WHAT IS A KNEE SPRAIN?
A sprain of the knee occurs when the ligaments, tough bands of fibrous tissue that connect the upper and lower leg bones at the knee joint, are injured. The knee joint is held together by four main ligaments.
The anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL) form a pattern like "X" inside the knee joint, stabilizing it against front-to-back and back-to-front forces. Typically, the ACL sprains after one of the following knee movements: a rapid stop; a twist, pivot, or change in direction at the joint; excessive extension (hyperextension); or a direct hit to the outside of the knee or lower leg. These type of sports injuries is quite prevalent among athletes such as footballers, basketballers, soccer players, rugby, wrestling, gymnastics, and skiing athletes.
The anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL) form a pattern like "X" inside the knee joint, stabilizing it against front-to-back and back-to-front forces. Typically, the ACL sprains after one of the following knee movements: a rapid stop; a twist, pivot, or change in direction at the joint; excessive extension (hyperextension); or a direct hit to the outside of the knee or lower leg. These type of sports injuries is quite prevalent among athletes such as footballers, basketballers, soccer players, rugby, wrestling, gymnastics, and skiing athletes.
The posterior cruciate ligament (PCL) works in conjunction with the anterior cruciate ligament (ACL) to maintain the stability of the knee. It most frequently sprains as a result of a direct blow to the front of the knee, such as colliding with the dashboard in a car accident or landing hard on a bent knee when participating in sports. PCL injuries are most prevalent in athletes that participate in football, basketball, soccer, and rugby.
Medial collateral ligament (MCL) – The MCL runs down the internal side of the leg, supporting the knee. As is the case with the ACL, the MCL can be torn by a straight sideways impact to the outside of the knee or lower leg, as occurs in football, soccer, hockey, and rugby. The MCL can be torn after a serious knee twist while skiing or wrestling, most notably when the lower leg is twisted outwards, away from the upper leg, following a fall.
Lateral collateral ligament (LCL) – The LCL provides support for the knee's lateral side. This ligament is the least probable knee ligament to be sprained. This is because the majority of LCL injuries occur as a result of a blow around the inside of the knee, which is typically protected by the opposing leg.
Just like other types of injuries, knee sprains are also graded
Mild (Grade I) –This type of injury strains the ligament, resulting in minute rips. These microscopic tears have little effect on the knee joint's overall capacity to support your weight.
Moderate (Grade II) – The ligament is partially torn, and the knee is slight to moderately unstable (or gives way periodically) while standing or walking.
Severe (Grade III) – The ligament has been entirely ripped or has split from the bone at its end, making the knee more unstable.
When a major sprain occurs in one of the knee ligaments, there is a good probability that other sections of the knee will be affected as well. For instance, because the MCL helps to protect the ACL from some types of extreme knee forces when the MCL is damaged, the ACL can become prone to injury. The ACL is injured in more than 50% of moderate or severe MCL sprains.
Sprains of the knee are extremely common. ACL sprains typically result in more severe symptoms than MCL injuries. Many MCL sprains are so minor that they may not require medical attention.
Competitive athletes, more than any other group, face an extremely high risk of knee sprains and various sorts of knee issues. The knee is the most frequently injured joint in high school athletes that engage in football, soccer, or wrestling in the United States.
Symptoms
The symptoms of a knee sprain vary according to the ligament that has been torn:
Sprain of the ACL
A popping sensation inside your knee at the time of injury
Significant swelling of the knee within a few hours of injury
Severe knee discomfort that stops you from participating in your activity
Discoloration around the knee in black and blue
Instability of the knee – the fear that your wounded knee will buckle or give way as you attempt to stand
Sprain of the PCL
Mild swelling of the knee, with or without instability of the knee
Mild difficulty with knee movement
Mild soreness at the back of the knee that becomes more severe when kneeling
Sprain of the MCL
Knee discomfort and edema
Knee buckling in the outer direction
Tenderness in the area surrounding the torn MCL (at the inner side of the knee)
Sprain of the LCL
Knee discomfort and edema
Knee buckling inward
Tenderness in the area surrounding the torn LCL (at the outer side of the knee)
Diagnosis
Your doctor will want to know how you injured your knee precisely by asking about:
The movement that resulted in the injury (sudden stop, twist, pivot, hyperextension, direct contact)
Whether you felt a pop inside your knee at the time of the accident.
How long did it take for swelling to manifest?
Whether you were unable to work immediately following the injury due to severe knee discomfort
If your knee instantly felt unstable and was unable to bear weight
The doctor will evaluate both of your knees and compare the injured knee to the healthy one. During this exam, the doctor will look for symptoms of swelling, deformity, discomfort, fluid within the knee joint, and discoloration in your injured knee. If you do not have excessive pain or swelling, the doctor will analyze your knee's range of motion and test the strength of the ligaments. This is done by You bending your knee during the examination, while your doctor will gently pull forward or backward on your lower leg where at the junction where it meets the knee.
If the results of your physical examination indicate that you have sustained a major knee injury, diagnostic testing will be ordered to further analyze your knee. These may include conventional X-rays to rule out ligament separation from bone or fracture. Additionally, a magnetic resonance imaging (MRI) scan or camera-guided knee surgery may be performed (arthroscopy).
Duration Estimated
The duration of a knee sprain is determined by the type of sprain, the severity of the injury, your rehabilitation program, and the sports you participate in. Milder Grade I and II MCL or LCL sprains often heal within two to four weeks, however other forms of knee sprains may take four to twelve months to cure.
Prevention
You can help prevent sports-related knee injuries by taking the following steps:
Before engaging in physical activity, it is important to warm up and stretch.
Strengthen the leg muscles surrounding your knee, particularly the quadriceps.
Avoid abrupt increases in the intensity of your workouts. Never attempt to push yourself too hard or too quickly. Gradually increase your intensity.
Put on supportive, comfortable shoes that fit your feet and your sport. If you have foot alignment issues that may increase your risk of a twisted knee, consult your doctor about corrective shoe inserts.
If you participate in football, consult your sports medicine physician or athletic trainer about particular shoe cleats that may help lower your risk of a knee injury.
If you ski, utilize correctly installed and adjusted two-mode release bindings. Ascertain that the binding mechanism functions properly and that the boots and bindings are compatible.
Treatment
If you have a Grade I or Grade II knee injury, your doctor will almost certainly prescribe that you follow the RICE rule: Rest, Ice, Compression, and Elevation.
Allow the joint to rest.
Reduce swelling by icing the affected region.
Apply an elastic bandage on the swelling to compress it.
Elevating the damaged knee is a good idea.
Your doctor may recommend that you wear a knee brace for a brief amount of time and take an NSAID such as ibuprofen to relieve discomfort and swelling. As the discomfort in your knee progressively subsides, your doctor will recommend a rehabilitation regimen to strengthen the muscles surrounding your knee. This regimen should assist in stabilizing your knee joint and preventing further injury.
If you have a Grade III knee sprain or numerous ligaments are affected, your treatment will vary according to the severity of the sprain:
Grade III ACL or PCL sprain – Your damaged ligament may be surgically repaired using either your own tissue (autograft) or donor tissue (allograft). Almost all knee reconstructions are performed with the aid of a camera (arthroscopic) surgery.
Grade III MCL sprain — This injury is often treated conservatively with rest, ice, nonsteroidal anti-inflammatory drugs (NSAIDs) (such as ibuprofen), and physical rehabilitation. Surgery may be done to repair a damaged MCL in some instances.
Grade III LCL sprain – A severe LCL sprain frequently requires surgical repair of the torn ligament.
Multiple ligaments are simultaneously injured — Your doctor will describe the many surgical choices open to you.
When Should You Consult a Professional
If you have a knee injury, contact your doctor immediately to request an urgent evaluation if the knee:
The area becomes extremely painful or swollen
unable to support the weight
It has the appearance of buckling or giving out.
Prognosis
Around 90% of persons with ACL injuries and 80% of people with PCL injuries can expect a full recovery with appropriate treatment and physical therapy. Almost all MCL sprains and the majority of LCL sprains have a favorable outcome.
As a long-term problem, some persons who sustain ACL or PCL sprains eventually experience discomfort in the damaged knee joint due to osteoarthritis. This symptom may not manifest itself for several years following the initial knee injury.
