Multi-ligament Injuries

Knee Anatomy

The knee is a complex joint which consists of bone, cartilage, ligaments and tendons that make joint movements easy and at the same time more susceptible to various kinds of injuries.

 Knee problems may arise if any of these structures get injured by overuse or suddenly during sports activities. Pain, swelling, and stiffness are the common symptoms of any damage or injury to the knee. Common causes of knee injury include:

• Fracture of the femur (thighbone) or tibia and fibula (leg bones)
• Torn ligament (either cruciate ligament or collateral ligament)
• Rupture of blood vessels following a trauma that leads to accumulation of extra fluid or blood in the joint
• Dislocation of kneecap (patella)
• Torn quadriceps or hamstring muscles
• Patellar tendon tear

Types of Ligament Injuries

ACL tear

An ACL injury is a sports related injury that occur when the knee is forcefully twisted or hyperextended. An ACL tear usually occurs with an abrupt directional change with the foot fixed on the ground or when the deceleration force crosses the knee. Changing direction rapidly, stopping suddenly, slowing down while running, landing from a jump incorrectly, and direct contact or collision, such as a football tackle can also cause injury to the ACL.

MCL tear

The medial collateral ligament (MCL) is the ligament that is located on the inner part of the knee joint. It runs from the femur (thighbone) to the top of the tibia (shinbone) and helps in stabilizing the knee. Medial collateral ligament (MCL) injury can result in a stretch, partial tear, or complete tear of the ligament. Injuries to the MCL commonly occur because of a pressure or stress on the outside part of the knee.

PCL tear

PCL injuries are very rare and are difficult to detect than other knee ligament injuries. Cartilage injuries, bone bruises, and ligament injuries often occur in combination with PCL injuries. Injuries to the PCL can be graded as I, II or III depending on the severity of injury. In grade I the ligament is mildly damaged and slightly stretched, but the knee joint is stable. In grade II there is a partial tear of the ligament. In grade III there is a complete tear of the ligament and the ligament is divided into two halves which can make the knee joint unstable.

The PCL is usually injured by a direct impact, such as in an automobile accident when the bent knee forcefully strikes the dashboard. In sports, it can occur when an athlete falls to the ground with a bent knee. Twisting injury or overextending the knee can cause the PCL to tear.

PLC (Posterolateral Corner) tear

The PLC is a combination of structures that help stabilise the outside of your knee. The main parts are the lateral collateral ligament (LCL), popliteus tendon and popliteofibular ligament. These can be injured during a direct blow, twisting or hyperextension to the knee.

These injuries can also occur during a knee dislocation or in combination with an ACL tear.

Treatments for Ligament Injuries

Immediately following a knee injury before being evaluated by a doctor, you can initiate the R.I.C.E. method of treatment:

• Rest: Rest the knee as more damage could result from pressure on the injury
• Ice: Ice packs can be applied to the injured area to reduce swelling and pain. Never place ice directly over the skin. Ice should be wrapped in a towel and applied to the affected area for 15-20 minutes four times in a day for several days
• Compression: Wrapping the knee with an elastic bandage or compression stocking can help minimize the swelling and support your knee
• Elevation: Elevating the knee above the heart level will also help reduce swelling and pain.

It is important to seek your doctor’s advice if you hear a popping noise or feel as if your knee has given way at the time of injury and if you are unable to move your knee because of severe pain.