The Anterior Cruciate Ligament (ACL)
The Anterior Cruciate Ligament (ACL) connects your thigh bone to your shin bone and helps to control forwards and rotational movements of your shin on your thigh bone. It is called the cruciate ligament, not because it is crucial to the knee, but because it forms a cross with the Posterior Cruciate Ligament (PCL).
The Cruciate ligaments are most commonly injured during sports which require a lot of agility such as basketball, netball, football etc. If you tear your ACL/PCL it will initially be very painful however, if the ligament is completely torn then the pain may only last a short time. there will be swelling present around the knee for several days after the injury and likely a feeling of instability when you try to run will remain.
Although the ACL and PCL are important for running and changing direction, if a person decided that he or she no longer needs to be able to do this, they can quite easily live without an ACL/PCL.
An ACL/PCL reconstruction is a common but complicated procedure with a lengthy rehabilitation time. the procedure involves harvesting tendon from either the hamstring tendon or patella tendon to sew in place of the ruptured ligament.
In the event of a suspected ACL/PCL ligament injury it should be a priority to have it assessed by a physiotherapist who can offer a preliminary diagnosis, then if necessary, refer you to an orthopaedic surgeon for imaging and possible surgery.
Medial/Lateral Collateral Ligaments
The medial and lateral collateral ligaments (MCL and LCL) are the ligaments which run down the inside (medial) and outside (lateral) of the knee. The two ligaments help to keep the knee joint in place and protect against sideways movements of the leg on the thigh.
The most common way for an LCL/MCL injury to occur is a blow the outside or inside of the leg during competitive sport such as football, rugby, basketball etc. if the knee is hit on the outside it will push it inwards, stretching the medial ligament, the opposite can be said for the lateral ligament.
If you have injured an MCL/PCL you will have instant pain and experience swelling around either the inside or outside of the knee. This area will also be tender to touch and you may or may not experience instability while walking.
Once assessed by your physiotherapist, they will be able to help you on a path to rehabilitation which will usually involve a period of support using bracing to allow the ligament appropriate rest to heal.
The meniscus is a horse shoe shaped object made from a special strong yet lubricated substance which sits in the middle of the knee joint to help the joint fit together better. it is most commonly injured in running and jumping activities due to excessive stress on the knee joint and may or may not be instantly painful.
Once injured the meniscus will often cause pain deep in the knee when it is fully flexed or pain on some twisting movements, however it can also cause special symptoms such as locking or clicking of the knee.
Only part of the meniscus receives a blood supply meaning that if injured, it is unable to heal itself like other body tissues. If this happens and you are experiencing persistent pain surgical intervention may be indicated to remove the injured section of meniscus. In some cases badly damaged menisci can be completely removed, as they are not crucial to knee function if the person is elderly and does not intend on playing sport again.
If you have pain deep inside or on the inside of the knee please see your physiotherapist for an assessment to determine if you have a meniscal injury. Once diagnosed treatment of your injured meniscus will focus around unloading the knee joint to allow the meniscus time to heal while strengthening and lengthening surrounding muscles to support the joint for the return of activity.
Patello-Femoral Pain (PFP) is a broad term used to describe pain in the knee caused by the joint between the femur and patella. The patella (knee cap) sits on top of the femur and helps by providing a mechanical advantage for you quads muscle by increasing the lever arm. In people without pain the patella slides smoothly over a section of the femur lined by cartilage as the knee bends in and out, however, in some people the patella can be pulled into the wrong places.
The most common cause of this is tightness in the outside of the leg, and weakness of the inner quads muscles. Often seen in runners and cyclists, this pain will often feel like an ache at the front of the knee after exercise or sitting down for a long time. Pain will also usually felt by moving around the knee cap.
Treatment for this condition usually involves initially relieving pain by taping the patella into a more comfortable position, mobilising the stiff patella to allow for free movement, loosening lateral structures such as the illiotibial band and lateral quads and strengthening medial quads to allow for correct movement.
Patella Tendonitis is one of the most common tendon injuries seen in the body. The tendon connects the patella to the tibia (shin bone) and allows us to straighten our knee. This condition is most commonly seen in young males, runners, and jumpers and is colloquially known as Jumper’s Knee. If you have this condition you will most likely feel pain while you run, jump, walk down stairs or do a deep squat, you will also have tenderness just under the knee cap at the front of the knee.
Treatment of this condition follows tendon injury treatment outlined in the tendon section. Specifically, there will be some activity restrictions initially such as running and jumping.