:

Rehabilitation postoperatively is done immediately. A physical therapist is appointed to train the individual with suitable exercises to strengthen the joint to its original capacity and restore adequate knee movements. Prosthetic devices such as a cane, crutches, or walker may be prescribed until the joint regain functionality. A continuous passive motion (CPM) machine may help move the joint while the individual relaxes. An exercise program at home will help to keep joint functionality intact.

Postoperative Complications:

1. Operative site infection.

2. Stiffness of the knee.

3. Blood clots (deep vein thrombosis).

4. Damage to the blood vessels and nerves.

5. Loosening of the implant.

6. Plastic liners wearing out.

7. Dislocation of the knee cap.

8. Ligament injury.

9. Addiction to narcotic pain relief medication that is provided short-term for certain cases.

Conclusion

The knee joint is a synovial joint articulating a pair of long bones, separated by a capsular ligament and articular cartilage. The anterior cruciate ligament is the most prone among all the knee ligaments to be injured during a sudden twisting motion. The posterior cruciate ligament may get damaged in cases where a sudden, direct impact occurs. Unlike cruciate ligament injuries, an injury to the collateral ligament not only causes the knee to pop and buckle but also causes pain and swelling at the affected site. The symptoms may mimic other conditions or medical problems, and physician consultation for a definitive diagnosis is fundamental. The doctor determines the treatment modalities for a knee ligament injury based on several factors ranging from the age and extent of damage to the presence of other conditions.