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Injury of Knee Ligaments

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Abstract

The anterior cruciate ligament (ACL) is an intra-articular but extra-synovial ligament that is the primary restraint to anterior tibial translation and secondary restraint to tibial rotation. At least two-thirds of ACL tears occur during noncontact injuries. ACL rupture may be isolated, or concurrent lesion to medial collateral ligament (MCL) and the capsule and/or to lateral collateral ligament (LCL) and posterolateral corner may occur. At the time of injury, the athlete hears a “pop” and feels pain, and giving way symptom, and although may be able to walk off the field however shows inability to continue the activity. The injury is accompanied by swelling due to hemarthrosis. ACL rupture is functionally disabling and predisposes to subsequent injuries of the menisci and cartilage and early onset of osteoarthritis. The level of activity of the patient, the desire to return to the pre-injury level, and the recurrent giving way symptoms indicate operative treatment plan that consists of arthroscopic ACL reconstruction. Medial collateral ligament provides 78% of the valgus restraining force of the knee. MCL injury is common during contact sports and may result from contact or noncontact valgus stress. It presents as an isolated injury or commonly in combination with injury to the ACL, posterior cruciate ligament (PCL), or both. Isolated MCL tear leads to valgus laxity in flexion indicated by valgus stress test at 30° of flexion, while additional injury to the secondary valgus restraints (posteromedial capsule or ACL) leads to increased laxity and positive valgus stress testing at extension. Acute isolated MCL injury is treated with nonoperative management except from the case of bony avulsions where acute repair may be indicated. Combined MCL and cruciate ligament injuries are treated with a nonoperative management of the MCL with the delayed treatment of the ACL once the MCL is healed. Chronic MCL injuries that lead to inability to participate in athletic activities are treated via operative reconstruction. The PCL accounts for about 95% of the total restrain to posterior translation of the tibia in regard to the femur. It can be injured from a posteriorly directed force on the upper front of flexed knee, fall on a flexed knee, and knee hyperflexion or hyperextension. Isolated PCL injury may occur or combination with posterolateral corner (PLC) injury resulting in posterolateral rotatory instability (PLRI). Nonoperative management is proposed for acute grade I–II isolated PCL injuries, while surgery is recommended in patients with grade III injuries, symptomatic grade II injuries, chronic symptomatic isolated PCL lesions, and multi-ligament injuries. The LCL is the primary static restraint to varus opening of the knee. The posterior lateral corner (PLC) of the knee consists of various anatomic structures with primary function to resist varus rotation, external tibial rotation, and posterior tibial translation, and its injury results in posterolateral rotatory instability (PLRI). The LCL is most commonly injured in combination with one of the cruciate ligaments. PLC injuries are often accompanied by other ligamentous injuries, especially PCL injury. Grade III LCL injuries are treated surgically. For acute injuries of the posterolateral structures, PLRI surgical treatment within 2 weeks is widely recommended before significant capsular scarring occurs.

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Authors and Affiliations

  1. Orthopaedic Sports Medicine Center, Department of Orthopaedic Surgery, University of Ioannina, Ioannina, Greece

    Frantzeska Zampeli, Anastasios Georgoulis & Jim-Dimitris Georgoulis

  2. Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Suite 1011, Pittsburgh, PA, 15213, USA

    Freddie Fu

  3. Département de l’Appareil Locomoteur, Centre Hospitalier de Luxembourg – Clinique d’ Eich and Sports Medicine Research Laboratory, Luxembourg Institute of Health, Strassen, UK

    Romain Seil

  4. Clínica do Dragão, Espregueira-Mendes Sports Centre, FIFA Medical Centre of Excellence, Porto, Portugal

    João Espregueira-Mendes

  5. Dom Henrique Research Centre, Porto, Portugal

    João Espregueira-Mendes

  6. 3B’s Research Group – Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, S. Cláudio de Barco, 4806-909, Taipas, Guimarães, Portugal

    João Espregueira-Mendes

  7. ICVS/3B’s – PT Government Associated Laboratory, Braga, Portugal

    João Espregueira-Mendes

  8. Orthopedic Department, Minho University, Braga, Portugal

    João Espregueira-Mendes

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  1. Frantzeska Zampeli
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  2. Anastasios Georgoulis
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  3. Freddie Fu
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  5. Jim-Dimitris Georgoulis
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  6. João Espregueira-Mendes
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Correspondence to Frantzeska Zampeli .

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Editors and Affiliations

  1. Department of Orthopaedic Surgery, Academic Medical Centre, Amsterdam Zuidoost, Noord-Holland, The Netherlands

    C. Niek van Dijk

  2. Hopital de la Croix-Rousse, University of Lyon 1 Hopital de la, Croix-Rousse, Lyon, France

    Philippe Neyret

  3. Department of Orthopedics & Traumatology, Federal University of São Paulo, Vila Clementino - São Paulo, Brazil

    Moises Cohen

  4. Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy

    Stefano Della Villa

  5. 3B’s Research Group–Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, Guimarães, Portugal

    Helder Pereira

  6. ICVS/3B’s–PT Government Associate Laboratory, Braga/Guimarães, Portugal

    J. Miguel Oliveira

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Zampeli, F., Georgoulis, A., Fu, F., Seil, R., Georgoulis, JD., Espregueira-Mendes, J. (2017). Injury of Knee Ligaments. In: van Dijk, C., Neyret, P., Cohen, M., Della Villa, S., Pereira, H., Oliveira, J. (eds) Injuries and Health Problems in Football . Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-53924-8_15

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