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In this Prolotherapy
article about the ligaments of the knee Prolotherapy doctor Ross Hauser, M.D.
discusses knee pain, torn knee ligaments, LCL, MCL, ACL injuries.
If you have a
question about this article,
Ask Dr. Hauser
ACL
These are the deepest
ligaments of the
knee. They are approximately two inches
long and primarily give the knee its anterior/posterior stability. There are in
the neighborhood of 200,000
ACL injuries each year. These are one of the best
publicized of knee injuries. There is actually a very good reason for this.
While cruciate
ligament tears are not the most common
knee injury, they very
commonly do not heal well. The blood supply is from within the
ligament itself,
not from around it, and therefore when the ligament is torn, the blood supply is
commonly disrupted during the injury. (Rowley, D. The Musculoskeletal System.
New York, NY: Chapman & Hall Medical, 1997, p. 246.)
The cruciate ligament is unique in that it is inside the joint yet outside the
synovial lining of the joint. This is possible because the capsule of the joint
makes a kind of tube around both the anterior and posterior cruciate. They are
not bathed in the joint fluid.
ACL & MCL Injuries
The anterior cruciate is frequently injured during sports such as football,
soccer, and basketball. The most common cause of isolated
ACL injury is a
deceleration, cutting movement. When an athlete is struck by another player from
behind and the outside, the ACL and
medial collateral ligament (MCL) may both be
injured. Injury is often accompanied by an audible "pop" usually with, and
occasionally without, pain. If this injury occurs while bearing weight on the
knee, the meniscus
is regularly affected as well
(see
A Retrospective Study Shows Prolotherapy is Effective in the Treatment of MRI-Documented Meniscal Tears). The length and weight of
downhill skis combined with failure of the bindings to release during a fall are
a common cause of this type of injury during skiing, despite improved equipment.
In one study, investigators looked at what happens if you do
physical therapy
and external bracing to treat a transected ACL. The results were dismal, even
one and a half years after injury there were a total of 32 percent who did
"good" or "excellent," with a staggering 54 percent who did poorly! Thirty-five
percent went ahead and had surgical reconstruction during the follow-up period.
(Clin Orthop. 1990; 259:192-199.)
ACL injuries need to be taken very seriously. On this point surgeons and
Prolotherapy doctors
agree. The only difference is how you repair it. If the ACL is
completely torn,
surgery
is needed. For everything else,
Prolotherapy should be
instituted.
Prolotherapy
can tighten up loose knees as long as the two ends of
the ligament are still attached.
Untreated, relaxed, or
torn ACLs have clearly been shown to lead to degeneration
of the meniscus and eventual degenerative
arthritis. Whereas treatment of the
ACL seems to save the meniscus and preserve the joint from
osteoarthritis. (Scott,
W. Dr. Scott's Knee Book. New York, NY: Fireside, 1996, p.75. Feretti, A.
Osteoarthritis of the knee after ACL reconstruction. Int Orthop. 1991;
15:367-371.)
PCL
The posterior cruciate ligament (PCL) is also about two inches long. It limits
backward motion of the tibia, the large bone just below the knee. It is uncommon
to injure the PCL during sports. More commonly, it is injured during a motor
vehicle accident when the knees hit the dashboard. A person who sustains a PCL
injury without other associated ligament disruption will probably remain symptom
free. (Torg, J. Natural history of the posterior cruciate ligament-deficient
knee. Clinical Orthopaedics. 1989; 246:208-216.)
If pain does occur,
Prolotherapy to the two attachments of the PCL inside the
knee is effective at tightening these ligaments.
MRI scans are quite inaccurate at
diagnosing cruciate ligament injury. They are
not as accurate as one would think in differentiating between a
complete tear
and a partial tear. (Scott, W. Dr. Scott's Knee Book. New York, NY: Fireside,
1996, p. 74.)
We have had plenty of occasions where the
MRI - (Knee
Research Study) showed extensive knee damage and
Prolotherapy completely relieved the pain. Obviously, the more extensive
injuries in and around the knee require more
Prolotherapy injections per visit,
and often an increased number of visits.
(Watch where do Prolotherapy
injections go and do they hurt?)
Of course, surgery is repeatedly recommended for torn cruciate ligaments. For
anything except complete rupture (grade 3 injury) of the anterior cruciate
ligament, avoid surgery if possible. The fact that there are so many ways to
perform the surgery is an indication that there is no one excellent method. The
repair of a transected cruciate ligament was successful in only two-thirds of
175 patients who were treated surgically, when followed up one to eight years
later. (Lysholm, J. Long-term results after early treatment of knee injuries.
Acta Orthop Scand. 1982; 53:109-118.) In our opinion, there is a better way and
that way is
Prolotherapy.
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