Brief overview
- Prognosis: With early treatment, good chances of recovery. In some, usually severe cases, symptoms such as pain or instability in the joint remain.
- Treatment: Acute treatment by immobilization, cooling, compression and elevation. Other options include physical therapy/muscle training, pain medication and surgery.
- Symptoms: pain, swelling, bruising if vessels are involved, limited range of motion, and problems walking
- Examination and diagnosis: palpation, joint function tests, x-ray examination, magnetic resonance imaging (MRI).
- Causes and risk factors: Abrupt twisting motion with the leg extended, sports accidents or falls; sports with abrupt changes in direction are particularly risky. Previous knee injuries increase the risk.
- Prevention: Targeted training of the muscles, warming up before sports, supportive bandages or tapes.
What is a torn inner ligament?
Together with injuries to the anterior cruciate ligament, the inner ligament tear in the knee is one of the most common ligament injuries in the knee. Around eight percent of all knee injuries affect the medial ligament. However, many medial ligament injuries are so minor that they are not recorded. In many cases, an inner ligament tear occurs along with other injuries, especially injuries to the medial meniscus.
In comparison, an inner ligament tear in the foot, especially in the ankle, is not as common.
Anatomy – Inner Ligament of the Knee Joint
The inner ligament of the knee joint (ligamentum collaterale tibiale) is about ten centimeters long and runs on the inside from the lower end of the thigh bone (femur) to the shin bone (tibia). Portions of the medial collateral ligament are connected to the medial meniscus in the knee, so both structures are usually injured at the same time.
How long does it take to heal from a torn inner ligament?
After an inner ligament tear, most affected persons return to sporting activity relatively quickly. However, it is difficult to determine the optimal and exact time for this. The duration of the healing process is individual and depends on the severity of the injury, but is usually four to six weeks. What else can you do with a torn inner ligament?
Taking into account personal circumstances and progress, and in consultation with therapists, a gradual return to activity is advisable. Some therapists recommend protecting and stabilizing the injured knee joint for some time with a bandage, a splint (orthosis) or with tapes. In order for the healing process to be as positive as possible and without lasting discomfort, experts advise starting sports or other strenuous activities carefully and slowly.
As with all ligament injuries, pain often remains – so-called strain pain. In rare cases, a so-called “complex regional pain syndrome” (CRPS) develops, in which the pain lasts longer and is more severe than expected. Overall, however, a torn knee ligament usually has a good prognosis, so that cycling, for example, is possible again soon after treatment.
What is the therapy for a torn inner ligament?
In the acute treatment of an inner ligament tear, doctors advise sticking to the PECH rule: Rest, ice, compression, elevation. This means sufferers should stop sporting activity immediately, elevate the knee (above heart level), cool it with ice or cold water and apply a compression bandage. If necessary, painkillers can also help. The so-called non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are particularly suitable.
Conservative treatment
In the case of a second-degree tear of the medial collateral ligament, it is advisable to immobilize the knee in a splint (orthosis) for a short time first and to relieve the pain until it has subsided. In general, it is important to start promoting joint movement (mobilization) as early as possible.
Surgical treatment
Depending on whether the ligament is partially or completely torn, it is possible to suture it (ligament suture) or replace it with a graft.
If the inner ligament is also torn out of the bone, the doctor fixes it back in place during surgery. He uses, for example, drill wires, screws or small nails (pins) for this purpose. Surgery is also indicated in other cases, such as when there are other knee injuries in addition to the torn inner ligament (such as meniscus damage).
How can you recognize a torn medial collateral ligament?
In addition to the ligament tear, sometimes small blood vessels are injured, causing a bruise. People with an inner ligament tear also often have a feeling of instability in the knee joint. The knee can then often no longer be bent without pain. Walking without problems is difficult or even impossible.
How is a torn medial collateral ligament diagnosed?
Specialists for a torn medial collateral ligament are orthopedists, trauma surgeons and sports physicians. The diagnosis of a torn inner ligament can usually be made on the basis of the description and clinical examination. When talking to the patient, the doctor will ask the following questions, among others:
- How did the accident happen?
- Where do you have pain?
- Are certain movements difficult or painful?
- Have you had a knee injury before?
- Are you putting extra strain on your knee?
The leg is moved to check which movements are possible for the affected person and to find out how much the function is restricted compared to the other leg. A comparison is made between the movement of the leg by the doctor (passive) and by the patient’s own muscle strength (active). The doctor also checks how easy it is for the injured person to walk and how stable the injured knee is.
A crucial part of the examination is the so-called valgus stress test. The patient lies down for this. The leg is extended for the first examination and the knee is bent 20 to 30 degrees for the second examination. The doctor holds the thigh firmly and gently pushes the lower leg outwards (“X-leg position”). In the case of a torn inner ligament, the knee can be “opened up” more than the healthy knee of the other leg in this way.
Classification
Imaging
If there is neither swelling nor bruising and there is no pain during the examinations, imaging is not necessary. This is because in these cases, the doctor does not assume additional injury to the bone.
If there is a suspicion that the inner ligament tear is accompanied by bony injuries, the doctor usually x-rays the knee. He usually takes two pictures from different directions and one picture while the knee is bent. If necessary, other special settings such as tunnel images or held images are performed.
Sometimes calcifications at the origin of the medial ligament show up on the x-ray. This so-called Stieda-Pellegrini shadow is an indication of a previous injury.
Magnetic resonance imaging (MRI) is necessary in only a few cases. These include severe medial ligament injuries and suspected involvement of the meniscus .
What causes an inner ligament tear?
An inner knee ligament tear occurs when the lower leg is pushed outward or rotated too much while the leg is extended. This usually happens with sudden changes in direction or speed and with contact injuries. It happens especially often in sports such as soccer, basketball, tennis, skiing, rugby and wrestling.
If the lower leg twists, further injuries to the cruciate ligaments and menisci often occur. This combination is what experts call an “unhappy triad” of injuries.
Risk factors for an inner ligament tear include previous knee injuries. That’s because if damaged structures don’t heal completely, they remain vulnerable to re-injury.
Can you prevent an inner ligament tear?
In the case of a torn inner ligament, the twisting movement in an extended leg position in particular causes a tear. When doing sports, for example, always make sure that you lift your leg off the ground or bend it slightly when you turn. In this position, the collateral ligaments are loosened and move better with the movement.
Doctors always recommend warming up well before doing sports. This loosens the ligaments, makes them more elastic and prepares them for the upcoming load.
If you have already suffered a knee injury, bandages or tapes are suitable as supports, with which the joint is somewhat relieved and secured.
