Ligament Injury (Sprains and Torn Ligaments)

What ligaments do

Ligaments are strong, slightly elastic bands of collagen that hold bones together at joints and guide movement. They contain nerve sensors that tell the brain where the joint is (proprioception). Ligaments have a limited blood supply, so they heal more slowly than muscle, and some, like the ACL inside the knee, heal poorly on their own.

Sprain vs strain

Grades of ligament injury

Common ligament injuries

• Ankle sprain: the most common ligament injury, usually the outer ligaments after rolling the foot inward.
• ACL injury: a pop during pivoting or landing, rapid swelling and a knee that gives way. Often occurs with meniscus tears.
• MCL injury: from a blow to the outside of the knee; inner knee pain; usually heals without surgery.
• PCL injury: from a blow to the front of the shin with the knee bent, such as hitting a dashboard.
• Wrist sprain: from a fall on an outstretched hand; scapholunate ligament tears can cause lasting instability.
• Thumb ulnar collateral ligament ("skier's thumb"): weakness pinching; complete tears often need surgery.
• Shoulder (AC joint) and elbow ligament injuries.

Symptoms

• pain at the joint, worse with movement or weight-bearing
• swelling, often within hours
• bruising
• a pop or tearing sensation at the time of injury
• reduced movement
• a joint that feels loose, wobbly or gives way

Diagnosis

A clinician examines the joint, comparing it with the uninjured side, and performs stress tests (for example, the Lachman test for the ACL or the anterior drawer test for the ankle).

• X-rays: to rule out fractures, using guidelines such as the Ottawa ankle and knee rules
• MRI: for suspected complete tears, knee injuries with instability, and injuries not improving
• Ultrasound: for some superficial ligaments, such as in the thumb and ankle

Treatment

First 48 to 72 hours

• Protect: use a brace, splint or crutches as needed
• Rest from activities that cause pain
• Ice for 15 to 20 minutes every 2 to 3 hours, with a cloth between ice and skin
• Compress with an elastic bandage
• Elevate the injured limb above heart level
• Pain relief: acetaminophen (paracetamol) or ibuprofen, following the label dose

Rehabilitation

• start gentle movement as soon as pain allows, usually within a few days
• progress to strengthening and balance exercises
• physical therapy for moderate and severe injuries, and for return to sport
• a brace or taping during sport for several months after significant sprains

Early, guided movement leads to better recovery than prolonged immobilization for most sprains.

Surgery

Surgery is considered for:

• ACL tears in active people or those with repeated instability
• complete thumb ulnar collateral ligament tears
• multiple ligament injuries of the knee
• chronic instability that persists despite rehabilitation

Complications

• chronic ankle instability and repeated sprains
• ongoing pain and stiffness
• post-traumatic arthritis, especially after ACL and meniscus injuries
• missed fractures or tendon injuries

Prevention

• warm up and include balance and strength training
• use neuromuscular training programs to reduce ACL injuries in sports
• wear appropriate footwear and braces after past injuries
• avoid exercising when very fatigued

Frequently asked questions

How do I know if my ligament is torn?

A torn ligament often causes a pop at the time of injury, rapid swelling, bruising, and a joint that feels loose or gives way. Partial tears cause pain and swelling with less instability. A clinical examination, sometimes with MRI, confirms it.

How long does a ligament injury take to heal?

Mild sprains usually heal in 1 to 3 weeks, moderate sprains in 3 to 6 weeks, and severe sprains in 6 to 12 weeks or longer. After ligament reconstruction surgery, such as for the ACL, return to sport typically takes 9 to 12 months.

Can a torn ligament heal on its own?

Many ligaments heal well without surgery, including most ankle and MCL injuries, even complete tears. Some, such as the ACL, rarely heal on their own because of their location and blood supply, and may need reconstruction if instability persists.

What is the difference between a sprain and a strain?

A sprain is an injury to a ligament, which connects bones at a joint. A strain is an injury to a muscle or tendon. Both cause pain and swelling, and both are treated initially with rest, ice, compression and elevation.

Should I walk on a sprained ankle?

For mild sprains, walking as pain allows usually helps recovery. If you cannot take 4 steps, have tenderness over the ankle bones, or the pain is severe, get an X-ray first. Use crutches or a brace if needed.