Knee Injury - Ligaments in Action

Sports injury accounting for meniscus or ligament injuries of the knee are common owing to high activity levels. Usually, the patient is a young adult presenting with acute onset pain and swelling of the knee, with sensation of give way while climbing up or downstairs.Young patients often wish to pursue active sports, which makes newer research into the treatment modalities, a prime necessity.

Meniscus Injuries usually present with knee effusion, may cause locking episodes and/or persistent pain along the joint line. Patient usually complain of inability to put full weight over the affected limb. The medial or the inner side meniscus is more prone to injury owing to specific anatomy and peripheral attachments. Ligaments that stabilize the knee include the Anterior and Posterior Cruciate ligaments. They prevent abnormal translation between the Tibia (leg bone) and Femur (thigh bone). An injury to the ligaments may cause a feeling of give way.

The diagnosis can be ascertained with reasonable certainty using Magnetic Resonance Imaging. However, sometimes the findings may not be confirmatory, and an arthroscopy of the joint is required. Knee arthroscopy may be performed both to diagnose and to treat the condition.

Meniscus tears at some location, and if presenting within a week may be repaired using arthroscopic techniques. This provides good long term results. If presenting late, or extensive tear, the torn portion is resected by arthroscopic technique, leaving a thin intact rim. Meniscus tears, if not treated properly have been known to contribute to development of arthritis.

Ligament tears may be treated with physiotherapy or surgical intervention. Tears associated with bony island should be treated surgically on urgent basis. Mid-substance tears do not heal by themselves, and need reconstruction. Ligament reconstructions should be delayed for 4-6 week, and aggressive physiotherapy should be done in the meantime.

Anteior Cruciate Ligament reconstruction is one of the commonly performed surgeries by Orthopaedic surgeons handling sports injuries. It can be reconstructed using tendons from the inner aspect of knee or from the patellar ligament (knee cap region). Both offer equally satisfying results, however Patellar tendon bone graft offers better biological bone to bone incorporation. Meniscus transplants from cadaver donors is the new technology in the closet.

Patients usually require a 6 month period before they can get back to contact sports, with prolonged supervised intensive physiotherapy. Important to understand that, not all patients with Meniscus tear or ligament tear need surgery. However, timely performed arthroscopy helps in early rehabilitation.