Treating Knee Ligament Injuries
April 29, 2025
The knee is the largest joint in the body and one of the most easily damaged. Knee ligament injuries are common, especially sprains.
And while knee injuries often happen among athletes, a twist or unfortunate hit to the knee can injure a ligament, too.
Franciscan Health Indianapolis orthopedic surgeon Sean Calloway, MD, talks about common causes of knee ligament injuries and how knee injuries are treated, often without the need for surgery.
What Are Ligaments In The Knee?
The ligaments in the knee help control motion by connecting bones and bracing joints against abnormal impact.
“When we're talking about ligaments of any part of the body, a ligament is what connects bones together,” said Dr. Calloway, an independent orthopedic surgeon who chooses to practice at Franciscan Health. “This is a little bit different than when we talk about tendons, because tendons connect muscle to bone.”
There are four main ligaments in the knee, and they are categorized as collateral ligaments and cruciate ligaments.
Collateral ligaments
Collateral ligaments are the ligaments on the inside of the knee (medial collateral ligament) and outside of the knee (lateral collateral ligament).
“These prevent shifting in and out of the knee,” Dr. Calloway said.
Cruciate ligaments
Possibly more well-known are the cruciate ligaments, the two main ligaments on the inside part of the knee, behind the knee cap.
“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,” Dr. Calloway said. “The PCL, the posterior cruciate ligament prevents the shin bone from moving backward as compared to the thighbone.”
What Are The Most Common Knee Ligament Injuries?
The anterior cruciate ligament (ACL) in front of the knee and the medial collateral ligament (MCL) connecting the tibia and femur bones inside the knee are common injury sites; less common is damaging the posterior cruciate ligament (PCL) behind the knee.
“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,” Dr. Calloway said. “It's very common in athletes. These types of injuries are most caused by what in our field we call non-contact injuries. If you're watching an athlete running on the field, especially in football, you can see they plant their leg, their knee twists and they fall to the ground. So, a lot of times these types of non-contact injuries happen that way.”
The second most injured knee ligament is the MCL, located on the inside of the knee. MCL injuries can sometimes happen if someone or something hits the outside part of the knee.
“The other two ligaments, the PCL and the lateral collateral ligament, are a little bit more rarely injured,” Dr. Calloway said. “Those can sometimes happen with things like motorcycle wrecks.”
What Are Main Causes Of Knee Ligament Injuries?
Many knee injuries happen from contact or accidents, but knee ligament injuries can also happen without contact to the knee, such as from twisting or turning.
Dr. Calloway cautions that non-athletes can also be at risk for knee ligament injuries.
“Even outside of the world of sports, these types of injuries can happen,” he said. “Types of patients that I've seen in my clinic are things like tripping over a garden hose or slipping on ice. 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, there are a lot of things around the house and around the yard that can also cause issues.”
Who Is Most At Risk For Knee Ligament Injuries?
“Young women are actually at most risk for these types of injuries, especially when talking about the ACL,” Dr. Calloway said.
Although musculoskeletal injuries are usually not gender specific, the American Academy of Orthopaedic Surgeons notes that women appear to be more susceptible to ACL injuries than men. Women basketball players are twice as likely as their male counterparts to experience this kind of ligament injury. Women soccer players are four times as likely as men to experience an ACL tear.
“In young female athletes, especially high school basketball players or 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.”
What Are Symptoms Of Knee Ligament Injuries?
If you injure a knee ligament, you may hear a popping noise or feel your knee give out from under you. You may feel excruciating pain and be unable to walk. But after some types of knee injuries, you may not feel the pain right away. Within two to 12 hours, you'll probably experience pain and swelling.
“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,” Dr. Calloway said. “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.”
Symptoms of minor sprains and strains of the knee ligament are less severe, he added.
“So, it's a small twist of the knee that gives you a little bit of a twinge of pain, but it doesn't necessarily completely send you to the floor or send you to the emergency room,” Dr. Calloway said. “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.”
What Should I Do For A Minor Knee Injury?
For minor knee injuries, doctors often recommend following the RICE method of rest, ice, compression, and elevation for the first 24 to 72 hours after the injury. Try to take it easy immediately after you injure yourself. Ice your knee for 15 minutes every two hours to reduce inflammation and pain. Anti-inflammatory medications such as ibuprofen can be very helpful as well. Wrap the affected area with an elastic bandage to provide compression and reduce swelling. Elevate your leg. These steps also will help take down swelling.
“We always want to think about is what happens during the injury, but also what happens immediately after,” Dr. Calloway said. “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.
“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.”
When Should You See An Orthopedic Specialist For Knee Pain?
Feeling a pop or having swelling in the knee are signs that you should see a specialist for your knee injury.
“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,” Dr. Calloway said. “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.”
Some people will feel a "pop" in their knee at the time of the injury, and they may have trouble with knee stability afterward. They may report that their knee seems to be "giving way" underneath them.
“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,” Dr. Calloway said.
How Are Knee Ligament Injuries Treated?
Most of the treatment options for knee ligament injuries do not include surgery.
Treating knee ligament injuries without surgery
Many common knee ligament injuries, such as knee sprains or knee strains, do not need to be treated with surgery.
Minor sprains and strains can be treated with RICE (rest, ice compression and elevation) – and an important element, time.
“The delay in you being able to take care of yourself can make this last much longer than it needs to,” Dr. Calloway said.
Anti-inflammatory medications such as ibuprofen and Aleve may be part of the treatment plan, as well as knee braces to support the joint.
“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,” Dr. Calloway said. “That's when we talk about wearing a brace to help support the knee. 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.”
Surgery for knee ligament injuries
For some more serious knee ligament injuries, surgery may be needed to repair a tear or reconstruct the ligament.
If you have lingering knee pain that doesn’t resolve with rest, reach out to Franciscan Health’s orthopedic specialists to help find a plan of care to get you back to enjoying the activities you love.
