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What does a medial ligament tear of the knee joint mean?
The medial ligament of the knee (ligamentum collaterale mediale) is a wide and thick cord of fibers that runs from the thigh bone (femur) to the shin bone (tibia) on the inside of the knee .
It is about four to six inches long. The primary role of the medial collateral ligament is to prevent excessive internal flexion of the leg (adduction); it also serves to stabilize the knee joint and enables rotation.
Causes of the internal ligament tear
Typically, medial ligament tears occur during activities that excessively stretch the ligament. This can happen suddenly as a result of external violence, but also as a result of continuous overloading.
Two main movements put tension on the medial ligament:
- twist,
- Inward force applied to the knee (from outside to inside).
If these movements (even in combination) are excessive and the stretch capacity of the ligament is exceeded, inner ligament damage can occur.
Medial collateral ligament tears are most common in contact sports and where there are rapid changes in direction.
Injured athletes increasingly include football, tennis, basketball players and alpine skiers.
Typical injury mechanisms:
- a twisting movement of the knee while the body weight is on the leg that is firmly planted on the ground (especially when landing after a jump).
- direct trauma to the outside of the knee, forcing it to buckle in the opposite direction (e.g., when another player hits the outside of the knee). Only rarely does a medial ligament lesion develop over a period of time from repetitive movements, such as kicking the leg while swimming breaststroke.
Symptoms of the medial ligament tear
The main symptom of a medial ligament injury is the occurrence of pain in the ligament, i.e. in the inner area of the knee.
Severe swelling can be felt at the level of the tear.
In the two days following the injury, bruising occurs, the joint swells, and the patient limp.
With more serious injuries, the patient feels instability or the feeling that the knee is giving out.
Symptoms of medial ligament damage are proportional to its extent.
Depending on their severity, medial ligament lesions can be divided into a scale from I to III.
Grad I
Incomplete lesion of the medial ligament (partial tear). The ligament still has continuity and symptoms are minimal. The patients complain of pressure pain when touching the band and are soon able to practice their sport again.
Most athletes have to sit out 1-2 weeks.
Grade II
A second-degree lesion is also a partial tear, but patients experience instability when turning and standing up. Pain and swelling are greater than Grade I, and 3-4 weeks of immobilization are usually required.
Grad III
In a grade three lesion, the ligament is completely torn. The injury causes great pain and swelling . Bending the knee often causes problems. Other signs of a medial ligament tear include instability and knee deflection. Usually the knee joint has to be protected by a knee bandage or splint, the healing process takes at least 6 weeks.
Diagnosis of the medial ligament tear
The doctor has the accident described, asks about past, similar injuries and the current condition of the knee.
Test: Pressure is applied to the outside of the injured knee, first with the leg bent and then straight. Depending on the degree of pain or stiffness of the knee joint, the lesion can be assigned to the first, second or third degree of severity.
If the pain and swelling on the day of the injury is so severe that the test cannot be performed, wearing a splint, cooling and elevating the knee may be necessary.
Imaging diagnostic procedures
If pain and swelling decrease, the doctor can make the diagnosis; he can order a magnetic resonance imaging (MRI), which in 90% of cases shows the severity of the injury. However, it provides little detail in partial lesions.
The MRI shows the anatomy of the part of the tissue well and is helpful for confirming the diagnosis of a suspected lesion of the meniscus and the cruciate ligaments . This method is also suitable for detecting bone edema or a cartilage-bone fracture . Magnetic resonance helps locate the medial ligament injury but is not an exact method of determining the severity of the tear.
Sonography is another imaging technique used to evaluate the soft tissues of the knee, although MRI is currently one of the most accurate diagnostic tools .
Therapy for internal ligament tears
As with all distortions , the initial treatment is carried out using the RICE protocol (rest, ice, compression, elevation), which means rest, ice packs, compression and elevation. Only partial weight bearing is allowed and as long as the limp persists, assistants are to be used.
The medial ligament has an abundant blood supply and usually responds well to conservative management. If the torn ligament is not serious, rest, immobilization of the knee with a splint , taking painkillers (NSAIDs) such as ibuprofen and physiotherapy may already be sufficient.
To protect the knee, the doctor may recommend wearing a bandage that allows knee flexion but limits lateral movement.
Such a bandage is prescribed for the first 72 hours. Depending on the development of pain and swelling, a rehabilitation program can be started after a few days.
Once symptoms have resolved, an exercise program to regain muscle strength and normal range of motion in the knee should be initiated. If you experience pain while performing the exercises, proceed with caution to avoid further irritation. Depending on the severity of the injury, it can take anywhere from one to eight weeks to fully recover.
First and second degree lesions are not treated surgically. The joint must be stabilized with the help of a knee bandage or orthosis that is attached above and below the kneecap. Walking aids are only needed for the first few days.
Complete ruptures of ligaments used to be operated on, but today surgery is no longer attempted; Rather, the focus is on using a knee joint orthosis with flexion and extension limitation. Some authors recommend an immediate increase in range of motion (ROM), while others maintain the knee in 30° flexion for up to 6 weeks.
Crutches are usually needed for 1-2 weeks.
The goals of exercise therapy are pain reduction, restoration of ROM, and muscle strength.
The exercises to regain normal range of motion are performed in the pool or passively.
Quadriceps muscle training begins with isometric contractions of the quadriceps and then progresses to closed kinetic chain exercises.
Athletes with first and second degree injuries can usually return to sport after 2-3 weeks; if the ligament is completely torn, it takes at least 6 weeks.
To prevent further medial ligament injuries, the vastus medialis oblique of the quadriceps muscle, which is often weak in athletes with medial ligament injuries, can be strengthened.
Complications of internal ligament tears
If instability and knee weakness persist, surgical intervention may be necessary.
Surgical intervention for a torn inner ligament
It is generally accepted that the isolated medial ligament tear rarely requires surgery; there is a study that certifies good results for both surgical and conservative treatment.
If the inner ligament rupture occurs in combination with a tear in the anterior or posterior cruciate ligament, an operation is unavoidable.
Another indication for surgery is persistent instability; in this case, the surgeon will recommend augmentation by allografts.
Recovery times for medial ligament tears
Long-term studies have shown that almost all patients with first and second degree lesions were able to return to sports activities within 3 months without any problems.
In isolated third-degree lesions, a return to pre-injury performance is possible in 6-9 months.
Prognosis for internal ligament rupture
With appropriate care, the majority of patients with mild medial ligament injuries can return to sports and all daily activities after 2-8 weeks.
In the case of a complete tear in the inner ligament, a long rehabilitation phase is important in order to regain full functionality.
Patients who, in addition to the medial ligament lesion, have other injuries to the knee structures (e.g. cruciate ligaments or meniscus) must follow a very long rehabilitation process.
