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The Cruciate Ligaments Of The Knee

How Are Knee Sprains And Tears Classified

Cruciate ligaments of knee ( attachment , function & injury) English , DR. SAMEH GHAZY

A healthcare provider will grade your injury by how severe it is and what symptoms you have:

  • Grade 1: A grade 1 injury to a knee ligament is a minor sprain. The ligament is overstretched or just slightly torn. With a grade 1 knee strain, youll have minimal pain, swelling or bruising. Youll still be able to put weight on the affected leg and bend the knee.
  • Grade 2: A grade 2 knee sprain is a moderate tear of the ligament. Signs include bruising, swelling and some pain. With a grade 2 injury, youll have some difficulty putting weight on the leg or bending the knee.
  • Grade 3: A grade 3 injury is a complete tear or rupture of the knee ligament. Grade 3 injuries often involve more than one knee ligament. With this level of injury, you will experience severe bruising, swelling and pain. You wont be able to put weight on the leg or bend the knee.

Should I Expect Pain After Cruciate Ligament Surgery

Every procedure causes pain. We always strive to minimise pain as much as possible. The anaesthetist often uses a so-called nerve block before the surgery, numbing the respective knee for about 30 hours. This already manages the greatest wave of pain, which can then be easily treated with regular medication. Our goal is for you to experience as little pain as possible.

What Are The Common Treatments For Knee Injury

Treatment for a knee sprain or torn ligament can vary greatly, depending on:

  • How long youve had symptoms.
  • How many knee ligaments are injured.
  • Severity of the injury .
  • Whether pain or inability to put weight on your knee is interfering with your life.
  • Whether the injury weakens the knee and puts you at risk for more injuries in the future.

Treatment may range from nonsurgical to surgical:

  • RICE: rest, ice, compression with an elastic bandage and elevation.
  • Assistive devices .
  • Immobilization .
  • Physical therapy.
  • Surgery by an orthopedic surgeon to repair or rebuild the damaged ligament.

Also Check: How To Read An Mri Of The Knee

What Happens Before Surgery For A Torn Cruciate Ligament

Prior to surgery, the physician will conduct detailed medical diagnostics. He will first ask the patient about the accident and any remaining feelings of instability. This provides information about the type and extent of the cruciate ligament injury. Unfortunately, a cruciate ligament tear is often only diagnosed years later, since many patients consider the accident a trivial injury .

If the patient has strong thighs, a cruciate ligament injury is often not medically diagnosed and the trauma is initially overcome without further treatment. However, over the course of time, the instability worsens. Arthrosis can develop, as the accident often also damages the cartilage inside the knee. The problems are often not discovered for years. Instability arises, e.g. when walking upstairs or with rotary motion. The result is persistent knee pain.

In addition to testing movement, which is most likely to shed light on concomitant meniscus injuries, specific stability tests can be used to diagnose a cruciate ligament tear.

In addition, MRI imaging can easily show the torn cruciate ligament. An X-ray is necessary to rule out concomitant damage to the bone in the knee. Joint aspiration extracting synovial fluid from the knee complex can provide information about a cruciate ligament tear: Since the cruciate ligaments are well supplied with blood, the rupture of the cruciate ligament causes bleeding into the joint. Blood is detected in the synovial fluid.

What Does Surgery Involve

Anterior Cruciate Ligament (ACL) Injuries

There are various surgical techniques performed to stabilize the knee joint following cruciate rupture. The surgeon inspects the joint, removing fragments of the ruptured ligament and repairing the menisci if needed, then fashions an artificial ligament to stabilize the joint and prevent abnormal motion. Most often the artificial ligament is placed outside the joint capsule of the knee joint . See handout “Cranial Cruciate Ligament Repair: Extracapsular Repair and TightRope Procedure” for further information. There are newer surgical techniques available called a tibial plateau leveling osteotomy or a tibial tuberosity advancement . Both are especially beneficial for larger, more athletic dogs. Your veterinarian will discuss the best treatment option for your pet. See handouts “Cranial Cruciate Ligament Repair: Tibial Plateau Leveling Osteotomy ” and “Cranial Cruciate Ligament Repair: Tibial Tuberosity Advancement ” for further information on these procedures.

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How Do You Rehabilitate A Torn Pcl

Quad sets

  • Sit with your affected leg straight and supported on the floor or a firm bed. Place a small, rolled-up towel under your knee. …
  • Tighten the thigh muscles of your affected leg by pressing the back of your knee down into the towel.
  • Hold for about 6 seconds, then rest for up to 10 seconds.
  • Repeat 8 to 12 times.
  • Pcl Injuries And Reconstruction


    The knee is the largest joint in your body and one of the most complex. Three bones meet to form the knee joint: the thighbone , shinbone , and kneecap . The kneecap sits in front of the joint to provide some protection. Knee ligaments connect the thighbone to the lower leg. The four primary ligaments in the knee act like strong ropes, holding the bones together and keeping the knee stable.

    • Collateral ligamentsFound on the inside and on the outside of the knee, these ligaments control the sideways motion of the knee and brace it against unusual movement.
    • Cruciate ligamentsFound inside your knee joint, these ligaments 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 knee’s back and forth and rotational/twisting motion.
    • Posterior cruciate ligamentsLocated in the back of the knee, this ligament keeps the tibia from moving backwards too far. Stronger than the anterior cruciate ligament and injured less often, the posterior cruciate ligament has two parts that blend into one structure that is about the size of your little finger.


    An injured ligament is considered a sprain, and is graded on following severity scale:



    An injury to the posterior cruciate ligament typically requires a powerful force, such as a bent knee hitting a dashboard in a car accident or a fall onto a bent knee during sports.


    Nonsurgical Treatment


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    How Is An Acl Tear Treated

    Right after the injury, an ACL tear is treated with:

    • RICE: Rest, Ice, Compression , and Elevation
    • over-the-counter pain medicine such as acetaminophen or ibuprofen

    Most partial tears can be treated with bracing and physical therapy . A person might need to use crutches as the tear heals.

    Some complete ACL tears need surgery. The need for surgery depends on many things, including:

    • the type of the activities the person wants to do
    • if the person is an athlete

    Combined Knee Ligament Injuries

    Anterior Cruciate Ligament (ACL) Injury

    Posted on July 13, 2016

    The knee is the largest joint in your body and one of the most complex. It is also vital to movement. Your knee ligaments connect your thighbone to your lower leg bones. Knee ligament sprains or tears are a common sports injury.

    In the past, injuring more than one knee ligament would put an end to future sports activities. Today, many athletes are able to return to high level sports following multiple ligament injuries.

    Also Check: Knee Cartilage Repair Surgery Recovery Time

    Which Dogs Are More At Risk

    Cruciate ligament damage is most commonly seen in overweight middle-aged dogs. Another group of dogs that suffer from this disease are those receiving corticosteroid medications. The problem appears suddenly often after some sudden twisting movement or jumping up or out of an elevated location. The pet often yelps at the sudden pain that occurs.

    In light to moderate weight breeds , use of the knee often becomes normal with time and rest. Lightweight dogs are sometimes placed on anti-inflammatory and pain management medications as well as glucosamine and plan a program of rest and physical therapy while the joint heals.

    A recent study identified the following breeds as being particularly at risk for this phenomenon: Neapolitan mastiff, Newfoundland, Akita, St. Bernard, Rottweiler, Chesapeake Bay retriever, and American Staffordshire terrier.

    Anatomy Of The Knee Ligaments

    Three bones meet to form your knee joint: your thighbone , shinbone , and kneecap . Your kneecap sits in front of the joint to provide some protection.

    Bones are connected to other bones by ligaments. There are four primary ligaments in your knee. They act like strong ropes to hold the bones together and keep your knee stable.

    Collateral Ligaments

    These are found on the sides of your knee. The medial collateral ligament is on the inside and the lateral collateral ligament is on the outside. They control the sideways motion of your knee and brace it against unusual movement.

    Cruciate Ligaments

    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 knee.

    Also Check: What Is Runner’s Knee

    How Long Can A Dog Go With A Torn Acl

    Brumett said dogs who have a cruciate ligament rupture that dont have surgery, rehab or bracing can develop some level of stability on their own in six to 12 months and these dogs are typically comfortable going on walks, running or jumping. With a brace a dog can be back out playing in a just few weeks.

    How Can I Prevent Knee Ligament Injuries

    Posterior view of knee joint

    Not all knee injuries can be prevented. But you can take steps to keep your knee ligaments safer, especially during exercise:

    • Avoid sports that involve tackling, such as football and rugby.
    • Exercise on level surfaces to decrease the chances youll twist a knee.
    • Maintain a healthy weight to reduce pressure on the knees.
    • Vary your exercise routine, combining weight training and aerobic activities .
    • Warm up before you exercise, increase intensity gradually and stretch afterward.
    • Wear shoes that fit well.
    • Wear all appropriate safety equipment for any sports you play.

    Recommended Reading: How To Fix Sore Knees

    Cruciate Ligament Reconstruction By Tendon Transplant

    The traditionally most commonly used surgery is cruciate ligament reconstruction. The surgeon first removes the entire torn cruciate ligament to prepare for cruciate ligament reconstruction. Parts of other tendons in another location of the knee are removed to use as the graft. Typically, part of the patellar tendon between the patella and tibia is used. But even the hamstring, located at the back of the knee, can be used as the bodys own transplant.

    The advantage of an autologous graft is that the body obviously will not reject the transplant. The graft is harvested from the patients body patella tendon or hamstring tendon. After anchoring it to the femur and tibia with bone screws, the body soon assimilates it and supplies it with blood vessels which grow into the graft.

    One drawback of the autologous tendon transplant to treat the cruciate ligament tear is the painful weakening of the leg caused by harvesting the tendon . The areas where the tendon is harvested are sometimes painful and weak for months. Harvesting the tendon reduces the maximum strength. However, this is only important in competitive athletes. Following surgery, the patient will require a lot of physiotherapies and rehabilitative training.

    Cruciate ligament reconstruction, however, also does not restore the nerve supply of the cruciate ligament crucial for coordination. This can also have its drawbacks in competitive sports. However, in most patients this is irrelevant.

    Enhancing Healthcare Team Outcomes

    The diagnosis and management of ACL are best by an interprofessional team that includes an emergency department physician, orthopedic surgeon, sports physician, nurse practitioner, and a physical therapist. The initial treatment of ACL is RICE therapy. ACL injuries, depending upon their severity, can be managed nonoperatively or operatively. The patient with an anterior cruciate ligament injury should be referred to the orthopedic physician to discuss treatment options and a physical therapist for rehabilitation. Care coordination between PT and the treating clinician is often the task of a specialty-trained orthopedic nurse, who can also counsel the patient on their condition and treatment. The outcomes for patients with ACL injury are good, but the recovery may take at least 3 to 9 months of intense physical therapy.

    Recommended Reading: What Is The Average Age For Knee Replacement Surgery

    How Are Cruciate Ligaments Injured

    The anterior cruciate ligament is one of the most common ligaments to be injured. The ACL is often stretched and/or torn during a sudden twisting motion . Skiing, basketball, and football are sports that have a higher risk of ACL injuries.

    The posterior cruciate ligament is also a common ligament to become injured in the knee. However, the PCL injury usually occurs with sudden, direct impact, such as in a car accident or during a football tackle.

    What Are The Symptoms Of A Knee Ligament Injury

    Lachman Test | Anterior Cruciate Ligament (ACL) Rupture Knee

    Cruciate injury

    A cruciate ligament injury often causes pain. Often you may hear a popping sound when the injury happens. Then your buckles when you try to stand on it. The knee also swells. You also are not able to move your knee as you normally would. You may also pain along the joint and pain when walking.The symptoms of a cruciate ligament injury may seem like other health conditions. Always see your healthcare provider for a diagnosis.

    Collateral ligament injury

    An injury to the collateral ligament also causes the knee to pop and buckle. It also causes pain and swelling. Often you will have pain at the sides of the knee and swelling over the injury site. If it is an MCL injury, the pain is on the inside of the knee. An LCL injury may cause pain on the outside of the knee. The knee will also feel unstable, like it is going to give way.

    Read Also: What Foods Help Knee Joints

    Is It Too Late

    Without an intact cruciate ligament, the knee is unstable. Wear between the bones and meniscal cartilage becomes abnormal and the joint begins to develop degenerative changes. Bone spurs called osteophytes develop and chronic pain and loss of joint motion result. This process can be arrested by surgery but cannot be reversed.

    • Osteophytes are evident as soon as 1-3 weeks after the rupture in some patients
    • In one study a group of dogs was studied for 6 months after cruciate rupture. At the end of 6 months, 85% of dogs under 30 lbs of body weight had regained near normal or improved function while only 19% of dogs over 30lbs had regained near normal function. Both groups of dogs required at least 4 months to show maximum improvement.

    A dog with arthritis pain from an old cruciate rupture may still benefit from a TPLO surgery. It may be worth having a surgery specialist take a look at the knee. Most cases must make do with medical management.

    If the rupture occurred some time ago, there will be swelling on side of the knee joint that faces the other leg. This is called a medial buttress and is a sign that arthritis is well along. It is not unusual for animals to be tense or frightened at the vets office. Tense muscles can temporarily stabilize the knee preventing demonstration of the drawer sign during examination. Often sedation is needed to get a good evaluation of the knee. This is especially true with larger dogs.

    Can You Play Sports With A Torn Pcl

    Nonsurgical treatment of an injured PCL will typically last six to eight weeks. You will be able to return to your sports activities when your quadriceps muscles are back to near their normal strength, your knee stops swelling intermittently, and you no longer have problems with the knee giving way.

    Read Also: What To Do About Severe Knee Pain

    Symptoms Of Cruciate Ligament Tears

    A clear cracking sound can be heard when a cruciate ligament tears. The knee then swells up quickly and becomes very painful. Although the pain dissipates somewhat after a short time, it usually intensifies again if stress is placed on the knee. The knee becomes unstable when a person attempts to walk, and it also bends to the side. A person with a torn cruciate ligament cannot stretch or bend their leg. Its also possible that a bruise might form, and blood is sometimes released internally later on.

    What to do if you suspect a torn cruciate ligament? If you tore your cruciate ligament, the first aid measures include elevating the leg, applying a compressive bandage and cooling the painful area.

    Despite the symptoms mentioned above, a torn cruciate ligament isnt always noticed right away. Nevertheless, a wobbly and unstable gait becomes apparent at the latest when the knee joint starts giving out.

    For some patients, known as copers, the knee joint actually remains functionally stable despite the presence of a torn cruciate ligament. They are able to offset the structural deficit using the surrounding well-trained muscles. The non-copers cannot compensate in this manner, and their torn cruciate ligament results in a functionally unstable knee joint.

    How Do I Strengthen My Knee Flexors

    this animation to get Anatomy Of Knee Ligaments a look at the anatomy ...

    Sit on a table or desk with your legs hanging freely, and place a thin pad under your knee, so that the knee is slightly higher than the hip. Extend the knee slowly with the foot flexed, until the leg is extended hold 3-5 seconds, and then lower slowly under control. Do 10 repetitions and repeat with the other leg.

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    Can An Acl Tear Get Worse

    When you tear your ACL, you have a 50-50 chance of damaging other structures in your knee, including your meniscus the cartilage that serves as a shock absorber between the shin bone and thigh bone and the other ligaments in the knee joint. If you put off treatment, these injuries get progressively worse.


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