Injury to the cruciate ligaments is sometimes referred to as a "sprain." The ACL is most often stretched or torn (or both) by a sudden twisting motion (for example, when the feet are planted one way and the knees are turned another).
The PCL is most often injured by a direct impact, such as in an automobile accident or football tackle.
Symptoms and Diagnosis
Injury to a cruciate ligament may not cause pain. Rather, the person may hear a popping sound, and the leg may buckle when he or she tries to stand on it. The doctor may perform several tests to see whether the parts of the knee stay in proper position when pressure is applied in different directions. A thorough examination is essential. An MRI is very accurate in detecting a complete tear, but arthroscopy may be the only reliable means of detecting a partial one.
For an incomplete tear, the doctor may recommend that the patient begin an exercise program to strengthen surrounding muscles. The doctor may also prescribe a brace to protect the knee during activity. For a completely torn ACL in an active athlete and motivated person, the doctor is likely to recommend surgery. The surgeon may reattach the torn ends of the ligament or reconstruct the torn ligament by using a piece (graft) of healthy ligament from the patient (autograft) or from a cadaver (allograft). Although synthetic ligaments have been tried in experiments, the results have not been as good as with human tissue. One of the most important elements in a patient's successful recovery after cruciate ligament surgery is a 4- to 6-month exercise and rehabilitation program that may involve using special exercise equipment at a rehabilitation or sports center. Successful surgery and rehabilitation will allow the patient to return to a normal lifestyle.
What Is the Most Common Cause of Medial and Lateral Collateral Ligament Injuries?
The MCL is more easily injured than the LCL. The cause is most often a blow to the outer side of the knee that stretches and tears the ligament on the inner side of the knee. Such blows frequently occur in contact sports like football or hockey.
Symptoms and Diagnosis
When injury to the MCL occurs, a person may feel a pop and the knee may buckle sideways. Pain and swelling are common. A thorough examination is needed to determine the kind and extent of the injury. To diagnose a collateral ligament injury, the doctor exerts pressure on the side of the knee to determine the degree of pain and the looseness of the joint. An MRI is helpful in diagnosing injuries to these ligaments.
Most sprains of the collateral ligaments will heal if the patient follows a prescribed exercise program. In addition to exercise, the doctor may recommend ice packs to reduce pain and swelling and a small sleeve-type brace to protect and stabilize the knee. A sprain may take 2 to 4 weeks to heal. A severely sprained or torn collateral ligament may be accompanied by a torn ACL, which usually requires surgical repair.
Tendon Injuries and Disorders
What Causes Tendinitis and Ruptured Tendons?
Knee tendon injuries range from tendinitis (inflammation of a tendon) to a ruptured (torn) tendon. If a person overuses a tendon during certain activities such as dancing, cycling, or running, the tendon stretches like a worn-out rubber band and becomes inflamed. Also, trying to break a fall may cause the quadriceps muscles to contract and tear the quadriceps tendon above the patella or the patellar tendon below the patella. This type of injury is most likely to happen in older people whose tendons tend to be weaker. Tendinitis of the patellar tendon is sometimes called jumper's knee because in sports that require jumping, such as basketball, the muscle contraction and force of hitting the ground after a jump strain the tendon. After repeated stress, the tendon may become inflamed or tear.
Symptoms and Diagnosis
People with tendinitis often have tenderness at the point where the patellar tendon meets the bone. In addition, they may feel pain during running, hurried walking, or jumping. A complete rupture of the quadriceps or patellar tendon is not only painful, but also makes it difficult for a person to bend, extend, or lift the leg against gravity. If there is not much swelling, the doctor will be able to feel a defect in the tendon near the tear during a physical examination. An x-ray will show that the patella is lower than normal in a quadriceps tendon tear and higher than normal in a patellar tendon tear. The doctor may use an MRI to confirm a partial or total tear.
Initially, the doctor may ask a patient with tendinitis to rest, elevate, and apply ice to the knee and to take medicines such as aspirin or ibuprofen to relieve pain and decrease inflammation and swelling. If the quadriceps or patellar tendon is completely ruptured, a surgeon will reattach the ends. After surgery, the patient will wear a cast for 3 to 6 weeks and use crutches. For a partial tear, the doctor might apply a cast without performing surgery.
Rehabilitating a partial or complete tear of a tendon requires an exercise program that is similar to but less vigorous than that prescribed for ligament injuries. The goals of exercise are to restore the ability to bend and straighten the knee and to strengthen the leg to prevent repeat injury. A rehabilitation program may last 6 months, although the patient can return to many activities before then.
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