Knee ligament damage accounts for up to 40% of all knee injuries, occurring mainly in young athletic adults. Damage can be confined to a single ligament; however it can also involve multiple ligaments and even the menisci. The greater the number of structures involved, the more significant the functional impairment and the risk of neuromuscular damage.
A major factor at play in ligament injury is the loss of neuromuscular control, arising from the lack of input from the damaged ligament. The muscles are unable to work in coordination to stabilise the knee. The outcome is a feeling of instability and “giving way” where there is a sudden loss of control over the knee injury. Effective treatments attempt to relieve pain, redress the lack of stability and imbalance incurred by the injuries, as well as prevent degenerative damage occurring. AposTherapy offers pain relief and improved joint function by reducing and redistributing the loads away from the injured knee’s affected zones. The treatment strengthens and retrains neuromuscular control, allowing the muscles and nerves to work together in stabilizing the knee. AposTherapy enables all the knee structures to move together with optimal coordination for long-term healthy joints.
There are 4 ligaments within the knee joint that are affected by knee ligament damage: the anterior cruciate ligament (ACL), the posterior cruciate ligament (PCL), the medial collateral ligament (MCL) and the lateral collateral ligament (LCL).
ACL Injuries: Rupture of the ACL is one of the most common knee injuries and reconstructive surgeries. ACL tears mainly affect physically active young adults between the ages of 15-25. A tear of the ACL typically occurs through twisting or over-extension of the knee while the foot is planted firmly in the ground. Almost two-thirds of ACL injuries are accompanied by minor meniscal damage and half are accompanied by MCL damage. Many patients report a “pop” in their knee injury. Injuries are usually painful, but the intensity of pain varies significantly between patients. By and large ACL injuries are severe and patients often have trouble walking immediately after injury, with the most noticeable post-injury change is severe instability of the joint.
PCL Injuries: PCL injuries often occur after direct trauma to a flexed knee. They may also occur in conjunction with MCL or LCL injuries. In contrast to ACL injuries, patients often believe a PCL injury is minor and they continue to go about their normal activities.
MCL Injuries: MCL injuries are second to ACL injuries in frequency, accounting for 7.9% of all knee injuries. The MCL is typically injured in a blow to the outer side of the knee joint, or from any sudden force that bends the knee inwards. Lateral meniscal injuries as well as ACL tears often accompany MCL injuries. Patients typically report a tearing sensation followed by pain, swelling, stiffness and instability.
LCL Injuries: In contrast to MCL injuries where the blow is to the outer knee, LCL injuries are often caused by a blow to the inner side of the knee. An injury to this ligament alone is rare because such a force is usually protected by the opposite leg. 25% of all LCL injuries are associated with meniscal injuries and nerve damage. Patients complain of pain and swelling on their outer knee. As with ACL injuries, the level of pain varies greatly among patients.
Ligament injuries are either treated by surgical repair together with rehabilitation, or by rehabilitation therapies alone. Patients are usually referred for surgery if there is an extensive ligament tear, involvement of other ligaments, chronic knee instability, and/or a need for a strong knee for work or competitive sport activities. The ACL is by far the most frequently repaired ligament. However, latest evidence from the field has shown that patients with an ACL tear treated with immediate surgical reconstruction do not necessarily fair better than patients with delayed or no reconstruction. After ACL tears, PCL tears are the second most common type of injury to be referred for reconstruction. MCL and LCL are rarely repaired - these surgeries are mainly reserved for injuries with damage to multiple ligaments simultaneously.
Rehabilitation programmes carry huge therapeutic value for ligament injuries either alone, or pre/post surgery. They focus on regaining the full range of motion and muscle strengthening exercises. Closed kinetic chain exercises that have the foot planted firmly in the ground are used to strengthen the hamstring and quadriceps. These exercises are initially performed using body weight alone and additional weights are added thereafter.
Since instability is often one of the most critical issues in these types of injury, exercises that enhance balance, proprioception and coordination are also crucial in both surgically treated patients and conservatively treated patients.
AposTherapy is an effective, non-operative treatment option for ligament injuries that can also prove helpful in pre and post surgery rehabilitation. Therapy is carried out with the help of a biomechanical system, worn on patients' feet and personally calibrated to realign their joints and introduce controlled micro-instability. The exercises performed as part of AposTherapy improve neuromuscular control around the knee. Research has demonstrated that AposTherapy re-establishes neuromuscular control. AposTherapy can measurably reduce pain and improve the walking patterns, function and quality of life of patients following a ligament injury. These improvements fall directly within the goals of rehabilitation programmes for all ligament injuries.
AposTherapy combines in a single treatment approach for knee ligament damage. With many different essential therapies and exercises, such as improving range of motion, restoring neuromuscular control, proprioceptive and balance. AposTherapy is very convenient and easy for patients to use and can be carried out as part of routine daily activity. Perhaps, most importantly, patients with ACL, PCL, MCL and LCL injuries who use AposTherapy show excellent results, achieved within a very short period of time.