To fully understand knee injuries we must first look at the anatomy of the knee. The knee is made up of the femur (thigh bone), tibia (leg bone), and patella (knee cap). It is all connected to to the fibula, the small bone on the outside part of the leg. All these bones are connected by a serious of ligaments, four altogether, two cruciate and two collateral.
The two collateral ligaments are the medial (MCL), that hold the tibia on the inside area of the knee to the femur, and the lateral (LCL) that holds the fibula to on the outer area of the knee to the femur. The MCL is most often the ligament involved in knee injuries. MCL injuries are almost always caused by a blow to the outside area of the knee that is followed by a sharp pain located with in the knee. Most MCL injuries are easily treated by resting, icing, and bracing the knee, as well as a program for rehabilitation. MCL injuries rarely require any type of surgery. The LCL is not often injured on its own. Most of the time it is injured when another more severe injury occurs that does require surgery.
The ligaments that are in the middle of the knees joint connect the tibia to the femur are the cruciate ligaments. The meaning of cruciate is cross and these two important ligaments cross each other. Their are the ACL (anterior) in the front and the PCL (posterior) in the back. The knee injury that requires surgery most often is the ACL. This ligament is most often injured when there is a sudden directional change when someone is running, called cutting. Also ACL injuries can occur when a person os running and suddenly slows down as well as if the knee is hyperextended or receive a direct hit. There are many cases where just a minor injury can cause a tear of the ACL that requires surgery.
The pain associated with an ACL tear may be delayed. Although a pop may be heard and the knee will give out. The pain will usually occur two to twelve hours later, when the person attempts to put weight on the leg to stand. Ice should be used immediately to control swelling and the knee should be elevated until an orthopedic surgeon can be consulted. Orthopedic surgeon specialize in knee injuries involving ligaments. When an ACL injury is walked or ran on, the cartilage inside that is used to give cushioning can become damaged.
ACL injuries are diagnosed only after a complete physical examine of the knee is completed. The exam will involve many test that will determine if the knee is able to stay in its correct position when it has pressure applied to it from several directions. Most orthopedist also perform an x-ray along with magnetic resonance imaging (MRI). While most trained professionals can diagnose an ACL injury just on examinations, the MRI will give them a better idea of the knee's structure inside. When an ACL is torn, it simply is not able to heal on its own properly. When trying to decided what the best treatment option is going to be there are several factors to consider.
Patients activity level plays an important role. Patients who are very active or do manual labor for a living are going to have better outcomes from surgery to reconstruct their ACL. Those who also injure another major ligament along with the ACL or have cartilage damage will need surgery most of the time. If a person lead a sedentary or inactive life style they may have treatment options that do not involve surgery. However, if they have periods of instability where their knee gives out, surgery may be needed to stop the chance for further knee damage.