Ligament/cartilage injuries

Knee ligament and cartilage (meniscus) injuries are very common and are often sports related, although they can occur from a trauma during everyday activities.

The most common are:

• a sprain/strain – one or more ligaments is overstretched through twisting or pulling
• a tear – either a partial tear or complete rupture of the ligament
• injury or tear to the cartilage in your knee – the cartilage is a crescent-shaped disc called a meniscus, that acts as a ‘shock absorber’ in your knee
• Cartilage injuries could be caused by an acute injury or trauma or due to a more gradual onset because of age related changes to the cartilage.

Ligaments connect one bone to another. The ligaments outside your knee joint are called the medial collateral ligament (inner knee) and the lateral collateral ligament (outer knee). They provide your knee with stability and limit the amount it can move from side to side.

The medial collateral ligament is strong and can be sprained or completely ruptured (torn) if you twist your straightened leg at the same time as being knocked sideways, for example, when being tackled in rugby.

The ligaments inside your knee joint are called the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL). These ligaments provide stability to your knee when it is in different positions, particularly in the forward and backward movements of the knee joint. People who sustain an injury to their ACL may complain of symptoms of the knee ‘giving out’.

Acute cartilage injuries may cause the knee to get stuck in one position or ‘lock’. If this is happening to your knee please speak with your GP or a physiotherapist as soon as possible.

Some cartilage injuries may be as a result of a natural ageing process. These might cause pain and swelling without any locking. This may need time to settle and exercises to keep the knee mobile and strong.

How to manage it? 

• Follow the advice in early management of sprains and strains section
• Rest the leg and apply ice for 15-20 minutes every few hours for the first 48 hours after the injury.
• Take some painkillers so you are comfortable.
• A simple strain of the medial collateral ligament should settle very quickly. If things are not improving please see further advice from your GP or self-refer to physiotherapy.
• If you have been informed you have an ACL injury or ligament injury and have spoken to a health care professional you may benefit from the following exercises. Please click here for an ACL prehabilitation programme.

On some occasions an acute knee injury needs urgent medical care. Go to an urgent treatment centre or emergency department if you:

• have severe pain or feel faint, dizzy or sick from the pain
• heard a snap, grinding or popping noise at the time of the injury,
• had a large amount of swelling which appeared instantly after the injury (within an hour)
• you are unable to weight bear because of the pain

Pain relief

Painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. Always follow the instructions on the packet.

Anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Follow the instructions on the packet and discuss using them safely with a pharmacist, especially if you have any underlying health conditions

However, you should not take ibuprofen for 48 hours after an initial injury as it may slow down healing.

Up to date guidelines can be found on the NHS website:

Ibuprofen

Paracetamol

Other medicines can help to reduce inflammation, swelling and pain. You should discuss this with your GP if the simple pain relief advice does not help or if you are needing to take ibuprofen for more than 10 days.

Ice

Some people find using ice helpful on the painful area.

For ice therapy use a damp cloth containing an icepack (or bag of frozen peas) over the top of the painful area to help numb the pain. Leave it on for up to 20 minutes and use up to 3 times a day.

• You should be cautious using these treatments if you have altered skin sensation or circulatory problems.
• Check the skin regularly during and after the ice pack application
• Stop if there is excessive pain, numbness or tingling
• Do not put ice directly on to the skin as this may cause a burn

As the pain improves, gradually re-introduce any normal day-to-day activities that you have been avoiding, returning to full activity.

Physiotherapy 

If you find that you are not improving, some advice or treatment from a physiotherapist can be helpful in managing knee pain. Click here to self-refer to a physiotherapist.

How to prevent ligament and cartilage injuries?

There are some precautions you can take to try to reduce the risk of injuring your knee.

• Exercise regularly to maintain a good level of fitness. This will mean your muscles are stronger and better able to support your joints, including your knees. If you haven’t been active for a while, start gently and gradually increase the intensity.
• Spend five to 10 minutes warming up before exercise to increase blood flow to your muscles and reduce the chance of an injury. Many sports professionals advise stretching your muscles after warming up and again after cooling down; however the benefit of stretching before or after exercise is unproven.
• Vary your knee movements: Anterior knee pain (pain in the front of your knee) is generally the result of overusing the joint, so it is important to try and vary the stresses you place on your knee. For example, runners should make sure they mix up the surfaces they run on to include uphill runs and flat ground
• Stretch regularly: Keep the muscles in your legs as flexible as possible by regular stretching.
• Strengthen your leg muscles: Perform regular exercises such as squats and lunges to strengthen and keep your leg muscles in good condition.

Footwear: Ensure sports shoes are appropriate for the activity and are replaced regularly to avoid excessive wear. In osteoarthritis of the knee good, cushioned footwear has also been shown to be beneficial.