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Common Knee Ligament Injuries
Featuring:
Sean Calloway, MD
Dr. Sean Calloway is an orthopedic and sports medicine surgeon with Franciscan Physician Network Orthopedic Specialists. Originally from Valparaiso, Indiana, Dr. Calloway received his undergraduate degree from the University of Notre Dame and his medical degree from the Indiana University School of Medicine. He completed additional orthopedic training at Campbell Clinic in Memphis, Tennessee and an orthopedic sports medicine fellowship in Santa Monica, California. Dr. Calloway has extensive experience with athletes of all levels. He’s served as the team physician for USA Men’s, Women’s, Boys’, and Girls’ national soccer programs, as well as the Indianapolis Indians and Mooresville High School Athletics. Dr. Calloway’s main goal as a sports medicine surgeon is to return patients to their previous level of activity. Transcription:
Scott Webb: Knee ligament injuries are common, especially playing sports, and most of the treatment options do not include surgery. And here today to talk more about knee ligaments, the most common injuries and the treatment options is Dr. Sean Calloway. He's an orthopedic surgeon with Franciscan Health.
This is the Franciscan Health Doc Pod. I'm Scott Webb. So Dr. Calloway, thanks for your time today. We're going to talk about common knee ligament injuries. And I think that's the point, right? Is that these types of things are common and folks may do it this way or that way, or not exactly know what they did, but that's why we have experts like yourself. So, as we get rolling here, as an orthopedic surgeon, what are the most common knee ligament injuries that you see in the office?
Dr. Sean Calloway: I think, first, it would take a little bit of a step back and talk about the anatomy of the knee. And I think it's also important to talk about what a ligament actually is. When we're talking about ligaments of any part of the body, a ligament is what connects bones together. And this is a little bit different than when we talk about tendons, because tendons connect muscle to bone.
So as we look at the ligaments of the knee, there are really four main ligaments that we talk about. So, there's ligaments on the inside and outside of the knee. We call those collateral ligaments. On the inside of the knee, it's called the medial collateral ligament. On the outside of the knee, it's called the lateral collateral ligament. And these prevent shifting in and out of the knee. There are also two main ligaments on the inside part of the knee, behind the knee cap. And these are what we call cruciate ligaments. The anterior cruciate ligament, also known as the ACL, prevents the shin bone from moving forward on the thighbone, and it also prevents some rotation of the knee. And then finally, the PCL, the posterior cruciate ligament prevents the shin bone from moving backward as compared to the thighbone.
So when we look at all four of those ligaments of the knee, the most commonly injured ligament is called the ACL, which you've probably heard about. It's very common in athletes. And these types of injuries are most commonly caused by what, in our field, we call non-contact injuries. So if you're watching an athlete running on the field, especially in football, you can see they plant their leg and all of a sudden that their knee twists and they fall to the ground. So, a lot of times these types of non-contact injuries happen that way. And that's really the most commonly injured one.
The second most commonly injured ligament is on the inside of the knee called the MCL. And that can sometimes happen if someone or something hits the outside part of the knee. And then, the other two ligaments, the PCL and the lateral collateral ligament are a little bit more rarely injured. And those can sometimes happen with things like motorcycle wrecks.
Scott Webb: Yeah, I think you're so right. I think most of us who watch sports were familiar with MCL, ACL. Both my kids played sports. My daughter's a basketball player, so I worry about her ACL all the time every time she drives the lane. You know, I'm worried that this is going to be the big one. So, let's talk some more then about the primary causes of knee ligament injuries. I know you said that, you know, some are sometimes from contact or accidents, sometimes they're non-contact. It's the twisting and turning with soccer, basketball, football, whatever it might be. Are there some people that are just more prone to these types of injuries, males versus females, or vice versa, that kind of thing?
Dr. Sean Calloway: Yeah. You hit the nail on the head with your example. Young women are actually at most risk for these types of injuries, especially talking about the ACL. So in young female athletes, especially high school basketball players, high school soccer players, the problem is that the body's changing and muscles are changing at different rates. And a lot of times with how physical and how quick these sports are now moving, the body isn't ready for that. So, young women whose hips tend to be a little bit wider than the knees already put the knee in a risky position for this type of twisting injury. So, that's the age range that are most prone to this.
But even outside of the world of sports, these types of injuries can happen. Types of patients that I've seen in my clinic are things like tripping over a garden hose or slipping on ice, these types of injuries can happen. With the MCL, it could be the dog running through the house and hitting the outside part of the knee, making the inside part be injured. So while we always talk about sports and that's the type of thing that we think about, and it's on the tv and then the news, there are a lot of things around the house and around the yard that can also cause issues.
Scott Webb: Yeah. You're so right. As we get older, we all seem to be more prone to injuries. Let's talk about the symptoms a little bit. You know, I think that, again, framed through sports, we're all sort of familiar with watching. sports and you see an athlete just sort of crumble to the floor or crumble to the field and you think, "Oh gosh, that's ACL at a minimum," right? But are there some other symptoms? Is it possible to strain these ligaments and not necessarily, you know, tear them so dramatically? So, could there be some symptoms associated with some minor injuries that we should be on the lookout for?
Dr. Sean Calloway: Yeah. I think that's a really good point and a really good question. All the press and publicity is on the larger knee injuries, the ones that are keeping these professional athletes or your kids or family members out for six months to a year. But there are more minor sprains and strains of the knee that can happen, and those symptoms, I think when you think about it, are just a little bit less severe. So, it's a small twist of the knee that gives you a little bit of a twinge of pain, but doesn't necessarily completely send you to the floor or send you to the emergency room. And those are the types of things that we are able to use the rest, the ice, the elevation, those types of treatments, maybe some anti-inflammatories as well.
But when we think about the larger types of injuries to the knee, the main thing that we get concerned about as orthopedic surgeons is when you feel a pop. So if you have swelling in your knee right after an injury or if you feel a pop, that's when we talk about more of the severe symptoms and severe types of injuries.
I think another thing that we always want to think about is what happens during the injury, but also what happens immediately after. So whether or not you're an elite athlete, a weekend warrior, or your dog trips over you in the house, right afterwards, your adrenaline's flowing and you're not really thinking about what just happened. You're thinking about getting up, maybe saving yourself the embarrassment of falling somewhere. And so, to really give it a little bit of time to see what happens. Sometimes these ligament injuries or these sprains or strains get better over the first day or two. But as you start putting more and more weight on it later that day, or if you get home or if you've been sitting in the car for 30 minutes, I think that gives you a better idea of where you're headed with overall treatment options.
Scott Webb: Yeah, I see what you mean. That we don't necessarily need to run to our primary or run to an orthopedic surgeon. But give us some idea, doctor, when it would be appropriate. So obviously, if it's been one of these catastrophic sort of knee events, then that would be obvious and a lot of times, you know, trainers would be involved at schools or whatever level. But for, you know, those of us who might injure ourselves around the house or slipping, sliding, whatever it might be, and we've given it a little bit of time, when do we know or when should we know that it's time to see someone like yourself?
Dr. Sean Calloway: I think the biggest factor in those, what we would consider tweener cases where it's maybe not a severe injury, but also not just something you can walk off, is swelling of the knee. So, when we look at injuries and what I would consider injuries that would require something to see us, it's if the knee is swollen. If you're able to walk off, so to speak, your injury and the next day you wake up and your knee looks back to normal, that's something that I would give a few more days. But when you start seeing swelling and it's not going down or it's lessening your ability to walk, that's when you go and see an orthopedic surgeon.
As you mentioned, if you do have that catastrophic twisting injury, feeling a pop, what I recommend always to my patients, whether or not they're athletes, is give it the night. You don't necessarily have to go to the emergency room, but you would want to call your orthopedic surgeon and obviously let them know. And at least in my clinic, I get all these patients in the next day to make sure that we can get them taken care of.
Scott Webb: Sure. Yeah. So then let's talk about finally here, as we wrap up, doctor, you say taking care of, so how do we treat these injuries? I'm fairly, you know, familiar with the catastrophic sports ones where, you know, major surgery's involved and there's a long rehabilitation process, you know, 10 months, 12 months in some cases. But generally speaking, when we think about the most common injuries, what are the treatment options?
Dr. Sean Calloway: I'll start off by going with more of the minor sprains and strains. And like I mentioned, a lot of these can be treated just with at-home remedies. So the old saying of RICE, of rest, ice compression, elevation, giving it a little bit of time, especially if you're a laborer or someone who has to be physical for their work, giving it a couple days just to rest because these sprains and strains, even though they're minor or may go away on their own, the delay in you being able to take care of yourself can make this last much longer than it needs to.
The middle ground, so specifically talking about things like the medial collateral ligament, you can have a partial tear of that ligament but still not require any surgery. So that's when we talk about wearing a brace to help support the knee. And braces are a really nice thing. I always say that there's no magical brace that's going to take away all of your pain or cure your symptoms, but a brace after a knee injury can really be helpful to get you back on your feet and allow your body to heal itself.
When it comes to medications, I think anti-inflammatories are the best. So, things like over-the-counter, ibuprofen and Aleve, as long as you don't have any symptoms of stomach problems or any allergies to them, I think that's the best class of medicines. And then, finally, when we go into, like you said, the more catastrophic injuries when we talk about younger athlete, it's usually surgery to get the ACL reconstructed to stitch the MCL back together. And if we talk about even the more severe side of things like the PCL or the ligaments on the outside of the knee, those are where we're talking about the recovery processes after surgery of 10, 12, 18 months even.
Scott Webb: Yeah. Well this has been really educational today. As I said, I worry about my daughter all the time, being a basketball player. I'm sure a lot of parents do, watching their kids play. You know, a lot of these common injuries don't require surgery. Some, you know, OTCs from your local drugstore, knee brace, maybe some ice, a little bit of time, our bodies will do some of the healing themselves. So, you know, good to know that there's options and that not everything is catastrophic. So, Dr. Thanks so much for your time. You stay well.
Dr. Sean Calloway: I appreciate it. Thank you.
Scott Webb: And for more information, go to franciscanhealth.org/orthocare. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.
Scott Webb: Knee ligament injuries are common, especially playing sports, and most of the treatment options do not include surgery. And here today to talk more about knee ligaments, the most common injuries and the treatment options is Dr. Sean Calloway. He's an orthopedic surgeon with Franciscan Health.
This is the Franciscan Health Doc Pod. I'm Scott Webb. So Dr. Calloway, thanks for your time today. We're going to talk about common knee ligament injuries. And I think that's the point, right? Is that these types of things are common and folks may do it this way or that way, or not exactly know what they did, but that's why we have experts like yourself. So, as we get rolling here, as an orthopedic surgeon, what are the most common knee ligament injuries that you see in the office?
Dr. Sean Calloway: I think, first, it would take a little bit of a step back and talk about the anatomy of the knee. And I think it's also important to talk about what a ligament actually is. When we're talking about ligaments of any part of the body, a ligament is what connects bones together. And this is a little bit different than when we talk about tendons, because tendons connect muscle to bone.
So as we look at the ligaments of the knee, there are really four main ligaments that we talk about. So, there's ligaments on the inside and outside of the knee. We call those collateral ligaments. On the inside of the knee, it's called the medial collateral ligament. On the outside of the knee, it's called the lateral collateral ligament. And these prevent shifting in and out of the knee. There are also two main ligaments on the inside part of the knee, behind the knee cap. And these are what we call cruciate ligaments. The anterior cruciate ligament, also known as the ACL, prevents the shin bone from moving forward on the thighbone, and it also prevents some rotation of the knee. And then finally, the PCL, the posterior cruciate ligament prevents the shin bone from moving backward as compared to the thighbone.
So when we look at all four of those ligaments of the knee, the most commonly injured ligament is called the ACL, which you've probably heard about. It's very common in athletes. And these types of injuries are most commonly caused by what, in our field, we call non-contact injuries. So if you're watching an athlete running on the field, especially in football, you can see they plant their leg and all of a sudden that their knee twists and they fall to the ground. So, a lot of times these types of non-contact injuries happen that way. And that's really the most commonly injured one.
The second most commonly injured ligament is on the inside of the knee called the MCL. And that can sometimes happen if someone or something hits the outside part of the knee. And then, the other two ligaments, the PCL and the lateral collateral ligament are a little bit more rarely injured. And those can sometimes happen with things like motorcycle wrecks.
Scott Webb: Yeah, I think you're so right. I think most of us who watch sports were familiar with MCL, ACL. Both my kids played sports. My daughter's a basketball player, so I worry about her ACL all the time every time she drives the lane. You know, I'm worried that this is going to be the big one. So, let's talk some more then about the primary causes of knee ligament injuries. I know you said that, you know, some are sometimes from contact or accidents, sometimes they're non-contact. It's the twisting and turning with soccer, basketball, football, whatever it might be. Are there some people that are just more prone to these types of injuries, males versus females, or vice versa, that kind of thing?
Dr. Sean Calloway: Yeah. You hit the nail on the head with your example. Young women are actually at most risk for these types of injuries, especially talking about the ACL. So in young female athletes, especially high school basketball players, high school soccer players, the problem is that the body's changing and muscles are changing at different rates. And a lot of times with how physical and how quick these sports are now moving, the body isn't ready for that. So, young women whose hips tend to be a little bit wider than the knees already put the knee in a risky position for this type of twisting injury. So, that's the age range that are most prone to this.
But even outside of the world of sports, these types of injuries can happen. Types of patients that I've seen in my clinic are things like tripping over a garden hose or slipping on ice, these types of injuries can happen. With the MCL, it could be the dog running through the house and hitting the outside part of the knee, making the inside part be injured. So while we always talk about sports and that's the type of thing that we think about, and it's on the tv and then the news, there are a lot of things around the house and around the yard that can also cause issues.
Scott Webb: Yeah. You're so right. As we get older, we all seem to be more prone to injuries. Let's talk about the symptoms a little bit. You know, I think that, again, framed through sports, we're all sort of familiar with watching. sports and you see an athlete just sort of crumble to the floor or crumble to the field and you think, "Oh gosh, that's ACL at a minimum," right? But are there some other symptoms? Is it possible to strain these ligaments and not necessarily, you know, tear them so dramatically? So, could there be some symptoms associated with some minor injuries that we should be on the lookout for?
Dr. Sean Calloway: Yeah. I think that's a really good point and a really good question. All the press and publicity is on the larger knee injuries, the ones that are keeping these professional athletes or your kids or family members out for six months to a year. But there are more minor sprains and strains of the knee that can happen, and those symptoms, I think when you think about it, are just a little bit less severe. So, it's a small twist of the knee that gives you a little bit of a twinge of pain, but doesn't necessarily completely send you to the floor or send you to the emergency room. And those are the types of things that we are able to use the rest, the ice, the elevation, those types of treatments, maybe some anti-inflammatories as well.
But when we think about the larger types of injuries to the knee, the main thing that we get concerned about as orthopedic surgeons is when you feel a pop. So if you have swelling in your knee right after an injury or if you feel a pop, that's when we talk about more of the severe symptoms and severe types of injuries.
I think another thing that we always want to think about is what happens during the injury, but also what happens immediately after. So whether or not you're an elite athlete, a weekend warrior, or your dog trips over you in the house, right afterwards, your adrenaline's flowing and you're not really thinking about what just happened. You're thinking about getting up, maybe saving yourself the embarrassment of falling somewhere. And so, to really give it a little bit of time to see what happens. Sometimes these ligament injuries or these sprains or strains get better over the first day or two. But as you start putting more and more weight on it later that day, or if you get home or if you've been sitting in the car for 30 minutes, I think that gives you a better idea of where you're headed with overall treatment options.
Scott Webb: Yeah, I see what you mean. That we don't necessarily need to run to our primary or run to an orthopedic surgeon. But give us some idea, doctor, when it would be appropriate. So obviously, if it's been one of these catastrophic sort of knee events, then that would be obvious and a lot of times, you know, trainers would be involved at schools or whatever level. But for, you know, those of us who might injure ourselves around the house or slipping, sliding, whatever it might be, and we've given it a little bit of time, when do we know or when should we know that it's time to see someone like yourself?
Dr. Sean Calloway: I think the biggest factor in those, what we would consider tweener cases where it's maybe not a severe injury, but also not just something you can walk off, is swelling of the knee. So, when we look at injuries and what I would consider injuries that would require something to see us, it's if the knee is swollen. If you're able to walk off, so to speak, your injury and the next day you wake up and your knee looks back to normal, that's something that I would give a few more days. But when you start seeing swelling and it's not going down or it's lessening your ability to walk, that's when you go and see an orthopedic surgeon.
As you mentioned, if you do have that catastrophic twisting injury, feeling a pop, what I recommend always to my patients, whether or not they're athletes, is give it the night. You don't necessarily have to go to the emergency room, but you would want to call your orthopedic surgeon and obviously let them know. And at least in my clinic, I get all these patients in the next day to make sure that we can get them taken care of.
Scott Webb: Sure. Yeah. So then let's talk about finally here, as we wrap up, doctor, you say taking care of, so how do we treat these injuries? I'm fairly, you know, familiar with the catastrophic sports ones where, you know, major surgery's involved and there's a long rehabilitation process, you know, 10 months, 12 months in some cases. But generally speaking, when we think about the most common injuries, what are the treatment options?
Dr. Sean Calloway: I'll start off by going with more of the minor sprains and strains. And like I mentioned, a lot of these can be treated just with at-home remedies. So the old saying of RICE, of rest, ice compression, elevation, giving it a little bit of time, especially if you're a laborer or someone who has to be physical for their work, giving it a couple days just to rest because these sprains and strains, even though they're minor or may go away on their own, the delay in you being able to take care of yourself can make this last much longer than it needs to.
The middle ground, so specifically talking about things like the medial collateral ligament, you can have a partial tear of that ligament but still not require any surgery. So that's when we talk about wearing a brace to help support the knee. And braces are a really nice thing. I always say that there's no magical brace that's going to take away all of your pain or cure your symptoms, but a brace after a knee injury can really be helpful to get you back on your feet and allow your body to heal itself.
When it comes to medications, I think anti-inflammatories are the best. So, things like over-the-counter, ibuprofen and Aleve, as long as you don't have any symptoms of stomach problems or any allergies to them, I think that's the best class of medicines. And then, finally, when we go into, like you said, the more catastrophic injuries when we talk about younger athlete, it's usually surgery to get the ACL reconstructed to stitch the MCL back together. And if we talk about even the more severe side of things like the PCL or the ligaments on the outside of the knee, those are where we're talking about the recovery processes after surgery of 10, 12, 18 months even.
Scott Webb: Yeah. Well this has been really educational today. As I said, I worry about my daughter all the time, being a basketball player. I'm sure a lot of parents do, watching their kids play. You know, a lot of these common injuries don't require surgery. Some, you know, OTCs from your local drugstore, knee brace, maybe some ice, a little bit of time, our bodies will do some of the healing themselves. So, you know, good to know that there's options and that not everything is catastrophic. So, Dr. Thanks so much for your time. You stay well.
Dr. Sean Calloway: I appreciate it. Thank you.
Scott Webb: And for more information, go to franciscanhealth.org/orthocare. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.