The knee is the largest and perhaps the most complex joint of the body, very important for the movement of the human body.

The knee ligaments connect the femur to the tibia, fibula and patella. The sprains of the knee ligaments are very common in sports activities.

Athletes involved in contact sports, such as football, are far more likely to injure their collateral ligaments.

 

ANATOMY

The knee joint consists of three bones: the femur, the tibia and the patella. The last one lies in front of the joint and provides, inter alia, protection. These bones are joined together by ligaments. There are 4 main knee ligaments that act as strong straps (ropes) holding the bones in place and stabilize the knee.

 

CRUCIATE LIGAMENTS

The cruciate ligaments are located within the knee joint and cross over each other, by forming an X, with the anterior cruciate ligament forward and the posterior in the rear. This formation controls the anterior/posterior movements, as well as a part of the knee rotation.

 

COLLATERAL LIGAMENTS

The collateral ligaments are located, as the name implies, on the lateral sides of the knee. The medial collateral ligament connects the femur to the tibia while the lateral collateral ligament connects the femur to the fibula. Both control movements on the lateral axis and protect the knee from abnormal varus and valgus movements.

 

DESCRIPTION

The knee is based on these ligaments and muscles for its stability, and is therefore easily injured. Any direct knee injury or strong muscle spasm or even a sudden change of direction during running can injure a knee ligament.

 

These injuries are called sprains and are classified according to their severity.

Grade 1: At this stage the ligament is slightly damaged, it is extended, but can still hold the joint stable.

Grade 2: The ligament is extended to the point that it becomes looser. This is often referred to as partial rupture of the ligament.

Grade 3: This damage is often referred to as complete rupture. The ligament is usually cut into pieces and the knee joint is unstable.

 

The medial collateral ligament is usually injured more often than the lateral one. Due to the complex anatomy of the outer surface of the knee, when the lateral collateral ligament is injured there is usually simultaneous damage to other parts of the knee.

 

ETIOLOGY

The injuries to the collateral ligaments are mainly caused by a force that pushes the knee sideways and are usually contact injuries, but not every time.

The injury to the medial lateral ligament is usually due to a force coming from the outer side of the knee that pushes the knee inwards (towards the other knee). Opposite movement can injure the lateral collateral ligament.

 

SYMPTOMATOLOGY

  • Pain on the lateral surfaces of the knee. If there is an injury to the medial collateral ligament, the pain occurs on the inner side. Accordingly, an injury to the lateral collateral ligament causes pain on the outer side of the knee.
  • Edema at the site of injury.
  • Instability (feeling that the knee is “out of its place”).

 

CLINICAL EXAMINATION

During the visit, the orthopedist gets a detailed medical history, by requesting information on the injury mechanism. At the same time, the doctor examines all structures of the injured leg through a detailed clinical examination. Most of the ligament injuries can be diagnosed by clinical examination.

 

DIAGNOSTIC EXAMINATIONS

Some of the tests that can help diagnose or confirm the diagnosis are:

Simple X-rays: Although they do not visualize the ligaments, they can highlight concomitant bone damage (e.g. a fracture).

Magnetic resonance imaging (MRI) that can better visualize soft tissues, for instance lateral ligaments.

 

TREATMENT

Injuries to the medial collateral lateral ligament rarely require surgical treatment. If only the lateral collateral ligament is injured, the treatment is similar to a sprain in the medial collateral ligament. However, if other knee structures are also injured, they should be treated at the same time.

 

CONSERVATIVE TREATMENT

Conservative treatment includes ice therapy, which is very important for the healing process. The most appropriate method for ice therapy is to place ice pads on the knee for 15-20 minutes each time, with 1-2 hour breaks. Chemical ice (blue) should not be used, especially in direct contact with the skin to avoid burns, while it is not considered very effective.

 

Immobilization: The knee must be protected from the mechanism that caused the injury. Furthermore, we need to modify daily activities to avoid dangerous and painful movements. For this reason, the Orthopedist recommends the use of a splint to protect injured ligaments from overloading, while the auxiliary use of a walking cane or crutches is often required.

 

Physiotherapy: After the first few days of immobilization, the Orthopedist may recommend a specific physiotherapy program to regain functionality of the joint and strengthen the muscles that support it.

 

SURGICAL TREATMENT

Most of the individual ruptures of the collateral ligaments can be treated satisfactorily without surgery. If the collateral ligament rupture has occurred in such a way that it is impossible to heal or is accompanied by other injuries, the Orthopedist should recommend surgical treatment.

 

RETURN TO SPORTS

When the normal range of motion has returned and the patient is able to walk without crutches, the Orthopedist may allow progressive return to sports activities. For example, in the case of football, light jogging may be allowed initially. In some cases, it is recommended to use a splint during sports activities, depending on the severity of the injury.