Cruciate Ligaments

The knee joint is stabilised by four major ligaments:

Anterior Cruciate ligament (front)
Posterior Cruciate ligament (back)
Medial Collateral ligament (inside)
Lateral collateral ligament (outside)

Click here for further information regarding the knee collateral ligaments

Anterior Cruciate ligament (ACL)

The anterior cruciate ligament is designed mainly to prevent the tibia (shin bone) shifting forwards in relation to the femur (thigh bone). It is one of the most debilitating ligament ruptures in the body and can take anywhere from 6 - 12 months to fully rehabilitate. The reason for this is due to the ligaments vital role in stabilization of the knee joint.

How is the ACL injured?

Injury to the ACL is usually as a result of either a

 - twisting motion to the knee
 - sudden deceleration whilst sprinting
 - landing awkwardly from a jump
 - impact to the outside of the knee i.e. rugby tackle

or a combination of the above.

As with all ligament sprains there are classifications which are explained below:

First degree ligament sprain

- Some stretching of the ligament fibres
- Minimum pain or discomfort
- Minimal or no swelling
- Normal range of movement

Second degree ligament sprain

-  Considerable proportion of ligament fibres torn
- Instability of the joint
- Moderate to severe pain, sometime unable to weight bear initially
- Swelling and possible bruising 

Third degree ligament sprain

- Total rupture of the ligament
- Severe swelling and bruising
- Large joint instability
- Although grade three tears can be extremely painful, some can be pain
  free due to tearing of sensory nerve fibres

The most common ACL injury is unfortunately grade three. There is often an audible crack or popping sound at the time of the injury followed by severe swelling within the hour.

Treatment

Treatment of an ACL injury depends on whether or not surgery is recommended. In both cases the rehabilitation process should concentrate on restoring range of motion in the knee as soon as possible, together with strengthening of the surrounding muscle groups. Preventing re-occurrence of an ACL tear is crucial due to the long period of rehabilitation that is so often needed. Therefore, rehabilitation should commence immediately after injury whether or not surgery is indicated. Most ACL injuries are through non-contact injuries i.e. twisting or landing from a jump.

In the USA there has been a large amount of research into preventing ACL injuries in young females. Unfortunalety due to the genetic make up of the female anatomy, they are at far greater risk than there male counterparts in terms of injury. The latest research has shown that there are certain exercises that can dramatically reduce the likelihood of ACL injuries which can be performed during training sessions. These exercises should also be used for rehabilitation in order to reduce the likelihood of re-occurrence.

To receive the best treatment for your discomfort arrange an appointment today or if you have any questions please feel free to email

Click here for detailed exercises on ACL prevention

Posterior Cruciate ligament (PCL)

The posterior cruciate ligament is designed mainly to prevent the tibia (shin bone) from shifting backwards below the femur (thigh bone). It has the opposite job to the ACL.

The PCL is much stronger than the ACL which means it is far less likely to suffer injury. However, injury to the PCL is usually as a result of a direct force to the anterior (front) surface of the tibia (shin bone).

Treatment of a PCL injury should again commence as early as possible in order to regain full range of motion within the knee. Strengthening of the surrounding muscles as soon as possible is also fundamental. Rehabilitation can then focus on correcting any weaknesses that may pre-dispose to further injury.

To receive the best treatment for your discomfort arrange an appointment today or if you have any questions please feel free to email