Anatomy

Cruciate Ligament: These are found inside your knee joint. They cross each other to form an “X” with the anterior cruciate ligament in front and the posterior cruciate ligament in back. The cruciate ligaments control the back and forth motion of your knees.

Collateral Ligaments: These are found on the sides of your knee. The medial or “inside” collateral ligament (MCL) connects the femur to the tibia. The lateral or “outside” collateral ligament (LCL) connects the femur to the smaller bone in the lower leg (fibula). The collateral ligaments control the sideways motion of your knee and brace it against unusual movement.

Causes
  • The anterior cruciate ligament can be injured in several ways
    • Changing direction rapidly or a planted foot with a twist
    • Stopping suddenly
    • Slowing down while running
    • Landing from a jump incorrectly
    • Direct contact or collision
  • The posterior cruciate ligament can be injured the following way:
    • A direct blow to the front of the knee (such as a bent knee hitting a dashboard in a car crash, or a fall onto a bent knee in sports)
    • Pulling or stretching the ligament (hyperextension injury)
    • Simple misstep
Symptoms
  • You may hear a “popping” noise and you may feel your knee give out from under you
  • Pain and swelling immediately or soon after an injury
  • Loss of full range of motion
  • Tenderness along the joint line
  • Discomfort while walking

There are several grades of sprains for all ligaments. They are:

  • Grade 1. The ligament is mildly damaged. It has been slightly stretched, but is still able to help keep the knee joint stable.
  • Grade 2. Stretches the ligament to the point where it becomes loose. This is often referred to as a partial tear of the ligament.
  • Grade 3. This type of sprain is most commonly referred to as a complete tear of the ligament. The ligament has been split into two pieces, and the knee joint has lost stability.
Treatment
  • Rest. Avoiding movements that exacerbate your pain.
  • Ice: Ice can be applied to reduce pain and swelling. Apply for 20 minutes at a time, several times a day, to keep swelling down. Do not apply directly to the skin.
  • Bracing
    • ACL knee stabilizing brace
  • Physiotherapy
    • As swelling goes down, a careful rehabilitation program is started. This will add stability to the knee and strengthen the remaining muscles and ligaments
    • Strengthening exercises of quadricep and hamstring
  • Medications
    • Nonsteroidal anti-inflammatory medicines. Drugs like ibuprofen and naproxen reduce pain and swelling. Like any over the counter medication, please read and follow the label. If you have a history of stomach ulcers, bleeding ulcers or heart conditions, these medications might not be right for you. Consult your physician if you have any questions.
    • Topical anti-inflammatories
      • Compound Topical Creams
      • Voltaren
  • Injections
    • Blood (PRP – Platelet Rich Plasma)
Surgery

For most sprains and strains of the ligaments, pain will slowly subside with rest and gradual return to activities. For grade 3 (complete tear), surgery may be recommended.

There are multiple techniques to complete a repair of the ACL and PCL. Please speak to your surgeon regarding the best surgical approach for you.