Recovery from your Ligament Tear is crucial in order to achieve your goals and gain rapid and long-lasting results. Your physiotherapist at Musculoskeletal Physiotherapy Australia has requested that you read this page so that you understand your condition and know how to best manage in between physiotherapy consultations.What are the Ligaments?
Ligaments are a fibrous material that acts to attach one thing in your body to another, usually bone to bone. Ligaments are usually very rigid, and therefore will not stretch much. The knee joint is a very complex joint, which is made up many ligaments, four different bones and many muscles cross it. The four main ligaments that cross the joint provide a great deal of the joint’s stability. The Anterior Cruciate ligament travels from the posterior (back), and distal (lower) portion of the femur (thigh bone), and attaches to the anterior (front), and proximal (top) portion of the tibia (shin bone). This prevents the tibia from translating forwards with regard to the femur.
The Posterior Cruciate ligament travels from the anterior, and distal portion of the femur, and attaches to the posterior, and proximal portion of the tibia. This prevents the tibia from translating backwards with regard to the femur. Together, the Anterior Cruciate ligament and Posterior Cruciate ligament cross over next to each other, which is where they get their names, to provide the knee with stability in the frontal plane (from front to back). The Medial Collateral ligament travels from the medial (towards the midline) and distal portion of the femur, to the medial and proximal portion of the tibia. This prevents a genu valgus (knocked kneed) effect at the knees, i.e. prevents the knees from buckling together. The Lateral Collateral ligament travels from the lateral (away from the midline) and distal portion of the femur, to the lateral and proximal portion of the fibula (the smaller shin bone). This prevents a genu varus (bowleg) effect at the knees, i.e. prevents the knees from buckling out to the side. Together, the Medial Collateral ligament and the Lateral Collateral ligament give the knee stability in the sagittal plane (from side to side). This is very important for turning while walking, running or jumping. Grading Ligament Tears Ligament Tears can be graded from I-III. A grade I tear is a minor tear, involving up to 25% of the fibres of the ligament. A grade II tear is a moderate tear, involving from 25-90% of the fibres of the ligament. These are usually the most painful tears. A grade III tear is a severe tear, involving from 90-100% of the fibres of the ligament. This may also be referred to as a “ruptured ligament”. This grade of tear is often not as painful, as there is no attachment left to cause pain, but the knee will feel very unstable.What caused my Ligament Tear?
Any action that puts more tension on the ligament than the ligament is designed to withstand is likely to cause ligament tears. The main four ligaments of the knee are very strong, so normal everyday activities are unlikely to cause a tear.
Causes can be split up depending on the ligament in question: The Medial Collateral Ligament The Medial Collateral ligament, as previously stated, resists genu valgus. Therefore, a force coming from the side when your foot is planted, such as in a football tackle, can result in a tear of the Medial Collateral ligament. The Lateral Collateral Ligament The Lateral Collateral ligament, as previously stated, resists genu varus. Therefore, a force coming from the midline of the body with your foot planted, (continuing with the previous example) such as if an opponent went in for a football tackle, but missed the first leg, can result in a tear of the Lateral Collateral ligament. This is an uncommon injury. The Anterior Cruciate Ligament The Anterior Cruciate ligament, as previously stated, resists forwards translation of the tibia on the femur. Therefore, a force coming from the front and hitting above the knee may cause a tear of the Anterior Cruciate ligament. A common cause of this is sudden stopping on a hard surface, such as in netball when players must stop suddenly to avoid running with the ball. The Posterior Cruciate Ligament The Posterior Cruciate ligament, as previously stated, resists backwards translation of the tibia on the femur. Therefore, a force coming from the front and hitting below the knee may cause a tear of the Posterior Cruciate ligament. A common cause of this is falling onto a bent knee, or the knees impacting the dashboard of the car in a car accident. The Unhappy Triad It is not uncommon, during injuries to the ligaments of the knee, to injure other structures. The Unhappy Triad is an injury where the both the Medial Collateral ligament and the Anterior Cruciate ligament are affected, as well as the Medial Meniscus. It is always important to assess ALL structure to ensure nothing is missed!How can you help me with my Ligament Tear?
A detailed history, taken by your Musculoskeletal Physiotherapy Australia Clinician, of the pain or injury can help to diagnose the injury, while a physical assessment of the knee, hip and surrounding structures, can determine the specific structure and the best course of action in treating the condition. Treatment will depend on the grade of the tear. For less severe tears, manual therapy and a graduate strengthening program will be needed to rehabilitate the knee. In some cases, the ligament may be completely ruptured (grade III), and surgery may be required to reattach the ligament. In a grade III tear, it is still important to attend physiotherapy before and after surgery in order to speed up rehabilitation and minimise the risk of long term disability.What should I do to avoid aggravating my Ligament Tear?
- AVOID activities that aggravate your pain (this may include walking, during the acute phase of your injury), until you have seen a Musculoskeletal Physiotherapy Australia Clinician.
- AVOID running or high impact activities, especially activities that require sudden stopping or changes of direction.
- REMAIN ACTIVE, while avoiding aggravating activities.
- For RELIEF, applying ice to the area may help to reduce some pain and inflammation. Be sure to wrap the icepack in a towel, and only apply for 10 minutes every 2 hours. CEASE use if you have any negative reaction.
- For RELIEF, apply a gentle compression bandage to the injured area, and elevate the leg to reduce swelling to the area. Be sure not to cut off circulation to the lower leg!
- RECEIVE physiotherapy care to get your joints, ligaments, and muscles de-loaded and moving freely with no restrictions.
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