What is the treatment for a knee ligament injury?

Treatment for Knee Ligament Injuries

For knee ligament injuries, surgical reconstruction is recommended for anterior cruciate ligament (ACL) tears to reduce the risk of future meniscus pathology, particularly in younger and more active patients. 1

Initial Assessment and Treatment

• Acute knee ligament injuries should be evaluated for potential fractures using the Ottawa Ankle and Foot Rules to determine if radiography is needed 1
• Painful, tense effusions after knee injury may be aspirated to provide symptomatic relief 1
• Initial management should include controlling pain and swelling using:
  • PRICE protocol (Protection, Rest, Ice, Compression, and Elevation) 1
  • NSAIDs to improve healing and speed recovery 1

Treatment Based on Injury Type and Severity

Anterior Cruciate Ligament (ACL) Injuries

• Early surgical reconstruction is preferred for acute isolated ACL tears because the risk of additional cartilage and meniscal injury increases within 3 months 1
• When performing ACL reconstruction:
  • Both single-bundle and double-bundle techniques can be considered as outcomes are similar 1
  • For skeletally mature patients, bone-patellar tendon-bone (BTB) autografts may reduce risk of graft failure or infection, while hamstring autografts may reduce anterior or kneeling pain 1
  • Anterior lateral ligament (ALL) reconstruction or lateral extra-articular tenodesis (LET) can be considered with hamstring autografts to reduce graft failure and improve short-term function 1

Medial Collateral Ligament (MCL) Injuries

• For combined ACL and MCL tears, non-surgical treatment of the MCL component typically results in good outcomes 1
• Surgical treatment of the MCL may be considered in select cases 1
• Isolated grade III MCL injuries usually heal spontaneously without surgical intervention 2

Lateral Ankle Sprains (for comparison)

• Functional treatment is preferred over immobilization for ankle sprains 1
• If immobilization is needed for pain control, it should be limited to a maximum of 10 days 1

Rehabilitation Protocol

• Functional rehabilitation (motion restoration and strengthening exercises) is preferred over immobilization 1
• Manual joint mobilization combined with exercise therapy provides better outcomes than exercise therapy alone 1
• Functional evaluation, such as hop tests, may be considered as one factor to determine return to sport after ACL reconstruction 1

Prevention Strategies

• Training programs designed to prevent injury can reduce the risk of primary ACL injuries in athletes participating in high-risk sports 1
• Prophylactic knee bracing is not a preferred option to prevent ACL injury 1
• Functional knee braces are not recommended for routine use after isolated primary ACL reconstruction as they confer no clinical benefit 1

Long-Term Considerations

• ACL reconstruction may improve long-term pain and function 1
• Inadequate treatment of ligament injuries can lead to chronic problems such as decreased range of motion, pain, and joint instability 1
• Severe knee ligament injuries can result in permanently decreased bone mineral density in the injured knee 3

Common Pitfalls to Avoid

• Delaying surgical treatment for ACL tears beyond 3 months increases risk of additional cartilage and meniscal injury 1
• Relying solely on time from surgery/injury to determine return to sport rather than functional evaluation 1
• Using ACL repair instead of reconstruction, as repair is associated with higher risk of revision surgery 1
• Prolonged immobilization, which can lead to joint stiffness and muscle atrophy 4