Ligament Injuries

Most ligament injuries are quite painful, even minor ones. In fact, minor injuries can be more painful than major injuries. The knee may just feel too unstable for you to even walk let alone engage with sports. If neglected, ligament injuries can end up a lot worse with stiffness or persistent instability being a problem. Much of this can be avoided by getting an early diagnosis and starting early treatment — frequently, the good news is that only physiotherapy is needed. An accurate early diagnosis will make it possible to predict recovery times and plan treatment.

A ligament is a piece of gristly tissue that acts like a strap, or check rein, to prevent the knee coming apart. A knee ligament typically joins one bone to another, holding them together and stopping the knee moving abnormally. When injured the ligament may snap, get pulled off the bone or detach with some bone on the end of it. Ligament injuries are graded from 1 to 3. A grade 1 injury is where the ligament has torn but only very slightly stretched. However, they can be quite painful and may lead to stiffness if the knee isn't moved. Grade 2 injuries will have stretched the ligament so that I can easily feel some gapping or instability in the knee and you may also notice that the knee feels wobbly. Many grade 1 and 2 injuries can be treated with a brace, but if neglected, grade 2 injuries can lead to either instability or stiffness. Grade 3 injuries are full ruptures leading to significant instability that may require complex bracing protocols or surgery. Some patients are misled by grade 3 injuries as they aren’t always as painful as one would imagine given the severity of the injury. You will very often notice bruising coming out with these or swelling of the lower leg. Chronic over-use ligament injuries can be quite troublesome when exercising — the knee tends to get stiff and improve with exercise only to hurt later.

If you suspect you have a ligament injury you could give the knee a chance to settle by avoiding sports and activities. If the knee has swollen, apply ice, compression and elevation as well as over-the-counter pain relief. If you can tolerate anti-inflammatory medication you can take that for pain and swelling. Physiotherapist-directed exercises can also help to improve strength and flexibility in the knee. However, it is difficult to know if you are following the correct treatment unless you, or your physiotherapist, are confident about both the diagnosis and severity of the injury. Establishing the grade of ligament injury is crucial. Bear in mind MRI scans are notoriously unreliable for grading the severity of a ligament injury, so seeking advice early may lead to a quicker and more complete recovery.

Many knee injuries will not come to any harm if ignored, but if you are not getting the correct treatment for a ligament injury it can have a significant impact on both the length of recovery and final outcome (return to full health/activity). You may be able to wait for it to heal but that is quite a gamble if you don't know what you are dealing with. Some of the more serious injuries actually result in minimal swelling and can hurt less than major disruptions.

These will depend on which ligament has been injured, the severity of the injury, the time since injury and what activities and sports you wish to go back to. Collateral injuries can be treated with physiotherapy if minor, or bracing and surgery if more serious. Cruciate ligament injuries may be treated similarly but the best option for you will greatly depend on the sports you want to return to. Surgery is frequently the best option to treat an Anterior Cruciate Ligament (ACL) rupture, particularly if the patients enjoys a lot of sport, but predicting who will require surgery following an ACL rupture can be difficult. I believe some injuries are better suited to non-operative treatment but they require careful evaluation to identify them. Again, MRI is a poor predictor of who does and doesn’t require surgery. It will also depend on which of the two cruciate ligaments have been injured — the Posterior cruciate ligament (PCL) requires surgery much less frequently than injuries to the Anterior Cruciate Ligament (ACL).

I have treated many thousands of patients with ligament tears. If you have torn a ligament, I’ll be able to give you a diagnosis after talking to you and examining you — usually before you have had a scan. The scan (MRI and/or X-ray) can help better understand outcomes, meniscus tears and treatment options. I’ll tell you what I think might be best for you to do to get back doing what you want to be able to do in terms of sports, activities and travel.

I have treated many thousands of patients with ligament tears. If you have torn a ligament, I’ll be able to give you a diagnosis after talking to you and examining you — usually before you have had a scan. The scan (MRI and/or X-ray) can help better understand outcomes, meniscus tears and treatment options. I’ll tell you what I think might be best for you to do to get back doing what you want to be able to do in terms of sports, activities and travel.

I will run through the pros and cons of each treatment option and I’ll always try to avoid surgery where possible. My aim is always to get patients back to full fitness and return to sports. If you are a skier I’ll even take you skiing at my Return to Ski Day when you have recovered to help you get back skiing with confidence.