Following recent cruciate knee injuries to Marcus Rojo and Zlatan Ibrahimovic of Manchester United, we thought that we would discuss the anatomy and how physiotherapy can help in such cases. Cruciate ligament injuries are common in contact and non-contact sports which involving sudden changes in direction such as football, rugby, netball and basketball.

Anatomy and Injury Mechanism

There are two cruciate ligaments in the knee; the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL). Both ligaments are situated deep in the knee and connect the femur (thigh bone) to the tibia (shin bone). The ACL connects to the front of the tibia; hence the name anterior cruciate ligament and the PCL connects to the back, hence posterior cruciate ligament.

The ACL is more commonly injured than the PCL. It is normally injured when the knee is twisted when the foot is in contact with the ground, or as Ibrahimovic injured it, by hyperextending the knee (see below). The PCL is more commonly injured by a blunt force to the front of the shin when the knee is bent, like during a rugby tackle. It can also be injured when hyperextending the knee.


How do you know if you have injured your ACL or PCL?

Patients often report that they felt or heard something snap during the injury and they are in a lot of pain. Because both ligaments have a good blood supply, the knee swells immediately post injury, which is normally a clear indication. Patients report that the knee feels unstable and it gives way on them. Often patients also struggle to bend and straighten their knees fully.

So how can physiotherapy help?

If you have injured your ACL or PCL, then surgery to reconstruct the ligament is very common. Prior to the operation physiotherapy will help to improve pain levels, range of movement and strengthen the muscles in the leg, making post-operative rehabilitation easier and more successful.

Likewise after the operation, physiotherapy is required to improved function and strength. The rehabilitation process normally takes 6-9 months, before full contact sport can be again undertaken.