Knee Ligament Injury: All You Need To Know About Its Treatment

Knee ligament injuries are not just restricted to athletes and sports injuries, but they are commonly seen in domestic injuries amongst people. Almost 30 to 40 percent of the total knee ligament injuries are because of falls while walking or during road traffic accidents. Knee ligament injuries are more common among female. This is because of the hormonal factors in women that these ligaments are more prone to injuries. Also, some physiological features in women make female patients more prone to injuries. At the same time, people who have lax ligaments or people who have weak bones are prone to falling. Such a population will often come to an emergency department with a knee ligament injury.

Ligament injuries are the most common type of sports injury as well. Two most commonly affected joints are knee and shoulder in a human body during sports. In the lower limb, the knee joint is exposed to maximum stress during a sports activity like running, jumping, playing football or basketball. Especially when the thigh muscles are weak, then the entire stress is on the knee ligaments and is more prone to injuries with falls.

Primarily apart from a hinge joint movement of flexion and extension movements of knee joint, it is also exposed to a lot of rotator movements. While playing or during domestic falls the foot is stabilised on the ground, and the thigh bone femur rotates on the leg bone tibia this movement combined with flexion leads to jerk on the knee and a ligament injury.

After the clinical and radiological diagnosis of these injuries the patients always want to become all right and fit without surgery when it comes to knee ligament injury. In some cases with sedentary lifestyle and less demanding activity in middle aged patients, they can be healed by rest and immobilization with return to functional activity with mild instability in the knee joint. But it is important to understand which injuries will get healed without surgery. In some patients, delaying the surgery might lead to persistent instability with subsequent falls and secondary ligament, meniscus and cartilage injuries in short term. While in long term these patients due to knee instability can progress to knee arthritis and its consequences. Also, these patients with a delay in the surgery can deprive themselves of the active lifestyle that they used to live earlier.

The most critical part of knee ligament injury is knee rehabilitation. Before the surgery, the patients need physiotherapy exercises which are known as Prehab and it also has a significant bearing on the outcome of knee ligament surgery. After surgical treatment in form of arthroscopic ligament reconstruction or repair without physiotherapy, the knee remains to be weak and the muscles can become stiff leading to dissatisfaction in these patients. Also in this case the return to functional activity and then to subsequent sports is also delayed due to lack of confidence.

Prevention is better than cure. One must make the muscles stronger by doing regular exercises. While playing sports you should wear knee supports to protect your knee joint ligaments. Correct shoes while playing are important. The surface of the playground also matters. Playing on an uneven surface might cause injury to your knee commonly. Warming up before any sports activity is also crucial.

Treatment options for knee ligament injuries:

Most common fear of a knee ligament injured patient is whether he will be able to stand on his leg, walk and do sports activities subsequently. Yes, you shall stand, walk and return to sports. With the recent advances in surgical treatment this is possible. Patients who fits in for surgical treatment are those with active and aggressive lifestyle, young patients with lots of active lifestyle ahead, sports personnel with high end athletic sports are perfect candidates. Not all patients with ligament tear need surgery.

Current trend and focus of surgical treatment is to preserve the natural knee anatomy as much as possible. Hence surgical techniques like primary repair of the ligaments are given a priority. Arthroscopic surgeries benefit both surgeon as well as the patient. The minimally invasive knee ligament reconstructions lead to better functional outcomes and early return to active sports and functional activity. Using own body tendons as grafts like the Hamstrings, Bone tendon Bone grafts leads to faster healing of the graft tissue in the bony and leads to early rehabilitations. With recent advances in graft fixation techniques with adjustable loop devices have benefited many patient and made outcomes of knee ligament surgeries better to best.

(Dr. Parag Sancheti is a Chairman and Orthopedic surgeon at Sancheti Institute of Orthopedics and Rehabilitation, Pune)

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