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On
your knees
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A
common cause of anterior cruciate ligament injuries is sudden
rotation on a bent knee.
Photo by PTE Simone Heyer
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By
Tony Thomas
Knee ligament injuries are among the most common injuries affecting
members of the ADF.
Since the bony structure of the knee provides little stability, the
soft tissues are required to withstand high forces, often resulting
in overload and injury. This article will discuss some of the more
common ligament injuries to the knee.
Ligaments are the tough connective tissue bands that join bone to
bone. In the knee there are four main ligaments – two collateral
ligaments and two cruciate ligaments.
The collaterals are situated one on each side of the knee and their
primary job is to stop the knee bending sideways. The two cruciate
ligaments are situated deep inside the knee and their main function
is to control rotary movements.
Of these, the medial collateral and anterior cruciate are the most
commonly injured and these will be discussed below.
Sprains to these ligaments are clinically classified into three grades.
Grade one injuries consist of mild trauma to the ligament and no laxity
on testing. Grade two occur as a result of moderate to severe trauma
and some laxity on stress testing and grade three injuries result
from severe trauma with complete rupture of the ligament and significant
laxity.
Medial collateral ligament (MCL) injuries are usually a result of
trauma forcing the knee to bend sideways, and are commonly found in
contact sports such as rugby and soccer.
Grade one injuries may allow continued participation but grade 2 and
3 are usually associated with significant pain, instability and rarely
can the injured person continue their sporting activity.
Early medical assessment is essential in these injuries as any grade
2 or 3 strain should be treated for 4 to 6 weeks with immobilisation
in a brace that restricts side to side movement but allows some bending.
Failure to do this often results in poor long-term outcomes with prolonged
pain and instability.
In the early stages, rehabilitation focuses on decreasing swelling,
maintaining range of movement and maintaining muscle strength.
Once the brace is removed, treatment involves progressive strengthening,
gradual return to running then sport-specific drills.
The speed of progression varies between individuals and should be
closely monitored by your physiotherapist to ensure that you are progressing
at an optimal rate.
The rehabilitation process for the severe strains takes from 3 to
6 months, but for the mild grade 1 strains, this time period decreases
to around 3 to 4 weeks.
Anterior cruciate ligament (ACL) injuries can occur from traumatic
or non-traumatic injuries.
The most common non-traumatic cause is as a result of sudden rotation
on a bent knee, landing from a jump or decelerating suddenly.
Traumatic injuries to the ACL can happen from the same mechanism as
described for MCL or if the knee is forced back straight.
Grade 1 and 2 injuries can be managed conservatively (without surgery)
where rehabilitation focuses on balance and muscle strength, although
each patient requires a careful examination to determine the direction
of instability and monitoring for secondary complications that may
arise.
Treatment of grade 3 injuries will depend on a number of factors including
the patients' job and sporting expectations.
There are a few people who do not require surgery and with hard work
gain enough strength and control for the knee to function following
a complete rupture.
However, within the ADF a large proportion of these injuries do require
surgical reconstruction and extensive rehabilitation following this.
It is often six weeks before the patient may return to work and from
six to 12 months before the majority of patients may return to sport.
As you can see, the most common knee ligament injuries can be very
serious and appropriate early identification is necessary for successful
management.
For any knee injuries you should seek medical advice as early as possible
to ensure optimal outcome. |
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