Ligaments
It's easy to take your knees for granted.  You can walk, run, jump, sit, climb, or kneel because your knee joints are mobile.  Ligaments play a big role in bracing your knee joints for these kind of movements.  When a ligament is injured, you could feel like you can't move, or even stand up.  We will make a joint effort to return you to an active lifestyle.

Torn Ligaments
Two ligaments in your knees are more prone to being hurt.  Your anterior cruciate ligament (ACL) is in the center of your knee.  It is often injured by a twist. Losing control of your skis or falling off a ladder, for instance, can result in an ACL injury.  Your medial collateral ligament (MCL) is on the inside of your knee.  It is prone to blows from the side.  This common is common in contact sports such as football.  Injury to either ligament may weaken your knee joint, making it wobbly and causing other symptoms. Left untreated, other problems can occur.

A Joint Solution
Proper care can make your knee joint stable again.  It takes teamwork:   You, DR's. Joseph and/or Daniel Kalbac, and your physical therapist working together.  Before your knee can be treated, you'll need an evaluation.  After treatment, you play a large role in recovery.

An early evaluation
An evaluation helps us know how severe your injury is.  It also points to your best treatment options.  The sooner you're evaluated, the sooner you're treated, and the better your chance for recovery.

Treatment for your knees
A knee ligament injury can be treated in one of two ways: Nonsurgically or surgically.  Your treatment depends on the severity of the injury, and how active you hope to be. Rehabilitation also will be part of your treatment program.

Your role in recovery
Surgery isn't a cure-all.  Your return to active living depends largely on you.  You need to commit to regaining and maintaining strength in your leg.  A physical therapist will help you with exercise.

Your Mobile Knee
Your knee is a mobile, complex joint.  It can bend and rotate slightly.   Ligaments help control knee motion by connecting bones and stabilizing (bracing) the joint.  Tendons join muscles to bones.  Cartilage cushions the knee joint.   It also helps the knee absorb shock during motion.

ANTERIOR CRUCIATE LIGAMENT (ACL)
Your ACL crosses from the back of your femur to the front of your tibia.  It acts as a strong brace for your knee.  But the ACL can be injured if you twist your knee too far or change direction too quickly.

Torn from a Twist
Your ACL may be injured when you twist your knee beyond its normal range of motion. When you're on skis, for instance, you may "catch an edge".  This may cause you to twist your lower leg outward or inward.  You may hear or feel a pop.   You may have pain, swelling, or too much "play" in your knee.  A complete tear of your ACL is like rope fibers coming apart.  A partial tear can also occur.  You may injure other parts of your knee at the same time as you injure your ACL.

MEDIAL COLLATERAL LIGAMENT (MCL)

Your MCL connects your femur to your tibia along the inside of your knee joint.   An outside blow to the knee tears the MCL much like a strap stretched too far: It snaps.

YOUR EVALUATION

When you injure your knee, all you know at first is that something is wrong.  An evaluation helps reveal which parts of your knee is injured.  This evaluation may include a medical history, an exam, and sometimes tests.  This helps your doctor diagnose your knee problem and plan your treatment.

Medical History
Our doctors may ask you questions about your symptoms and how you injured your knee.  Your goals for returning to active living help your doctor decide which treatment plan might work best for you.

Physical Exam
A hands-on exam comes next.  It can help our doctors pinpoint your problem.   Checking for abnormal motion in your knee and for swelling or soreness is part of this exam.

A Lachman test lets our doctors check for too much forward movement of your tibia.  This is a sign of an ACL tear.  During a Valgus stress test, the doctor bends your knee from side to side to check for too much looseness.  This is a sign of an MCL tear.

Diagnostic Tests
Tests may be needed to confirm your diagnosis and to rule out other problems.   An arthrometer may be used to measure how stable your knee is.   MRI (magnetic resonance imaging) gives an inside view of your knee's soft tissues. X-rays are pictures of bones.  X-rays make it possible to see problems such as fractures.

ACL TREATMENT

Which treatment option is best for you depends on many things.  Sometimes an injury can be treated without surgery.  This may be an option if no other tissue is injured and if your lifestyle won't put high demands on your joint.  But a more active person might need surgery to help prevent reinjuring the knee joint.   Rehabilitation follows either option.

Nonsurgical Treatment
This treatment program includes rest and exercise.  After injury, your doctor may advise ice and elevation.  This controls swelling.  Using crutches or a brace lets you rest your joint.  That helps it heal.  Then your doctor or a physical therapist may design an exercise program to help you be active again.   Strengthening your muscles to make up for your weakened ligament is a long-term commitment.

Surgery
The most common type of surgery for an ACL injury is reconstruction.  This involves replacing the torn ligament with healthy tissue (graft).   This graft may be a patellar or hamstring tendon from your own knee or a donor graft.  To rebuild your ACL, your doctor may combine open surgery with arthroscopy.   This is a technique using smaller incisions to look and work inside your joint.   Surgery is followed by several months of rehabilitation to help restore your knee's normal function.

Your pre-op checklist

• Don't eat or drink after midnight the night before surgery
• Arrange for a ride home.  Also have a friend or family member help you for the first 24 hours after surgery.
• Bring any x-rays or other medical records with you as advised by your doctor.

Reconstruction: The Procedure

Fastening the graft.  The graft is fixed in place with scars, staples, or a special type of button.  Then your incisions are closed. Risks and complications.  As with other surgeries, reconstruction involves a small risk of infection and blood vessel or nerve injury.  Also, a graft may tear or stretch over time.  And scar tissue may form around the graft, later requiring treatment.

After Surgery
Right after surgery, you'll spend a few hours in a recovery area.  Your knee will be bandaged and wrapped.  Your leg may be elevated.  Your knee also may be iced and put in a brace to keep it from bending.  Your physical therapy may begin shortly after surgery.  This may include light exercises.  A machine may be used you keep your knee moving.  If you have a drain, it will be removed before you go home.

MCL TREATMENT

There are two options, surgical and nonsurgical, for treating and injured MCL.   But nonsurgical treatment is used more often.  This is true even for someone who's active.  The MCL often heals well enough without surgery.

Nonsurgical Treatment
Your doctor may advise nonsurgical treatment.  First arthroscopy or other diagnostic techniques may be used.  This confirms that you have no damage to your knee other than a torn MCL.  Then you may start a program that rests your knee joint and speeds healing.  After that, you can begin exercises.  The goal is to restore the function of your knee.

Ice and elevation reduce swelling.  They help prevent excess pooling of fluid in your knee.  Ice your knee 3 to 5 times a day for 15 to 30 minutes at a time.  If these steps don't control your pain, ask your doctor about other treatment options such as pain mediation.

Crutches or a brace may rest your joint for a while, helping it to heal.  Follow your doctor's advice about how much weight to put on your leg.   Also, ask it a sports brace is required for more high-risk movements.

Exercises are needed to restore the normal function of your joint.   Special exercises may be prescribed to increase your knee's range of motion, strength, and flexibility.  At first, though, you may be asked to limit how much you bend and straighten your knee.

Surgery sometimes is advised to repair your ligament.  Your doctor may screw, staple or stitch it back together.  Your doctor may also use arthroscopy or open surgery to repair any related injuries.

Your pre-op checklist

• Don't eat or drink anything after midnight before the surgery
• Arrange for a ride home.  Also have a friend or a family member help you for the first 24 hours after surgery.
• Bring any x-rays or other medical records with you as advised by our doctor.

Before MCL repair. Your doctor already knows that your MCL is torn.   Although your MCL can't be viewed through an arthroscope, your doctor may use one to look inside your joint for other injuries.. If present, an injury may be repaired through the arthroscope or through an open incision.

Repairing your joint.  Your doctor will screw, staple or stitch your ligament together through an open incision.  Later, this "hardware" may be removed if it causes pain.  A thin rubber tube may be placed in your joint for a while to remove excess fluids.  Then incisions are sutured closed.

Risks and complications.  All surgeries carry a slight risk of infection and blood vessel or nerve injury. The same is true for MCL surgery.  Also, scar tissue may form, needing treatment later on.

After surgery. Right after surgery, you'll spend a few hours in a recovery area.  Your knee will be bandaged and wrapped.  Your leg may be elevated.  Your knee may also be iced and put in a brace to keep it from bending.  Your physical therapy may begin shortly after surgery.  This may include light exercises.  A machine may be used to keep your knee moving.  If you have a drain, it will be removed before you go home.

YOUR RECOVERY

After ACL or MCL surgery, our doctors will prescribe a rehabilitation program.   You may meet with a physical therapist.  Your program depends on your injury, the type of surgery, and your goals for returning to active living.  At first, the focus is on your comfort and on speeding healing.  You'll start slowly.  You'll progress to more active physical therapy later on.

Reducing pain and swelling
Some types of treatment increase range of motion.  They may also help reduce pain and swelling.  Make sure to move your knee from time to time.  This aids healing.  Ice, elevation, and pain medications may also be prescribed. To help reduce pain, raise your leg above your heart level when possible.  Also, put ice on your knee for 15 to 20 minutes, as often as directed.

Gait Training with Crutches
Before you go home, you'll be given crutches for as long as directed.  Don't put more weight on the injured leg than your doctor advises.

Improving Range of Motion
Exercises to improve your joint's movement can reduce scar tissue.  Without these exercises, your knee will likely stiffen.  Your physical therapist may start you on these exercises.  Then you'll be given others to do at home.  Stop any exercise that cause sudden pain and discuss it with your physical therapist or doctor.

• Patellar Motion helps prevent scar tissue around your kneecap.
• Prone Flexion is an exercise that improves how mobile your joint is.

Follow-up
You will have follow-up visits with your doctor.  He may use this time to chart your progress, change your dressings, and check for any problems, such as infection. Call us if you have redness, extreme swelling, fever, or an increase in pain.  These may be signs of problems that require medical help.

YOUR LONG-TERM RECOVERY

As your ligament heals, you'll begin the next phase of recovery: preparing your legs for return to active living.  Progress may be slow at first, but your hard work will pay off.  For the first few months, a physical therapist may guide you through your exercise program.  In the end, it's up to you to maintain good leg strength and flexibility all your life.

Increasing Strength
Your ligament can be repaired or rebuilt.  But it won't be like new again.   It's time to call for help from your leg muscles.  Exercises can strengthen your hamstrings, quadriceps, and calf muscles.  This helps the bracing ability of your ligaments and helps prevent reinjury.

Improving Flexibility
stretching muscles improves flexibility.  This allows your knee to move better.  Use slow, sustained movements without bouncing.  You should feel a slight pull in your muscles, but not pain.

Returning to Active Living
Near the end of your formal rehabilitation program, your physical therapist may give you exercises designed to copy a certain movement.  These prepare you to return to a certain sport, work, or pastime.  For instance, a skier needs to prepare for sideways motions.  A football player can benefit from running patterns such as figure 8's.

Lifelong Protection
There's a beginning and an end to your formal rehabilitation.  but you must protect your knee and maintain strength all your life.  You may need to wear a brace for high-risk movements, such as twisting and turning motions common in sports.  Ask your physical therapist about good ways to keep strengthening the muscles that support your knees.

• The incline press strengthens quadriceps and hamstrings
• A calf stretch improves flexibility
• Hopping sideways, using rubber tubing, can help prepare you for the sideways motion of downhill skiing
• Working out in a health club is a good way to maintain strength in your legs.