The knee joint contains ligaments and menisci, which are structures that hold the bones of the knee joint (femur, tibia, fibula) in place, and enable the knee to withstand the tremendous forces that the joint is subjected to in our daily activities.
There are four primary ligaments in the knee:
Medial Collateral Ligament (MCL)
Lateral Collateral Ligament (LCL)
Anterior Cruciate Ligament (ACL)
Posterior Cruciate Ligament (PCL)
which provide multidirectional stability to the knee joint.
These ligaments are accompanied by the menisci (medial meniscus & lateral meniscus), which are two crescent-shaped cartilage-like structures that serve as “shock absorbers” between the femur and tibia, cushioning the knee joint during activities like running, walking, or jumping.
The most common cause of a ligament injury in the knee is trauma. In many cases, ligament and meniscus injuries occur together due to the forceful movement involved.
Common causes include:
Sudden pivoting movements during sports (e.g. football, rugby, basketball)
Falls or direct impact to the knee
Road traffic accidents
Age-related degeneration or pre-existing osteoarthritis
In older adults, even minor incidents can cause a meniscus tear if the cartilage is already worn down.
Symptoms vary depending on the severity of the injury but generally include:
Your doctor will:
Take a thorough clinical history (e.g. sport played, injury mechanism, timing of swelling or locking).
Conduct a physical examination to assess joint stability and pinpoint the affected ligament.
Order X-rays to rule out fractures.
Recommend MRI scans, which provide the clearest view of ligament tears, meniscus injuries, or associated cartilage damage.
Knee ligament and meniscus injuries can be managed through either non-surgical (conservative) or surgical approaches. The ideal course of action depends on several factors, including:
For professional sportspeople or those with an active lifestyle, surgical repair or reconstruction of the torn ligament may provide better outcomes and functionality than non-surgical options. For older patients who have more sedentary lifestyles, a course of intense physiotherapy may sometimes suffice.
Mild ligament sprains or partial meniscus tears may heal without surgery. In these cases, a PRICE protocol (Protection, Rest, Ice, Compression, Elevation), followed by early physiotherapy, is often sufficient.
Severe ligament injuries, complete tears, or unstable joints typically require surgical reconstruction to restore full function and prevent chronic instability.
If there are multiple concomitant injuries, such as combined ligament and/or meniscus injuries, surgery is often required to address the knee instability and/or locking symptoms to ensure optimal healing and recovery in the long run.
In many cases, especially for MCL and LCL injuries, non-surgical knee ligament injury treatment can be highly effective.
Non-surgical management typically involves:
Bracing the knee for approximately 6 weeks to stabilise the joint and prevent further injury while the ligament heals
Use of painkillers and non-steroidal anti-inflammatory drugs (NSAIDs) to relieve pain and reduce inflammation
A customised physiotherapy programme to restore joint strength, balance, and range of motion after immobilisation
This approach is particularly effective for MCL and LCL injuries, as these ligaments have a relatively good blood supply, allowing them to heal well without surgery.
However, for ACL and PCL injuries, non-surgical treatment is generally less successful. These central ligaments have a poor blood supply, making complete healing unlikely without surgical reconstruction — especially in patients with high functional demands.
When non-surgical methods are insufficient, especially in ACL and PCL injuries, your doctor may recommend surgery as the most effective treatment for ligament tear.
The most common surgical approach is “keyhole” surgery (arthroscopy).
During this procedure:
Two subcentimetre keyhole incisions are made on the knee
A small camera (arthroscope) is inserted through one incision to visualise the joint
Specialised surgical instruments are inserted through the second incision to repair or reconstruct the injured ligament
This method is a form of minimally invasive surgery (MIS), which offers several benefits:
Less post-operative pain
Faster recovery time
Smaller scars and improved cosmetic outcome
Lower risk of wound breakdown or infection compared to open surgery
In ACL or PCL injuries where the ligament is fully torn, reconstruction is performed using a tendon graft. This typically involves:
Harvesting strong tendons (usually the hamstring tendons) from just beside the knee
Using these tendons to replace the damaged ligament
Anchoring the graft to the original footprint of the ACL or PCL using arthroscopic techniques
Over time, the new tendon graft gradually integrates and transforms into a functional ligament, restoring knee stability and joint performance.
The meniscus is a cartilage-like structure made of collagen that acts as a cushion between the femur and tibia. Each knee has two menisci — the medial and lateral — which serve as shock absorbers and stabilisers during movement.
One of the challenges in treating meniscus injuries lies in its relatively poor blood supply, especially in the central region of the knee joint. This limited vascularity significantly affects the healing potential after a tear.
The likelihood of recovery depends on:
The size and location of the meniscus tear
The blood supply to the affected zone
How early treatment is initiated
Smaller meniscus injuries, especially those with minimal pain and no locking symptoms, are often suitable for conservative treatment. This typically includes:
Rest and activity modification
Painkillers and anti-inflammatory medications (NSAIDs)
Targeted physiotherapy to strengthen the muscles surrounding the knee and improve joint stability
However, there is a risk that the tear may worsen over time if left untreated or if the patient resumes high-impact sports too soon. Hence, regular monitoring is advised during recovery.
Larger meniscus tears or those that cause significant pain, instability, or locking (“jamming”) of the knee usually require surgical intervention.
The most common surgical procedure is arthroscopic “Keyhole” surgery (arthroscopy), which allows the surgeon to directly visualise and treat the damaged area through small incisions.
Whenever possible, the goal is meniscus preservation — repairing the torn edges using sutures to restore normal joint function and reduce the risk of developing early osteoarthritis in the knee in the future.
In cases of:
Extensive damage
Chronic, neglected tears
Irreparable fragments
the torn section may need to be partially removed. These patients may have a higher long-term risk of osteoarthritis, reinforcing the importance of early diagnosis and treatment.
While most non-surgical recoveries are smooth, potential issues include:
If you experience knee pain, instability, or locking after an injury, or suspect a ligament injury in your knee, do not delay medical attention.
Early diagnosis leads to better treatment outcomes, whether through physiotherapy, bracing, or surgery when needed.
Our friendly team is here to serve you. For urgent enquiries and appointment requests, please call or WhatsApp us directly.
