That pain in the knee

Dr. Deepak Chaudhary

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A ligament injury in the knees can bring your active life to a standstill with pain and instability, besides posing a threat to the healthy cartilage associated with it. To put it simply, ligament is a tough, fibrous connective tissue, composed mainly of long, stringy collagen bands attached to the bones, providing stability to the joint without compromising the mobility. There are four main ligaments in the knees — Anterior Cruciate Ligament (ACL), Posterior Cruciate Ligament (PCL), Medial Collateral Ligament (MCL), and Lateral Collateral Ligament (LCL). Among various types of knee ligament injuries, the one concerning the Anterior Cruciate Ligament (ACL) is the most common.

Causes

Sports injuries are the most common reason behind the knee ligament injuries. In most of the cases, it’s wrong landing by an athlete — instances like when the foot remains fixed on the ground and the body moves or rotates (pivots) over the knee — that leads to such injuries. However, this injury is not limited to just sports. It could happen elsewhere too, for example in a car accident when a bent knee hits against the dashboard with high impact.

Treatment

Cases with partial or complete tear of the ligament require a specialist opinion and advanced treatment in a clinical setting. Conservative treatment includes resting and elevating knees, applying ice, avoiding exercises and strenuous activities. Also, a brace may be advised to immobilise the knee depending on the ligament involved and the severity of the injury.

In case of complete tear of the ligament, it always requires reconstruction as this ligament does not heal on its own. The reconstruction of ligaments are done arthroscopically (minimally invasive key hole surgery), using patients ligament from some other part of the leg as a graft; generally a part of hamstring tendon is taken as the graft. Patient is made to walk from the day of the surgery, and is out of hospital the next day. He’s put on a rehabilitation exercise programme, which the individual can do on his own.

Meniscus, which acts as the shock absorber of the knee and supports the smooth functioning of the cartilage, also sustains injury with the ligament. The treatment of meniscul injury is a must along with the reconstruction of the ligament. In situations where meniscus cannot be repaired, it is partially removed but preserving the meniscus as much as possible is the priority of all surgeons.

—The writer is director, Centre for Sports Injury, Institute for Bone at BLK Super Speciality Hospital, New Delhi

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Prevention and exercises

• Get strength training
• Regular fitness activity
• Strengthening of the knees muscles
• Maintain flexibility of knee
• Doing sports specific training
•  Do proper warm-up and cool down before and after the exercise session respectively
•  Do proper strength training, graded with resistance and movements
•  Work on balance (both static and dynamic components)
•  Do stretching of muscles to maintain flexibility
•  Work on muscle imbalances
•  Work on agility and speed
•  Perform functional training
•  Always get tested for the pre-requisite parameters before returning to sports
•  Consult a sports injury specialist for even trivial injury so as to prevent any further damage or aggravation of injury