The most common of knee ligament injuries affect the ACL, or the anterior cruciate ligament and is one of the most daunting experienced by athletes.A knee injury can put an athlete on the side-line for some time and is prevalent in sports people across the board. In fact, 50% of adults are affected by knee pain, of which the majority are athletes, both professional and amateur.

Knee Ligament Injuries explained.

In the sporting community, ligament injuries occur often due to faulty bio-mechanics or overuse. Ligament injuries can either occur in isolation, or with more than one being affected. The most common combined knee ligament injuries are:

  • medial collateral (MCL),
  • ACL and
  • posterior lateral ligament PCL.

ACL injuries occur as result of direct contact, indirect contact or non-contact. Direct contact is when an object strikes the knee directly causing ACL damage e.g. a hockey stick to the back/outside of the knee. Indirect contact injury occurs where the force is applied to another area of the body and the force is translated through the knee, causing ACL failure e.g. a tackle in rugby. Non-contact accounts for 60-70% of ACL injuries and occurs with a quick change in direction or pivoting on a planted foot.

Usually, there is a malfunction in the bio-mechanics causing impact on the tibia (shin bone) or on the femur (thigh bone). Ligament ruptures are associated with a “pop” sound at the time of the injury, with the knee feeling like it’s coming apart, with loss of range in movement being experienced, as well as bruising and swelling around the knee.

Treatment of Injuries

A complete or unstable ligament injury is managed surgically, where the surgeon reconstructs the ACL by using a donor tendon from the hamstring, knee cap or quadriceps. After surgery, the knee is usually placed in a range-of-motion brace, which restricts full motion of the knee and is adjusted as rehab progresses.

Rehabilitation for knee ligament injuries

This is very important for a safe return to sport and can be broken down in 4 phases:

  1. Protection
  2. Early strengthening
  3. Strengthening
  4. Sport specific training

The Protection phase aims to promote healing and reduce inflammation by means of soft tissue manipulation and isometric quadriceps exercises. When these exercises are done, the ankle and hip are kept mobile to reduce further complications. Early strengthening aims to activate and strengthen stabilising muscles, as well as to start activating the bigger mobilising muscles.

As the patient begins to have more range of movement with knee, the rehabilitation programme progresses. A physiotherapist can guide the patient through the strengthening (both early and late) phase. Once the patient has regained full range of movement in the knee and has adequate strength, sports-specific drills will be introduced which help to ensure sufficient agility and then to correct bio-mechanics to prevent a recurrence.

This article was submitted by Grethe Geldenhuys who practises at the Paulshof branch of Lamberti Physiotherapy. Contact her for an appointment to discuss treatment for any knee ligament injury you have experienced.


  1. Raines, B. T., Naclerio, E., & Sherman, S. L. (2017). Management of Anterior Cruciate Ligament Injury: What’s In and What’s Out?. Indian journal of orthopaedics, 51(5), 563-575.
  2. Romeyn, R. L., Jennings, J., & Davies, G. J. (2008). Surgical treatment and rehabilitation of combined complex ligament injuries. North American journal of sports physical therapy : NAJSPT, 3(4), 212-25.