How Do You Treat ACL, MCL and Meniscus Injuries?

Ask The Doctor > Knee Pain > How Do You Treat ACL, MCL and Meniscus Injuries?

Injury to the knee joint can take a heavy toll on the life style of the patients. However, with proper precautions and care, the quality of life can be maintained to a large extent. Let us take a look at how knee injuries occur and how they can be managed and coped with.

The knee consists of various constituent and supporting structures. The main ligaments that provide structural support to the knee joint include the anterior cruciate ligament (ACL), the medial collateral ligament (MCL) and the medial and lateral menisci, among others.

Isolated injury to ACL can be the result of

Non-contact injury: may be the result of a change in direction, landing from height or hyperextension of the joint.
Contact injury: often involve other knee structures too, often resulting in the “O’Donoghue’s triad” or the “terrible triad” injury involving tears of ACL, MCL and the menisci. These injuries often follow exertion of valgus (inward force) on the knee. If an outward (varus) pressure is exerted on the knee as a result of trauma, injury to ACL and lateral collateral ligament can result.
Isolated ACL injuries are rarely encountered. Pain and swelling relief is done with analgesics and steroids. Physical therapy is quite effective in such patients.

If faced with the “terrible/unhappy triad”, surgery is the best option. The surgical options include

Autografting (from patellar tendon, Hamstring tendon or Quadriceps tendon)
Allografting (from patellar tendon, Achilles tendon, semitendinosus, gracilis, or posterior tibialis tendon of a cadaver).
A recently developed technique consists of autologous stem cell transplantation using mesenchymal stem cells (MSCs) for ACL reconstruction. The recovery from ACL injury can take up to 15 months.

MCL prevents hyperextension of the medial aspect of the knee. A heavy blow to the outside of the knee can cause buckling of the knee, resulting in tearing of the MCL. MCL injuries may be isolated or a part of complex injury to the knee.

The treatment of the torn MCL is usually done conservatively with analgesics for pain relief and anti-inflammatory steroid for inflammation. Immobilization of the affected knee followed by physical therapy is the most effective in isolated MCL injuries. Bracing of the knee is also done.

Surgery is rarely resorted to only in case of high grade injuries with excessive tearing of MCL. Surgical options include

MCL replacement
Non-surgical prolotherapy can also be done for MCL injuries. The patients can return to daily life activities quickly following MCL injuries.

Two menisci, lateral and medial ones, support the knee joint. Menisci are most commonly inured as a result of torsional or the rotational forces. Weight bearing can also result in meniscal injury.

Injury to the lateral meniscus is more serious a problem as it can hinder the recovery owing to the fact that the lateral meniscus is an avascular structure and is not directly supplied by blood vessels.

The swelling and pain from meniscal injuries are treated with the help of anti-inflammatory drugs and analgesics. Corticosteroid injections can also be given. Physical therapy by utilizing the techniques of electric stimulation, cold therapy and ultrasonography is quite effective

The surgical interventions include

Arthroscopy: complete or partial removal of the injured meniscus
Meniscal transplantation
Post-surgical rehabilitation is done with physiotherapy including strengthening exercises and bracing of the affected knee.

In order to maintain the quality of living, adjustments must be made to your lifestyle. These include:

Maintaining a healthy weight in order to spare already injured knees from bearing excess weight.
For weight maintenance, healthy dietary habits must be adopted with incorporation of fresh fruits and vegetables, omega 3 fats, whole grains and proteins in diet. Sweet foods and fat loaded junk food items must be avoided.
Low-impacts exercises should be made a regular part of the routine. Walking and swimming are effective exercises but they should be undertaken only after consultation with the physiotherapist.
Occupational and physical therapy programs help quick recovery and rehabilitation.
Lead a stress free life. Various relaxation techniques like deep breathing can also prove to be useful in this regard.
Adequate amount of sleep is essential to speed up recovery after knee sprain, so sleep while you can.
For pain relief, cold and warm packs are a good remedy. Cold packs help with inflammation while hot packs help alleviate the pain. Topical or oral pain relievers can also be used for this purpose.
Keep your knee warm especially during cold and rainy days.

Was this answer helpful?

Dr. Jimmy Obaji M.D.

Dr. Jimmy Obaji completed his residency in Family Medicine at the University of Manitoba. He currently operates a walk-in-clinic in downtown Toronto.

Book Appointment