Knee sprain and osteopathy
What is a knee sprain?
Knee sprains are caused by damage to one or more ligaments in the knee. The ligament or ligaments may be stretched beyond their physiological barrier or ruptured. The sprain can occur as a result of direct trauma such as an impact or indirect trauma such as twisting the knee.
Anatomy of the knee ligaments
The role of the knee ligaments is to stabilize the knee joint. There are 4 main ligaments:
Tibial collateral ligament
Origin: It is inserted on the posteroinferior part of the medial femoral epicondyle.
Path: It goes down, forward and slightly out.
Termination: It ends behind the crow's feet, on the upper 1/4 of the medial side of the tibia.
Fibular collateral ligament
Origin: It is inserted on the posteroinferior part of the lateral femoral epicondyle.
Trajectory: It is directed downwards, backwards and slightly inwards.
Termination: It ends on the lateral posterior part of the head of the fibula.
Anterior cruciate ligament (ACL)
Origin: It is inserted in the anterior intercondylar area of the tibia, against the medial meniscus.
Path: It goes up, back and out.
Termination: It ends on the posterior-superior part of the medical side of the lateral condyle of the femur.
Notes: This ligament is about 4 cm long and 8 mm in diameter. It is extra-articular and is very poorly vascularized. It is twisted into 2 parts:
- Antero-medial
- Posturo-lateral
It has a resistance of 160 kg and an elasticity of 20%.
Posterior cruciate ligament (PCL)
Origin: It is inserted in the posterior intercondylar area of the tibia.
Path: It goes upwards, forwards and inwards.
Termination: It ends on the anterosuperior part of the lateral aspect of the medial condyle of the femur.
Notes: This ligament is approximately 3 cm long and 14 mm in diameter. Unlike the ACL, it is well vascularized. It is twisted into 2 parts:
- Antero-medial
- Posturo-lateral
It is also more resistant than the ACL.
Injury mechanisms of knee sprains
Injury to the posterior cruciate ligament is rarer than injury to the anterior cruciate ligament. PCL injury occurs mainly during a violent impact.
Knee flexion, valgus, external rotation
Common mechanism in skiers! Beyond its physiological barrier, this movement often causes a rupture of the anterior cruciate ligament and sometimes also of the posterior one.
Knee extension, internal rotation
This classic injury mechanism is often found at the landing of a jump when the foot is blocked on the ground in internal rotation and the body pivots in the other direction. It is often found in soccer, volleyball, basketball, handball, etc. This usually causes an isolated rupture of the anterior ligament.
Hyperextension of the knee
Forced hyperextension of the knee can affect both cruciate ligaments as well as the posteromedial and lateral corner points. This mechanism often occurs during a collision or a countered strike.
Hyperflexion of the knee
Hyperflexion of the knee can lead to isolated rupture of the anterior cruciate ligament but also to damage of the menisci by crushing/shearing.
Knee varus and extension
This injury mechanism is rare but it can affect the entire external compartment and cause rupture of the tibial collateral ligament, posterior cruciate ligament, posterolateral corner point and popliteal tendon.
Stages of knee sprain
Stages of collateral ligament sprain
Collateral ligament damage is classified by degree of severity, depending on the extent of pathological laxity:
- Degree 1: the opening of the compartment reached is less than 5mm
- Degree 2: opening between 5 and 10 mm
- Degree 3 : opening > 10 mm
Symptoms of a knee sprain
- Pain
- Instability
- Blocking
- Effusion
- Cracking: the sensation of cracking during trauma often indicates damage to the anterior cruciate ligament.
Knee examinations
Clinical examination of the knee
The diagnosis of a knee sprain is above all clinical!
This examination must be :
- Complete: the examiner will have to test the ligaments but also other structures such as menisci, muscles, bones, etc.
- Comparative: the practitioner must test both knees
- Repeated a few days after the acute phase.
Orthopedic tests performed by your practitioner will reveal laxity in cases of ligament damage:
- Anterior laxity: possible damage to the ACL
- Posterior laxity: possible involvement of the PCL
- Lateral laxity: possible damage to one or more collateral ligaments
The specific tests for testing the main ligaments of the knee are :
- Dejour test
- Lachman test
- Hughston's test
- Drawer test
- Medial and lateral compartment laxity tests (gapping)
Complementary examinations of the knee
Complementary examinations traditionally begin with an X-ray of the knee in order to eliminate associated injuries such as osteochondral fractures. However, the X-ray does not show the ligaments.
Ultrasound can also be used to visualize the ligaments of the knee, but for the cruciate ligaments, it is quite complex.
MRI is the examination of choice for demonstrating damage to ligaments, particularly the cruciates. It should never be prescribed as a first-line examination!
Treatment of knee sprains
Osteopathy and knee sprains
Osteopathy in the short term?
In the short term, i.e. in the acute phase, osteopathy as such is not recommended. However, consulting an osteopath trained in the treatment of sportsmen and women can be very useful and can optimize recovery.
Your osteopath will be able to apply kinesiotaping or strapping in order to relieve the patient, stabilize the knee and thus avoid a recurrence. Indeed, when a sprain occurs, the risk of having another one in the following days is much higher.
Osteopathy in the longer term?
A knee sprain will cause compensations on the rest of the body. Indeed, the patient will limp and compensate by leaning on the other leg. This will cause imbalances. The osteopath's goal is to remove all these dysfunctions before they cause other pains such as lumbago or torticollis.
The osteopath, in parallel with the physiotherapist, will also work on the knee and its surrounding structures in order to remove all blockages and restore the proper function of all tissues.
In cases of surgery, it is necessary to wait 3 months before having an osteopathic session. If you have any questions, do not hesitate to contact your osteopath.
Physiotherapy
The main role of physical therapy in knee sprains is to strengthen the muscles of the knee to improve its stability. Indeed, outside of surgery, we cannot strengthen the ligaments, but we can easily strengthen the muscles which also have a great role in the stability of the knee.
In the case of surgery, the role of physical therapy before and after the operation is essential.
Surgery?
Surgery was performed very frequently during the last decades but it is not to be taken lightly, today it is only practiced in certain cases.
Ligament repair surgery, also known as ligamentoplasty, must be carefully considered in consultation with your orthopedic surgeon. Surgery is only performed in certain cases:
- High-level athletes in a sport requiring impeccable knee support (skiers, handball players, etc.)
- When functional rehabilitation fails: if, despite well done and followed physical therapy sessions, pain and/or instability persists, knee surgery can be considered.
- By age:
- Persons under 50 years of age for ACL,
- Less than 40 years for the LCP.
Postoperatively, the following are recommendations:
- Immediate support!
- Beginning of immediate rehabilitation (in closed chain)
- Swimming and cycling between the 2nd and 4th month
- Resuming running around the 5th month
- Resumption of pivot sports from the 8th month.
Marie Messager
Osteopath for sports
in Versailles
78 - Yvelines
