Ligament Injuries

Ligament injuries include damage to the fibrous tissues that stabilize and connect bones to each other in the joints. Generally, this damage occurs when the joint is forced into an unnatural position due to a blow, a fall, or a twist.

Depending on their severity, ligament injuries are divided into three categories:

• Grade I or sprain: There is stretching of the ligament and microscopic rupture.
• Grade II or partial rupture: The ligament is torn, presenting bleeding, and loses strength.
• Grade III or total rupture: The joint becomes unstable due to the loss of continuity of the ligament, which usually frays irregularly when torn.

Ligament damage is classified according to the joint affected. The most common are:

• Ankle ligament injuries: Ankle sprains are among the most common injuries, especially among athletes. It usually involves stretching or tearing of the ligaments on the outer part of the joint.
• Knee ligament injury: The strain or rupture can occur in any of the four main ligaments forming the knee joint. Some of the most common are:
  • Anterior cruciate ligament (ACL) injury: Associated with football players, tennis players, or skiers, it usually occurs due to an ankle lock that forces the knee to absorb all the weight's force. Complete rupture is more frequent than strain and is often accompanied by damage to other structures such as the meniscus or cartilage.
  • Posterior cruciate ligament (PCL) injury: Being stronger than the ACL, it is less likely to be injured. However, when it tears, it usually occurs alongside the ACL injury. It is more common among individuals who play football, ski, or rugby.
  • Medial collateral ligament (MCL) injury: Typical among football players, basketball players, skiers, and tennis players, the ligament tears or stretches when the direction is changed abruptly, or when the knee twists while running or upon landing after a jump.
  • Lateral collateral ligament (LCL) injury: Besides twists, it tears or ruptures due to a blow to the outside of the knee. It is common among football or American football players.
• Shoulder ligament injury: Known as "shoulder instability," it occurs when the ligament weakens and the humeral head no longer stays in the glenoid cavity of the scapula. It is common among swimmers or throw athletes due to the forces exerted on the joint during repetitive overhead motions.
• Elbow ligament injury: This affects the ulnar collateral ligament (UCL), which tears or strains due to excessive use of the joint or falls. It is a frequent injury in baseball, volleyball, or wrestling.
• Thumb ligament injury: Common among cyclists and skiers, the ligament is usually affected by a fall or by holding onto handlebars or ski poles for prolonged periods.

Although not a serious condition, ligament injuries are often painful and limit movement. As a result, sports activity may be restricted for a period, which can sometimes be prolonged.

Symptoms

Symptoms may vary slightly depending on the injured tendon, but the most characteristic ones are:

• Pain in the affected joint.
• Swelling in the injured area.
• Feeling that the joint is loose.
• Muscle spasms.
• Difficulty moving.
• Trouble bearing weight on the damaged joint.

Causes

The primary cause of ligament stretching or rupture is engaging in sports, as well as falls or impacts. The reasons for tissue stretching vary depending on the injured tissue:

• Ankle ligaments (anterior tibiofibular, posterior tibiofibular, and interosseous tibiofibular): due to a twist or an unnatural rotation of the joint.
• Anterior cruciate ligament: caused by a combination of three factors:
  • Internal rotation of the tibia or external rotation of the trunk.
  • Knee deviation inward.
  • Anterior translation of the tibia.
• Posterior cruciate ligament: due to extreme force that moves the tibia backward, such as in a head-on car accident.
• Medial collateral ligament: can be injured by:
  • Abruptly changing direction.
  • Twisting the knee while running.
  • Twisting the knee when landing on the ground after jumping.
• Lateral collateral ligament: due to a lateral blow to the knee, pushing it outward.
• Shoulder ligaments (glenohumeral, coracoacromial, and coracoclavicular or transverse humeral): due to trauma or repetitive overhead movements.
• Elbow ligaments (ulnar collateral and radial collateral): caused by repetitive movement, a blow, or unnatural twisting.
• Ulnar collateral ligament of the thumb: from a blow while holding an object, such as a car steering wheel or ski poles, or from falling with an extended hand.

Risk Factors

The risk of suffering a ligament injury increases with the following factors:

• Age: Over time, joints become stiffer, and balance is lost.
• Overweight.
• Engaging in sports, especially professionally.
• Lack of proper sports equipment.
• Having poor movement patterns.
• Having been in a prolonged period of rest.

Complications

When treated properly, ligament injuries usually do not lead to complications. However, if left untreated, they can result in:

• Joint instability.
• Pain and swelling.
• Tearing of other joint structures, such as surrounding bones.
• Arthritis.

Prevention

Although ligament injuries can occur accidentally, damage can be prevented by adopting the following measures:

• Strengthening muscles.
• Training to internalize the proper way of performing certain actions without harming the joints.
• Doing physical therapy exercises to adopt proper movement patterns.
• Using sport-specific equipment in the correct manner.
• Avoiding playing sports on artificial grass.

Which Doctor Treats Ligament Injuries?

Orthopedic surgeons, rheumatologists, and specialists in sports medicine or physical medicine and rehabilitation are responsible for diagnosing and treating ligament injuries.