Knee ligament injuries are common injuries and the commonest cause of knee ligament injuries in India are two wheeler injuries, unlike the developed countries where participation in sports is the main cause. The roads of the city are full of two wheelers. With the corporation digging up roads for sewage works, road widening, there are too many hazards for them as they have to weave through traffic, pedestrians, autos, animals and dug up roads. At times an unexpected object comes across and in order to avoid a collision, the motor cyclist brakes suddenly and can injure himself. As the vehicle comes to a sudden halt, in order to balance himself, he plants his leg on the ground, or may loose his balance and fall over, sustaining a blow to his shoulder. After his foot is planted on the ground, due to the inertia, the vehicle and the rest of the body are carried forward and thus occur a twisting injury to the knee joint. The menisci and ligaments of the knee are also often injured simultaneously.

Symptoms of the injury

1. The person may hear a popping or snapping sound in his knee. He is unable to stand up and balance himself.

2. Swelling may develop rapidly and this is due to accumulation of blood inside the joint (Haemarthrosis). This indicates a rupture of the knee ligaments, commonly the anterior cruciate ligament injury (ACL). Later the swelling subsides, but the ligaments do not heal. This is particularly true of the anterior cruciate ligament (ACL).

3. Giving away of the knee becomes a recurring complaint. During one of these episodes, one of the menisci (semi lunar cartilages) may get caught between the femur and tibia and may tear. This complicates matters as a bucket handle tear of the meniscus can lead to further episodes of giving away. This combination of injuries leads to instability and degenerative changes. Articular cartilage injuries can occur at the time of accident and may need attention. You can develop early arthritis of the knee by the age of forty.

Treatment

First aid
When there is swelling, the RICE method helps
R-Rest
I- Ice
C- Compression or Crepe bandage
E- Elevation.
D-Consult your Knee surgeon (doctor) if in pain. He may relieve you of pain by aspirating the blood from within the joint. Exercise of the thigh muscles is suggested.

Surgical treatment

If you are young and play sport or if you develop symptoms of giving way of the knee then the ligament injury needs to be surgically treated. Repeated episodes of giving way can cause damage of the menisci. Surgical treatment is called an ACL Reconstruction. It is best done after a short interval to allow the swelling to settle down. If treated early tears of the menisci can be repaired with arthroscopic assistance. Many orthopaedic surgeons excise the torn portion of the meniscus, but this may not be the best option. The best is to suture the meniscus if it is in a suitable site. Therefore the best time for an examination and surgical reconstruction is after three weeks, when the swelling has settled down and chances of success of repair of the semilunar cartilages are high.

ACL reconstruction can be done with the assistance of the arthroscopy or by an open operation. There is no age limit for this procedure. The advantages of an arthroscopic method are that the incision is smaller, and the sites of fixation of the graft can be accurately visualized. Donor tissues can be harvested from the patient's own neighboring tissues or can be from a cadaver. Following the surgery, the patient has to undergo a rehabilitation process. Eventually they can return to sport by the end of six months. Conservative treatment methods like prolonged immobilization, bracing are not effective in healing of the ligament or restoring stability.

Prevention

Adhere to lane discipline.
Avoid attending mobile calls when driving.
Do not over speed.
Two wheelers should stick to the left lane of the road.