© Roland Jeffery Physiotherapy 2011 Ph (09) 444-7643 Website www.rjphysio.co.nz

Collateral Ligament Injury (Knee). The knee. The knees of football players come under enormous stress and

strong healthy knees are crucial in preventing injury and performance. The knee is essentially a modified hinge joint located where the end of the femur (thigh bone) joins to the tibia (shin bone) (See Figure 1). In the knee, there are several structures: the collateral ligaments, the meniscus and cruciate ligaments (See Figure 1).

The knee has four main ligaments holding it in place, one at each side to stop the bones sliding sideways and two crossing over in the middle to stop the bones sliding forwards and backwards.

1) Medial collateral ligament (MCL) – runs along the inner part of the knee and prevents bending inwards (See Figure 1)

2) Lateral collateral ligament (LCL) – runs along the outer part of the knee and prevents bending outwards (See Figure 1) 3) Anterior cruciate ligament (ACL) – lies in the middle of the knee. It prevents the tibia sliding forwards in front of the femur. It also provides rotational stability to the knee (See Figure 1) 4) Posterior cruciate ligament (PCL) - works in conjunction with the ACL. It prevents the tibia sliding backwards under the femur (See Figure 1). If there is an injury to the knee, it is possible that more than one of these structures may be damaged.

What are collateral ligaments?

The collateral ligaments are found on the inside and outside of the knee joint. They are identified as the medial and lateral collateral ligaments (See Figure 2).

Figure 2: MRI Scan Knee Injury.

Figure 1: Knee Anatomy Figure 1: Medial Ligament Injury

© Roland Jeffery Physiotherapy 2011 Ph (09) 444-7643 Website www.rjphysio.co.nz

The medial and lateral collateral ligaments can be ‘sprained’ or ‘partially torn’ and yet the knee may still remain fairly stable. This is because a collateral ligament is not a single, thin ligament, but consists of many minor fibres or ligaments in different directions and layers. These mesh together into one single strong ligament. The medial collateral ligaments are commonly injured in football, especially during tackling (See Figure 3).

How do collateral ligament injuries occur? A ligament injury may occur when the knee is strained from a force from the inner side of the body. However, more often that not, it will be caused by a strain from a force that occurs from the outer side of the body. For example, while playing football, the outside of the knee may be hit or kicked with great force by an opponent. As the knee is pressed together on the outside and forced apart on the inside, the ligaments on the inside of the knee are injured (See Figure 3). When a collateral ligament is damaged, the extent of the damage may vary from just a small strain in the ligament, to a tear or total rupture of the ligament. A ligament injury may be accompanied by major or minor swelling of the knee joint.

What can the player do? Injuries to the collateral ligaments should receive initial injury management based on the RICE principle (Rest, Ice, Compression, Elevation). Applying ice to the injury as fast as possible will reduce the swelling and pain. The player should then seek the advice from a sports injury professional. They will guide the player on the best management plan depending on the diagnosis. What can the sports injury professional do? A physiotherapist or sports doctor will examine the player’s knee. The extent and speed of any joint swelling may indicate the seriousness of the injury. The sports injury professional will apply special tests to assess your knee injury and also check for soreness along the collateral ligaments, or where they are

Figure 3: Medial Ligament Injury.

© Roland Jeffery Physiotherapy 2011 Ph (09) 444-7643 Website www.rjphysio.co.nz

connected to the bone. As ligaments do not show up on x-rays, an x-ray will only be required to rule out the possibility of injury to the bone.

In the case of a mild injury, the treatment required may be the wearing of a compression bandage to support the knee and attending physiotherapy to rehabilitate the knee. A physiotherapist will monitor the player’s progress and advise them on the correct exercises and when to return to training.

Rehabilitation should start from the time of injury and will involve seeing a physiotherapist who will advise on the appropriate management plan. Rehabilitation can involve strengthening, stretching, and proprioception – as well as treatment aimed at reducing the swelling and pain (See Figure 6).

Most collateral ligament strains and tears respond well to physiotherapy and players will return to training and playing without the needing to see a specialist. The recovery time for a collateral ligament injury may take from between 2 – 8 weeks depending on the severity on the player’s injury. A sports doctor or physiotherapist will guide the player on a return to football.

Figure 6: Rehabilitation: Aqua Jogging, Strengthening and Proprioceptive Training.

Special Tests to assess a Knee Injury.