The most common and very well known ligament injury to the knee is of course the anterior cruciate ligament (ACL) tear. Injury to the ACL is well reported in many different sports. However, sports that involve contact and large impacts to the knee joint from forceful landings (skiing or snowboarding) commonly present with other knee ligament injuries. These ligament injuries include the posterior cruciate ligament (PCL), medial collateral ligament injury (MCL), and the lateral collateral ligament (LCL).

The ACL injury is far more prevalent, and arguably far more serious for the stability of the knee. I encourage you to explore our page on ACL injuries, where we go into a lot more detail on this injury. Due to the above reasons, we fortunately have an abundance of clinical research on ACL injuries. However, comically injuries to the PCL, MCL and LCL are like the lesser known cousin of the famous ACL. Which means there has been lower quality and less quantity of research into these injuries. Continue reading as we explain what is important about these injuries and why The Reform Lab Osteopathy is the location for you to complete your recovery.

Posterior Cruciate Ligament (PCL) injury

The PCL ligament is composed of two bundles, the anterolateral and the posteromedial. The anterolateral bundle is the larger bundle. The PCL is responsible for restraining translation of the tibia (shin bone) posteriorly. It also plays a secondary role in restraining rotation of the knee, between 90 to 120 degrees of knee flexion. PCL injuries often go undiagnosed due to the vague nature of symptoms. Primary symptoms that someone will describe are unsteadiness and discomfort.

The PCL is most commonly injured with a direct blow to the front of the shin, with the knee in a flexed (or hyper-flexed) position. Common mechanisms of injury this can be are in the case of a motor vehicle accident, where the knee can be smashed against the dashboard. In the sporting world, Australian rules football is a common game where this injury occurs. Primarily for those in the ruck position when they compete in mid air. Martial arts fighters, especially those who kick at the legs often will experience this type of injury. Although more commonly injured in hyperflexion of the knee, the PCL can be injured in a complex hyperextension position of the knee. This injury often involves other ligament and knee structures, such as the ACL.

The decision of what treatment option is best for PCL injuries is comes down to an expert clinical judgement from your osteopath. The excellent news is that the majority of injuries to the PCL do not require a surgical intervention. The recommended treatment for these injuries involves a structured and graded exercise rehabilitation program, which The Reform Lab Osteopathy is able to provide inside the elite facilities of Project Reform. The rehabilitation key is to get the quadriceps muscle strong, which will limit posterior translation of the tibia on the femur (thigh bone).

When is surgery recommended?

In cases where there is significant laxity and instability of the knee, PCL injuries may require a surgical fixation. If there is a combined injury including damage to the ACL, MCL or LCL, this will increase overall laxity of the knee. In these cases a surgical opinion is warranted. The last reason why surgery may be warranted is if conservative management is not working, and there remaining to be significant laxity of the knee.

As explained, conservative management for most PCL injuries is the treatment of choice. The Reform Lab Osteopathy stands out as being the allied health clinic with the experience and knowledge on treating sporting injuries. Additionally, our clinic is located inside the state of the art gym facility Project Reform. This ensures your rehabilitation will not be limited by lacking exercise/rehabilitation equipment.

Medial Collateral Ligament (MCL) Injury

The medial collateral ligament attaches on the inside of the knee. Its role is to prevent medial collapse of the knee joint. The ligament attaches on the femoral condyle and attaches itself on the medial tibia. With this ligament preventing medial collapse of the knee, it is crucial when it comes to overall knee stability. When we absorb load through the knee such as in tasks like jumping, or hopping, we commonly move into a medial knee collapse position. This position is known as valgus of the knee, and in the cases of ligament integrity, this position is not deemed dangerous or pathological.

The MCL is injured in non-contact situations such as high forceful landings (downhill skiing) and more commonly injured in contact sports like the football codes. Sports such as Australian rules football and soccer have an increased prevalence of these injuries due to the 360 degree nature of the sport. The mechanism of injury here is due to an opponent falling or crashing into the outside of the knee from a lateral to medial direction. This forcefully opens up the inside of the knee and results in valgus stress to the MCL.

How is it treated?

The key to treatment/management is due to the amount of laxity in knee extension. A grade 1 MCL injury is where the knee is stable in both flexion and extension, however tender over the medial aspect of the knee. This is regarded as a sprained MCL only. Grade 2 MCL injuries are when the knee is lax in flexion, however stable in extension. This is regarded as a torn MCL. Grade 2 injuries commonly result in swelling of the knee along with tenderness to the inside of the knee joint. Grade 3 injuries to the MCL are those which are both lax in flexion and extension positions of the knee. When a grade 3 MCL injury occurs, there is a torn MCL alongside a torn posterior oblique ligament of the knee. The posterior oblique ligament of the knee plays a crucial role in stability in knee extension.

If the MCL injury is graded as 1 or 2, most commonly this can be managed with exercise rehabilitation. Sometimes bracing the knee so that we protect medial knee collapse and extension is warranted for those regarded as grade 2. Alongside the bracing, we would commence structured exercise rehabilitation focusing on building foundational stability and confidence. Grade 3 MCL injuries will require a surgical opinion, however surgery is still not required. A comprehensive structured exercise program alongside bracing of the knee joint, is a recommended course of treatment. The Reform Lab Osteopathy through our holistic approach to treatment and rehabilitation is able to provide you with the acre you need. We operate out of the elite gym Project Reform, so that your rehabilitation will not be limited by lacking rehabilitation equipment.

Lateral Collateral Ligament (LCL) Injury

The lateral collateral ligament of the knee attaches on the outside of the knee joint. It plays a role in preventing forces that bow the knees. These forces are known as varus forces. The LCL injury is quite uncommon, due to the anatomy and uncommon nature of the mechanism of injury occurring. How it may occur is due to a contact mechanism, where an opponent collides on the inside of the knee, resulting in a varus force through the knee joint from medial to lateral. For injury to the LCL to occur, there needs to be quite a high amount of force occurring and as such the injury is more commonly involved with other structures of the knee. Isolated injuries to the LCL are uncommon.

There are two main groups of LCL injury. The first group is injury to the LCL and the hamstring tendon of the biceps femoris. These injuries commonly are referred to as posterolateral knee injuries. The second group are known as Segond fractures. A Segond fracture does not typically involve the a bone injury. It most commonly involves soft tissue structures, in particular avulsion of the knee capsule and anterolateral ligament. Segond fractures are always associated with an ACL tear.

These injuries, especially an isolated LCL injury is managed with exercise rehabilitation. The only time an LCL injury requires surgery is where the LCL and biceps femoris tendon have avulsed from the fibula head. As these injuries most often involve conservative management (osteopathy and exercise rehabilitation), The Reform Lab Osteopathy is able to completely treat this injury.