Anterior Cruciate Ligament Injuries (ACL)

Pathophysiology

The anterior cruciate ligament (ACL) provides stability to the knee joint by preventing the tibia from sliding on the femur and provides rotational stability in twisting movements. ACL injury often occurs during sports when the foot is planted and a sudden force hits the knee whilst the leg is straight or slightly bent. This can happen with sudden changes of direction, slowing down when running or landing from a jump. It is common in football, skiing and rugby.

Symptoms

  • Hearing a ‘pop’ or ‘crack’ or feeling of the knee giving way at the time of injury
  • Sudden onset of pain and development of bruising and swelling within a few hours of injury
  • Difficulty standing on the knee initially
  • Being unable to straighten the knee initially

Management

  • Activity modification
  • Ice or heat
  • Pain relief
  • Physiotherapy including range of movement exercises and a graded strengthening programme
  • Orthopaedic options- If traumatic and active/sporting lifestyle may consider repair, otherwise 3-6 months conservative management

Investigations

  • MRI with trauma if considering surgery

Collateral Ligament Injuries (MCL/LCL)

Pathophysiology

The Medial Collateral Ligament (MCL) is located on the inside of the knee and can be injured during force from the outside to the inside of the knee. The Lateral Collateral Ligament (LCL) is located on the outside of the knee and can be injured during high energy direct forces which are from inside to outside.

Symptoms

  • Localised tenderness over MCL or LCL
  • Some swelling
  • Feeling of instability
  • Pain levels variable
  • Often associated with ACL tear but rarely meniscus

Management

  • Activity modification
  • Ice or heat
  • Pain relief
  • Physiotherapy including range of movement exercises and a graded strengthening programme
  • Orthopaedic options- If traumatic and active/sporting lifestyle may consider repair, otherwise 3-6 months conservative management

Investigations

  • For multi-ligament tears MRI with if considering surgery
  • In sporting/active individuals with singular ligament tears MRI, otherwise conservative treatment 3-6 months

Posterior Cruciate Ligament Injuries (PCL)

Pathophysiology

Posterior Cruciate Ligament (PCL) tears are less common than ACL injuries due to the greater strength of the PCL, nearly twice the thickness. PCL injuries are often due to a blow to the shin whilst the knee is bent e.g. striking the knee against the dashboard during a car accident or falling whilst the knee is bent during sport.

Symptoms

  • Minimal pain or swelling
  • Vague feeling of instability

Management

  • Activity modification
  • Ice or heatPain relief
  • Physiotherapy including range of movement exercises and a graded strengthening programme
  • Orthopaedic options- If traumatic and active/sporting lifestyle may consider repair, otherwise 3-6 months conservative management

Investigations

  • For multi-ligament tears MRI with if considering surgery
  • In sporting/active individuals with singular ligament tears MRI, otherwise conservative treatment 3-6 months

Exercises to try:

Ligs

Wall Slide

Leaning against a wall, step your feet out in front of you and place them hip width apart

Slowly bend your knees and slide down the wall

Push back up to starting position and repeat

s

Straight Leg Raise

With your leg out straight in front of you

Lift your leg, keeping the knee straight

Slowly return to the starting position

a

Single Leg Stand Exercise

Holding on if needed

Stand on one leg and try to maintain your balance for 30-60 seconds

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