The Shoulder Pain Clinic

What is the anterior cruciate ligament?

The knee is a hinge joint held together by four ligaments. It is an important stabilizer of the knee joint. It connects femur to tibia and prevents anterior translation of tibia and provides rotational stability.

What are the symptoms?

The ACL is the most common injured ligament of the knee joint. ACL is injured in lateral rotation,sideways impact of knee and backward displacement when the lower leg is stable in position. Its frequently injured in atheletes and trauma victims.

What are the symptoms of an ACL injury or tear?

  1. Pop sound in knee
  2. Swelling of the knee
  3. Inability to bear weight on leg
  4. Instability of the knee while climbing up or down the hill.

Grades of ACL Injury

Grade 1: They have mild tear the ACL is mildly stretched but provide adequate stability to the knee joint.

Grade 2: ACL injuries are partial tears which are rare.

Grade 3: ACL tears are completely torn in half and give no stability to the knee joint.

ACL injury diagnosis ?

MRI knee shows the extent of tear along with associated injuries of knee

What is the treatment for an ACL injury or tear?

Treatment options are based on the patient’s age, symptoms, profession,partial or complete tear..

Nonsurgical: Nonsurgical treatment is preferred for partial ACL tear and in elderly population.. This would include immobilization, Rest, Ice application and physiotherapy.

Surgical: Surgical treatment is recommended for individuals with a grade 3 or complete ACL tear. Surgical options may vary based on the type of ACL injury, type and the age of the patient with knee arthroscopy.

The posterior cruciate ligament (PCL) is located inside the knee, just behind the anterior cruciate ligament (ACL). It is one of the ligaments that connect the femur to the tibia. The posterior cruciate ligament keeps the tibia intact and prevents posterior translation in relation to femur. A common cause of injury is a bent knee hitting a dashboard in a car accident or a football player falling on a knee that is bent. PCL can result from twisting injury or contact injury during sport


  1. Pain with swelling
  2. Stiff knee & limp
  3. Difficulty in walking
  4. The knee feels unstable

Diagnosis: Magnetic resonance imaging (MRI). MRI scans create better images of soft tissues and ligamentous injuries like ACL & PCL. X-ray can identify the PCL ligament avulsion injuries.


A. Nonsurgical Treatment: 

  1. Isolated PCL tears are mostly treated conservatively.

B. Immobilization: 

  1. with a knee brace
  2. Rest, Ice application, Compression, foot elevation over two pillows.
  3. Physiotherapy – Quadriceps, Hamstrings strengthening exercises.

Surgical Treatment:  Indications for surgery

  1. Multiligamentous Injury knee
  2. PCL tear with persistent instability or pain that is not improving with non-operative treatment.
  3. Surgery using Arthroscopic reconstruction.

What is a meniscus tear?

The menisci sit between the lower leg bone and thigh bone and protect the lower part of the leg from the shock created by our body weight.

Meniscus tears usually take place when the knee twists with knee bent and fixed on the ground.

What are the symptoms of a meniscus tear?

The most common symptoms are:

  1. Pain in the knee joint
  2. Swelling
  3. Catching or locking of the knee joint
  4. Inability to fully extend or bend the knee joint
  5. Limping

How is a meniscus tear diagnosed?

  • With an MRI Knee we can diagnose menical tear.

Types of Meniscal tears:

Treatment for a meniscus tear

  1. Icing
  2. Medication, such as ibuprofen
  3. Muscle-strengthening exercises
  4. Arthroscopic surgery


  1. Knee arthroscopy, a key hole surgery, is often used to treat meniscal tears. Arthroscopy is a keyhole surgery where small incisions are utilized and instruments are used to repair the defect.
  2. The meniscus is repaired with sutures which hold the meniscus together.

Your health care provider will first conduct a lateral collateral ligament test to reveal any looseness in the ligament. This test involves bending the knee to 25 degrees and placing pressure on the inside surface of the knee. Other tests may include: Knee joint x-rays.

What is a knee replacement surgery?

Knee replacement, also called Total knee arthroplasty or total knee replacement, is a surgical procedure to resurface damaged knee due to arthritis of various types. Cobalt Chromium Metal and plastic parts are used to cap the ends of the bones that form the knee joint, along with the kneecap which might be smoothened.

Osteoarthritis, a joint disease which is associated degeneration that affects elderly and middle aged where the joint cartilage is damaged due to wear and tear of the joint. Rheumatoid arthritis, inflammation of the synovial membrane and synovitis – pain and stiffness. Traumatic arthritis, arthritis due to injury to knee joint may cause damage to the cartilage of the knee.

The goal of knee replacement surgery is pain relief, restore function and motion.