Sports injuries (ligament and meniscus)
A torn cruciate ligament and a torn meniscus are among the most common knee injuries in athletes. On this page you can read what the signs are, how it is diagnosed, that not everyone needs an operation, and what to do after an injury.
What are sports injuries of the knee?
The knee depends on several structures for stability. Ligaments are strong bands that join bones together. The meniscus is a pair of crescent-shaped cartilage pads between the thigh bone and the shin bone that absorb impact and spread weight. Damage to these structures is common in sports with jumping, twisting and sudden stops, such as football, basketball, volleyball and skiing.
Two frequent injuries:
- Anterior cruciate ligament tear (ACL for short): the ligament that runs through the middle of the knee, stops the shin sliding forward and controls rotation. It usually happens without direct contact, on landing or a sudden twist.
- Meniscus tear: it may happen in sport during a twist, or at older ages, when the meniscus has weakened, with a simple movement such as getting up from a chair.
Who is it for?
If you have these signs after a blow or twist to the knee, it is best to see a doctor:
- A “pop” or a feeling of tearing at the time of injury
- Swelling of the knee (with a ligament tear often within about 24 hours; with a meniscus tear it may take 2 to 3 days)
- The knee giving way or feeling unstable
- The knee catching or locking
- Pain, stiffness and being unable to bend and straighten the knee fully
- Pain along the joint line
Pain and swelling may ease after a few days, but that does not mean the ligament has healed. Returning to sport too early may leave the knee unstable and cause further damage.
How is it diagnosed and treated?
Diagnosis. The doctor takes your history and compares the healthy and injured knee. An X-ray does not show ligaments or the meniscus, but it can rule out a fracture. An MRI gives the best picture of the ligaments, meniscus and cartilage and helps with the decision.
Non-surgical treatment. Both injuries may be managed without an operation. This includes:
- Rest and reduced activity, ice, an elastic bandage and keeping the leg raised
- Physiotherapy to strengthen the front thigh muscle and rebuild confidence in the knee
- For the meniscus, if there is no locking or marked swelling, many tears are first followed up without surgery
Surgical treatment. It is considered when:
- The knee is unstable and gives way in daily activity or sport
- Your sport or job involves a lot of twisting and changing direction
- There are other injuries (such as the meniscus or cartilage)
- A meniscus tear causes symptoms despite non-surgical treatment, or locks
For the cruciate ligament, “reconstruction” is usually done, which means a new ligament is made from the patient’s own tissue or donor tissue. Stitching the ligament is possible in special cases. For the meniscus, the surgeon can stitch the torn pieces (repair) or remove only the damaged part. These procedures are often done by arthroscopy (with a camera). Which method suits you is the surgeon’s decision.
Recovery
- After a meniscus repair. Because the tissue has to knit together, rehabilitation is longer. A reliable source gives about three to six months.
- After removal of part of the meniscus. Recovery is shorter, and a source gives about three to six weeks.
- After ligament reconstruction. The first stage (about week one to ten) is controlling swelling, regaining full straightening of the knee and switching on the front thigh muscle. Then strength, balance and movement control are rebuilt with physiotherapy. In the source, most patients return to full sport between six and twelve months.
- Conditions for returning to sport. No pain or swelling, full movement, and the return of strength and balance. The passing of time alone is not enough.
These ranges are general. The surgeon and physiotherapist will write your programme.
Risks
- Non-surgical treatment. The knee may stay unstable, and other structures may be damaged later.
- Ligament surgery. Infection (very rare with arthroscopic methods), blood clot, stiff knee, sometimes numbness beside the cut (which may be permanent), pain at the front of the knee, and rarely nerve or blood vessel damage. A source says that in the long term about 5 to 10 percent of patients may have instability.
- Meniscus surgery. Infection, clot, stiffness and swelling. A repair may not always succeed.
Your personal risk depends on the type of injury, your age and your sport. Ask the surgeon about this.
When to call
See a doctor sooner if:
- After a blow you cannot stand on the leg or the knee has locked
- The knee has swollen quickly and a lot
- After an operation: a temperature of about 38 degrees or higher, redness or discharge at the cut, or new pain and swelling in the calf
If leg pain or swelling comes with sudden shortness of breath or chest pain, call 115 (the emergency number in Iran) at once.
Every patient’s treatment plan is different; ask your doctor about your own situation.
Frequently asked questions
Do I definitely need surgery after a torn cruciate ligament?
Not always. Some patients, especially those who do not twist or change direction suddenly and whose knee is not unstable in daily life, manage with physiotherapy and muscle strengthening. Sources say that non-surgical treatment is always an option. The decision depends on age, activity, work and any other injuries, and is made with the surgeon.
What happens if I do not treat the tear?
If the knee is unstable and twisting activities continue, the meniscus, cartilage and other ligaments may be damaged further. For this reason it is best to be examined soon after an injury.
When can I go back to sport?
It depends on the type of injury and treatment. After ligament reconstruction, a reliable source says most patients return to full sport between six and twelve months. The conditions for returning are no pain or swelling, full movement of the knee, and the return of strength and balance, not just the passing of time. The doctor and physiotherapist approve it.
Does a torn meniscus heal by itself?
It depends on where the tear is. The outer part of the meniscus has a good blood supply and may heal by itself or can be stitched. The inner part has little blood supply, and a tear there that causes symptoms usually does not heal by itself. The doctor explains after examination and an MRI.
What should I do after an injury until I see the doctor?
Rest, ice (about 20 minutes at a time, with a cloth between the ice and the skin), a gentle elastic bandage and keeping the leg raised usually help. If you cannot stand on the leg or the knee has locked, see a doctor sooner.