How long will it take to heal a torn ligament?

How long will it take to heal a torn ligament?

Any twisting force on the joint causes stresses on ligaments surrounding that joint. If the twisting force exceeds the elastic limit of the ligament, it results in a ligament tear. A common example is ankle sprain which every one of us would have experienced at some point in our life.

I get to treat so many post-operative ACL tear (Anterior Cruciate Ligament) cases in our clinic to whom I teach ACL injury rehab protocol. They ask me so many questions related to a ligament injury, like what time it takes to heal? what is the degree of ligament tear and so on.

So in this article, we will discuss ligament injury in general, what its recovery time, its various classification?

How long will it take to heal a torn ligament?

To better answer this question and better understanding we must first try to understand the details of ligaments. So, what actaully is ligament and why ligament injury is so painful even if there’s no external visible injury.

What is a ligament?

The ligament is a fibrous band which connects the two adjacent bone so as to provide stability to the joint. They are flexible so as to allow normal movement in the joint but at the same time, they possess immense mechanical tensile strength so as to prevent unwanted movement and maintain the stability of the joint.

Every joint in our body has ligaments. This picture shows the ligament present on the inner side of ankle joint. In ankle sprain case it is the ligament which gets sprained.

Function of the ligament

1. Providing stability to the joint is its main function. They connect two adjacent bones of a joint and provide support from all the for direction.
2. The ligament has a rich nerve supply which makes it an important reflex organ.

To make it clearer let us try to understand it through an example. Ok, now close your eyes, tell someone to bend or straighten your one of the finger. Even though with closed eyes you can tell the position of the finger whether it is bent or straight. This helps to perform the complex coordinated activities needed for sport.

Types of ligament

To understand the science of ligament tear we must also learn the types of the ligament. Ligaments can be classified in two ways. First is according to their composition and second is according to their relation to joint.

A. According to their composition.

1. Most Ligaments consist of a protein substance called collagen. The organisation of collagen fibres gives the ligament its tensile strength.
2. Few ligaments are made up of elastin fibres. which make them more elastic and stretchable.

B. According to their relation to the joint.

1. Intrinsic ligaments: These are attached to the joint and lie in and around the joint.
2. Extrinsic ligaments: which are not attached to the joint and lie away from the joint.

Common causes of ligament tear

In medical term the ligament tear is also commonly termed as ligament sprain. According to the severity, the ligament sprain can be subdivided into two types.

1. Acute sprain

Recently young women of 24  years came to me with medial collateral ligament injury (sprain) at the right knee. while on holiday at Goa beach, she fell down with the impact on the knee but without any outside injury.

But after one day she found herself in pain over the inner knee (right knee). In this example, her knee subjected to valgus stress causing medial collateral ligament sprain.

By the above example I want to explain that: Violent force like twisting, wrenching, valgus stress or varus stress on joint may cause overstretching of the ligament.

2. Chronic sprain

The cause of chronic sprain of the ligament is repetitive stretching from a minor force which may be due to bad postural habit or poor gait.

A chronic lumbar sprain is the best example where bad posture leads to a chronic sprain of the interspinous ligament. So, how could we classify ligament sprain?

Classification of a Ligament sprain

According to the degree of damage to the fibres of ligament, it can be classified into 3 grades.

GRADE 1 SPRAIN

There is damage to a few collagen fibres, producing a local inflammatory response. This is characterised by pain over the affected ligament.

GRADE 2 SPRAIN

There is damage to a more extensive number of collagen fibres. This produces a more marked inflammatory response characterised by intense pain and joint effusion (swelling).

GRADE 3 SPRAIN

OR RUPTURE. There is a complete rupture of the ligament. Immediately after the rupture, there will be NO pain. Yes, there will be no pain but sometimes there will be pain but it will be due to spasms around the joint. This produces joint effusion and marked joint instability. Surgery may be necessary to restore joint stability.

How long does it take to heal ligament injury

The repair process of ligament tears is different from other soft tissues. The ligaments have fairly low vascularity (blood supply) which is why it takes much more time to heal. Muscle pain due to exercise heals within a week ( which happens due to micro-tear in muscle fibre).

But ligament sprain may take from month to year for a full recovery. The healing/recovery process of the ligament is the same as any other soft tissue, but it heals with the formation of fibrous tissue. The formation of fibrous tissue limits the elasticity of the ligament. It consists of the below-mentioned phases.

Inflammatory Phase: The inflammatory phase follows immediately after the injury. Depending on the severity it may last for 3-5 days. The internal bleeding and fluid from damaged cells together produce swelling within the joint. Joint swelling causes pain.

Repair Phase: After inflammation and swelling repair phase starts. It is mediated by blood clotting over the damaged tissue and lasts for 3-21 days after the injury. With blood clots, the fibroblast cells proliferate and begin to lay down collagen tissue.

Remodelling: Phase The remodelling phase follows the repair phase and can last for up to a year. It involves the maturation of collagen tissue and the realignment of collagen tissue. The haphazardly placed collagen tissue is weak, with the alignment of collagen tissue it gradually becomes stronger with much more tensile strength.  

Keep Reading: Ligament Injury of Knee? Follow These 7 Easy Exercises for Quick Healing

Sunit. S. Ekka

Dr Sunit Sanjay Ekka is a physiotherapist in practice for the last 15 years. He has done his BPT from one of the premium Central Government physiotherapy colleges, ie, SVNIRTAR. The patient is his best teacher and whatever he gets to learn he loves to share it on his Youtube channel and blog.