KNEE LIGAMENT INJURIES

• Knee ligaments are injured most often from indirect, twisting or bending forces on the knee, or often the result of rotational movement of the knee joint
• Four ligaments in the knee that are prone to injury are- Anterior cruciate ligament (ACL) , Posterior cruciate ligament (PCL), Lateral collateral ligament (LCL), Medial collateral ligament (MCL)
• With increasing sporting activities, injuries to the knee ligaments are on the rise
• The type of injury depends upon the direction of force and its severity
• Most common is MCL injury (40 %)

• ACL injuries: Happen during sports and fitness activities that can put stress on the knee, like
  • Suddenly slowing down and changing direction
  • Pivoting with the foot firmly planted
  • Landing awkwardly from a jump
  • Stopping suddenly in Collision
• PCL Injuries:
• Dash board injury- direct blow to proximal tibia with a flexed knee
• Falling on the knee while it's bent
• Hyper extension injuries
• Sports injuries
• LCL injuries:
• Commonly seen in gymnasts and tennis players
• Direct blow or force to the medial side of knee
• Excessive varus stress (adduction of the tibia on the femur), external tibial rotation and or hyper extension
• MCL injuries:
• Often happen during contact sports
• Direct blow to the lateral side of knee
• Excessive valgus stress (force has the effect of abducting the leg on the femur)

• Pain, often sudden and severe
• A loud pop or snap during the injury
• Swelling, feeling of looseness
• Inability to put weight on the joint without pain

Essential features

Medial collateral

• Pain- Medial side
• Swelling- Medial side
• Tenderness- Medially, on the femoral condyle
• Tests- Valgus stress positive at 30° knee flexion

Lateral collateral

• Pain- Lateral side
• Swelling- Lateral side
• Tenderness- Laterally, on fibular head
• Tests- Varus stress positive at 30° knee flexion

Anterior cruciate

• Pain- Diffuse
• Swelling- Haemarthrosis
• Tenderness- Vague
• Tests- Anterior drawer test positive , Lachmann test positive , Pivot shift test positive

Posterior cruciate

• Pain- Diffuse
• Swelling- Haemarthrosis
• Tenderness- Vague
• Tests- Posterior drawer test positive , positive posterior sag sign , Positive quadriceps active test

Stress test: This is a very useful test in diagnosing a sprain and judging its severity

• The ligament in question is put to stress by a maneuver
• When a ligament is stressed, in first and second degree sprains, there will be pain at the site of the tear
• In third-degree sprain, the joint will ‘open up’ as well

Anterior drawer test:

• Supine position
• Hip flexed 45⁰, the knee held in 90⁰ of flexion with tibia in neutral rotation
• Examiner stabilize the lower extremity by gently sitting on the foot
• A gentle anterior force to the proximal tibia is applied and anterior glide of the tibia is judged
• Increased tibial anterior gliding( Compared to opposite knee) and a soft endpoint inidicate an ACL tear

Lachmann test:

• Supine position
• Knee at 30⁰ of flexion
• With one hand distal femur is stabilized and with other hand a gentle anterior force to the proximal tibia is applied
• Increased tibial anterior gliding( Compared to opposite knee) and a soft endpoint inidicate an ACL tear

Posterior drawer test:

• With the patient lying supine and knee at 90⁰ flexion, the examiner fixes the foot on the table and pushes the proximal tibia backward
• A posterior sagging of the upper tibia may be obvious, and indicates a posterior cruciate tear

X- ray - bony avulsions and sag of Tibia

MRI - confirmatory

Arthroscopic examination

• Conservative method: Most cases of grade I and II injuries
• The hematoma is aspirated
• Knee is immobilized in a cylinder cast or commercially available knee immobilizer
• After a few weeks, the swelling subsides, and adequate strength can be regained by physiotherapy
• Operative methods: The operation is usually performed 2-3 weeks after injury after the acute phase subsides
• Repair of the ligament: It is performed for fresh, grade III collateral ligament injuries
• Reconstruction: This is done in cases of ligament injuries presenting late with features of knee instability

Ayurvedic Treatment

Internal medicines

Acute stage

• Musthadi marma Kashaya
• Rasna saptaka kashaya
• Punarnavadi Kashaya
• Laksha guggulu

Chronic stage

• Rasnaerandadi Kashaya
• Dhanwantara kashaya
• Gandha taila
• Brihat chagaladi Gritha

Procedure

Acute

• Stabilize with splinted bandage/ knee brace
• Lepa - Nagaradi
• Murivenna Pichu or Bandage

Chronic

• Upanaha
• Dhara – Dhanyamla, Murivenna, Dhanwantara, Maha kukkutanta taila
• Abhyanga and Ushma sweda - Dhanwantara taila + Murivenna
• Janu vasti
• Patra Potala Sweda
• Shashtika Pinda sweda
• Mamsa pinda sweda
• Matra Vasthi - Sahacharadi taila