Knee injuries - cruciate ligament

Reviewed by Mr Dai Rees, consultant orthopaedic surgeon

What kinds of knee injury are there?

In the knee, there are several structures: the collateral ligaments, the articular (joint) cartilages, the menisci and the cruciate ligaments. If there is injury to the knee, it is possible that more than one of these structures may be injured at the same time.

What are the cruciate ligaments?

There are two cruciate ligaments in the knee: the anterior (in the front) and the posterior (at the back).

The cruciate ligaments secure the stability in the knee in cooperation with other ligaments, the menisci and the muscles.

How do injuries to the cruciate ligaments occur?

Injuries to the anterior cruciate ligament are more common than injuries to the posterior cruciate ligament.

The posterior cruciate ligament is most commonly damaged in connection with road accidents. When the posterior cruciate ligament is torn across, the shin bone will move backwards on the thigh bone.

A lesion of the anterior cruciate ligament happens mostly in sporting situations where the foot is planted. For example:

if the leg is locked and the body is pushed forward.

if the bent knee is forced in the opposite direction to its natural motion.

a twist, for example while skiing or playing sport.

If the anterior cruciate ligament is totally torn across, the knee may become unstable and the shin bone will move forwards on the thigh bone.

What are the symptoms of an anterior cruciate ligament lesion?

Often a click is felt - followed by pain.

The knee swells due to blood from the bleeding cruciate ligament.

There will be pain in the knee in the following days or weeks.

When the knee is at rest, the cruciate ligament injury itself will not cause pain. However, it will feel unstable when any weight is placed on it and the patient will feel that they are not able to control their knee. This can cause further lesions, for example of the meniscus.

What can be done after an injury has occurred ?

Rest The injured knee must be rested for the first 24 to 48 hours to prevent any further injury.

Ice

The damaged area must be cooled by using an ice-pack or a packet of frozen peas. The ice must never have direct contact with the skin or the patient could get frostbite.

A cloth should be placed between the ice and the skin. Ice can be laid on the affected area for up to 20 minutes every hour, but for no longer than three hours in all.

Ice treatment has been known to be effective for up to 24 hours after an injury occurred.

Compression

An elasticated support bandage is designed for this purpose. The compression must be firm but not so tight that it affects the blood circulation.

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