Knee Instability

What is a knee instability?

There are 4 major ligaments in the knee joint which serve to stabilise the knee joint during movement. You might have heard of someone injuring their ACL, this is a common injury amongst the sporting population where it occurs primarily due to a forceful twisting of the knee. Injury to these structures normally result in pain and instability of the knee joint and a lengthy rehabilitation period.

When do I know if I have knee instability/ ligament injury?

Signs and symptoms of a knee instability may include:

Traumatic incident resulting in pain and swelling
Audible pop sound during traumatic incident
Instability of the knee
Feelings of knee giving way when walking or going down stairs

How is knee instability diagnosed and managed?

It is usually diagnosed through a history taking and physical examination carried out by a Doctor or Physiotherapist. The medical specialist will usually take an MRI to determine the extent of the ligament damage to determine whether a surgical intervention is warranted. In cases where the ligamentous injury is not as severe, it can be managed conservatively with Physiotherapy interventions.

How can Physiotherapy help?

The Physiotherapist will carry out an assessment of the knee, hip and ankle region. This would include an assessment of the range of movements in the lower limbs, examining your movement postures as well as your strength. In addition, clinical tests to assess and monitor the ligamentous laxity of your knee will also be performed. The role of the Physiotherapist is to help with maintaining the knee joint mobility and the muscles around the knee whilst the ligament recovers.

Treatment may include but it is not limited to:

Advise and education pertaining to your condition
Soft tissue therapy
Movement with mobilisation
Heat therapy
Electrotherapy
Dry needling
Shockwave therapy
Taping to offload the quads or patella tendons
Movement training
Return to sport training
Exercises for ligament injuries of the knee would include exercises for the hip, knee and calf muscles since these mnuscles groups contribute to the stability and function of the knee joint

Do I always need surgery for a ligament tear?

In cases of tearing the ligaments to the left and right of the knee joint, these usually have good healing capacities and are managed with Physiotherapy and rehabilitation.

However in the case of an ACL injury, studies have been mixed on whether a surgery is required. There have been cases where the ACL has shown to recover well and individuals do not feel instability within the knee. In most cases, a surgery is chosen if the individual is keen to return to a high level of sporting activity or physical demands are greater.

How long does it take for it to recover after an ACL surgery?

Day to day functions such as ambulation and climbing the stairs would largely be back to normal after the first 6 weeks to 3 months. Following which, depending on the individual’s recovery, running and jumping can start to be reintroduced during this period.

However, it should be duly noted that it will take 9 -12 months after surgery before an individual is allowed to properly return to competitive sport. Returning earlier than this time frame results in a higher re-tear rate of the ACL and is absolutely not worth the risk.