Knee injury after skiing

A 47 year old lady fell whilst skiing, experiencing severe knee pain and swelling and was initially taken to hospital.  Her knee was x-rayed and she was advised that she had not broken any bones.   On her return she was seen by an Orthopaedic Consultant and she had an MRI scan to get a more detailed assessment of her injury.  She was found to have ruptured her anterior cruciate ligament (ACL) with a smaller injury to her medial collateral ligament (MCL) along with a lot of bruising in the bones of her knee.

The ACL is deep inside the knee and is particularly important for keeping your knee stable.  The MCL is on the inner aspect of knee and stops your knee from bending sideways.  An injury to two of the four major knee ligaments increases the chances of requiring an operation.  However, it was decided to give her knee a chance to settle down and see if she could make a good recovery with physiotherapy alone.

At her initial assessment she was only able to bend her knee to ninety degrees (right angle), could not walk up stairs normally and was having to sleep with a pillow under her knee.  Despite her MRI showing that the main injury was to her ACL the main concern at this point was that her MCL was found to be very loose.  The priority was therefore to protect and treat that ligament to give it the best chance of tightening again.

Treatment consisted of a combination of ‘hands-on’ treatment directly to the ligament and electrotherapy.  Alongside this she was given  exercises to help maintain muscle activity and balance.   By seven weeks post injury her MCL had tightened well and was much less painful.  We were then able to start working on more challenging strength and stability work, focusing on her hamstring and adductor muscles.

By nine weeks she was able to begin simple hopping drills, focusing on maintaining good alignment and control throughout her whole leg.  At this stage she saw her Consultant again who was able to discharge her as she was no longer showing any signs of requiring surgery.

By sixteen weeks she had regained full range of movement and was close to full strength.  She could squat on one leg and hop with good control.  She had also been able to restart horse riding.  At this stage we were able to introduce more advanced drills involving change of speed and direction.  This enabled her to also start a gradual return to tennis and by six months following her injury she was able to play fully with a knee that felt strong, stable and painfree.

Knee injuries that involve tearing a ligament (or more than one!) are significant injuries.  However, with the correct treatment at the correct time and a bit of hard work you can make an excellent recovery.