Knee Ligament Injury
Your knees are mobile joints that allow you to walk, climb, sit, and kneel. Ligaments stabilize your knee joints for these movements. When you injure a ligament, it may feel as though your knee won’t even hold you up. Fortunately, you and your healthcare team can work together to return you to an active lifestyles.
Two ligaments in the knees are most likely to be injured. The anterior cruciate ligament (ACL) is in the center of the knee. It is often injured by a twisting motion, such as pivoting wrong or falling awkwardly. This unfortunately is one of the ligaments that I tore. The other ligament, the medial collateral ligament (MCL) is on the inside of the knee. It is normally injured from a blow to the side of the knee. This is common in contact sports such as football and soccer. Injury to either ligament causes pain and weakens the knee joint. Without treatment, the patient may develop many other knee problems that can have lasting effects.
Proper care can make the knee joint stable again. It takes teamwork: you, your doctor, and your physical therapist all working together. Before the knee can be treated, an evaluation is needed. After treatment, the patient plays a large role in the recovery of the knee. An evaluation helps the doctor know how severe the particular injury is. It also points to your best treatment options. The sooner the knee is evaluated. The sooner the patient can be treated, and the better the chance of full recovery. Unfortunately I was unable to get my knee repaired right away. Dr. Freddie Fu informed me that my knee will return to 95% capacity of what it was at before the tear. He informed me that 90% of people never return to 100% utilization of the knee. Dr. Fu also told me that since I am young, active, and healthy this surgery does not present any long term problems with my knee.
A knee ligament injury can be treated in one of two ways: nonsurgically or surgically. Your treatment depends on how severe the individual’s injury is and how active this person hopes to be afterwards. Rehabilitation is a major part of your treatment whether or not you have surgery. I am scheduled to have surgery May 19, 2005 which means I am in for an intensive 6 month rehabilitation assignment after surgery is complete. I have been informed that the active return is solely dependent on me. There must be a large commitment made to regaining and maintaining equal leg strength. A physical therapist will be assisting me in my recovery.
Anterior Cruciate Ligament (ACL)
The ACL crosses from the back of the femur to the front of the tibia. It acts as a strong support for the knee. But the ACL can be injured if you twist your knee too far or change direction too quickly.
The ACL is typically injured when you twist your knee beyond its normal range of motion. An example is when a person is snow skiing, and the ski “catches an edge,” this causes you to twist your lower leg either outward or inward. The person might hear or feel a pop, and your knee will give away. This is exactly what happened to me, but on the basketball court. I heard a pop and could not bend or extend my knee, and it swelled up immediately with excruciating pain. A complete tear of the ACL is like rope fibers coming apart. A partial tear can also occur. Other parts of the knee may be injured at the same time you injure your ACL. In my case, I completely tore my ACL and tore 3 of the 4 meniscal pads in my right knee. The meniscus acts as a shock absorber for the knee.
The type of surgery performed depends on the injuries to the knee. ACL surgery may be done using arthroscopy. This technique uses small incisions. It usually means a faster recovery and less scarring than with open surgery.
The most common type of surgery for an ACL injury is reconstruction. This involves replacing the torn ligament with new tissue called a graft. This graft may be a ligament or tendon from the persons own knee called an autograft or from a donor called an allograft. To rebuild your ACL, the doctor may combine open surgery with arthroscopy. With arthroscopy, a tiny camera lets the doctor see inside the joint. Tools inserted through small incisions are used to repair the joint.
After surgery, scar tissue can cause the knee to stiffen. Special exercises can help keep the knee flexible. A physical therapist will give instruction on the exercises. Then there will be others to be done at home. Patellar motions are done the physical therapist to help prevent scar tissue around the knee cap. Heel slides help with the joint mobility after surgery. Sit with your leg extended and place a towel under the heel of the injured leg. Pull the towel with both hands while sliding the heel toward the buttock. This is the most important and effective exercise after ACL reconstruction.
Long Term Recovery is the most important goal with ACL surgery. As the ligament is healing the next phase of recovery will begin. For the first few months, a physical therapist guides the patient an exercise program. The two main goals are increasing strength and improving flexibility. Your ligament can be repaired or rebuilt, but it will never be like new again. Exercises that strengthen the hamstrings, quads, and calf’s all help indirectly. All of these help support the knee joint and prevent re-injury. Stretching the muscles improves the flexibility. This allows your knee to be able to move and pivot better. Use slow, sustained movements without bouncing. Bouncing can be detrimental and actually re-injure the knee. A slight pull in the muscles is what is to be felt, but no pain.
Near the end of rehabilitation, different exercises may be started. Instead of working on certain muscles groups that directly affect the knee, practicing movements that occur natural is beneficial. This prepares the person to return to the chosen sport, work, or pastime. An example of a movement would be a football player running different pass patterns or figures 8’s. Using rubber tubing is exactly what Dr. Fu recommends doing. He explained how hopping sideways with the tube around the waist at slight tension can prepare the knee for sideways motions.
There is a beginning and an end to the formal rehabilitation processes. But, the patient must protect the knee and maintain strength for the rest of there lifetime. Wearing a brace is essential for high-risk involvements and movements, such as the twisting and turning motions common in sports. The physical therapist upon departure of their clinic will give advice and pamphlets on what should be done on a daily basis. Following these directions lead to a healthy, pain-free life.