Ligament damage can cause a sudden onset of significant pain, bruising and severe swelling, restricting movement as the pain becomes too much to bear. Serious ligament injuries can cause instability inside the joint and it is important that appropriate treatment is sought early on, in such cases. Delayed treatment may reduce the likelihood of returning to previous levels of activity due to the potential risk of a permanently weakened joint, potentially increased wear to the cartilage and, ultimately, potential problems relating to osteoarthritis.
The arrangement of the collagen fibres inside the ligament means that a great deal of force is required to cause damage. When a joint is forced to move beyond its normal range of movement as a result of an impact, fall, twisting or landing awkwardly or heavily, soft tissue damage can occur, commonly referred to as a sprain. Mild strains or sprains cause only mild to moderate pain and little or no swelling; moderate sprains show some swelling and crutches may be needed. In more severe cases, where the ligaments or tendons have been completely ruptured, you may feel or hear a snapping, popping or cracking at the time of injury. Pain and swelling will be intense, there may be bruising and the capacity to walk will be severely hampered due to the limited range of motion and ability to bear weight on the joint. Sprains are one of the most common forms of sporting injury, especially around the knee and ankle. In collision sports such as football or rugby, such injuries can be common.
Whilst ligaments are found in every joint in the body, the most common ligament injuries include:
- Torn medial collateral ligament (MCL)
- Torn lateral collateral ligament (LCL)
- Torn anterior cruciate ligament (ACL)
- Torn posterior cruciate ligament (PCL)
- Torn lateral ankle ligaments
- Torn acromio-clavicular ligaments
- Torn rotator cuff tendons
- Torn Achilles tendon
The medial collateral ligament (MCL) is one of the four main ligaments critical to the stability of the knee joint – preventing widening of the inside of the joint or ‘opening up’ of the knee. Damage to the MCL – located on the inside edge of the knee, is usually sustained following a blow to the outside of the knee (again, often sports-related), causing the outside to buckle and the inside to widen. The most common symptom of an MCL tear is pain, swelling and bruising, with patients also complaining of feelings that their knee will ‘give way’, and may be associated with other ligament damage.
The lateral collateral ligament (LCL) is located at the outside edge of the knee (opposite side to the MCL), and may be injured from a blow to the inside of the knee. This ligament is similarly associated with other knee ligament damage in severe injuries such as knee dislocation from motor vehicle accidents.
The anterior cruciate ligament (ACL) is one of the four major knee ligaments. ACL tears are commonly sports-related, for example landing heavily after jumping. The ACL plays an important part in stability and many patients with ACL damage hear a ‘popping’ sound upon injury and complain of feelings that their knee will ‘give way’ under them. Initial symptoms immediately after injury include knee pain, swelling and stiffness. Long-term ACL insufficiency may lead to the knee giving way with twisting and turning activities. Surgery may not be necessary if the tear is only small. Your level of activity is also a factor.
The posterior cruciate ligament (PCL), is very important in preventing the shin bone (tibia) from sliding backwards in the knee joint. These injuries may be less obvious, as strong thigh muscles help to support the knee. Recent research shows that the PCL may benefit from repair particularly in the acute phase of injury.
Torn lateral ankle ligaments
These injuries result from the foot twisting inwards, and result in swelling and bruising on the outside of the foot. These injuries often respond to bracing, but may deteriorate to produce an unstable ankle.
Torn acromio-clavicular ligaments
This type of injury may occur with a severe fall onto the shoulder. Damage to the acromio-clavicular joint (dislocation), may result in the collar bone (clavicle) becoming visible under the skin just above the shoulder, in addition to bruising and swelling. These may respond to careful bracing. Surgery holds the joint in position while the ligament heals.
Torn rotator cuff tendons
These are often 'wear and tear' injuries, and may present with pain in the shoulder when lifting the arm and hand above the head. Many patients respond to conservative treatment, but in the case of large tears, surgery may be required.
Torn Achilles tendon
The Achilles tendon is the strongest tendon in the body, and connects the calf muscles to the heel (calcaneus). It is very important in normal walking and jumping. Injury to this tendon usually occurs suddenly, often with a loud snapping noise during active sport. There is pain and swelling above the heel, with bruising. With conservative treatment these injuries require bracing for at least six weeks, and with young, active patients, surgical repair is a quicker option.
Important: The information and guidance provided here is general in nature and should not be considered as medical advice in any way. You should always seek detailed advice from a qualified medical practitioner.