Combined Ligament and Tendon Injuries: MRI Findings and Non-Surgical Knee Care

Introduction

Combined ligament and tendon injuries involve more than one ligament or tendon in the knee, often resulting from high-energy trauma, sports accidents, or falls. These injuries can lead to instability, pain, and functional limitation.

MRI is essential for accurate diagnosis, showing which structures are affected, grading the injury, and identifying associated bone or cartilage changes.

Non-surgical management—including physiotherapy, HotHeal Therapy, and shockwave therapy—can restore function and reduce pain in selected cases, sometimes avoiding surgery.

Understanding Combined Injuries

  • Common ligament combinations: ACL + MCL, ACL + PCL, MCL + LCL
  • Common tendon involvement: quadriceps tendon, patellar tendon, or popliteus tendon

Symptoms vary depending on the structures involved:

  • Knee instability or “giving way”
  • Pain along the inner, outer, anterior, or posterior knee
  • Swelling or stiffness
  • Difficulty walking, squatting, or performing sports movements

Types of Combined Injury

1. Partial Multiligament/Tendon Tear

  • Some fibers of multiple structures are disrupted
  • Moderate instability and pain
  • MRI shows partial discontinuity and edema

2. Complete Multiligament/Tendon Tear

  • Full disruption of one or more ligaments/tendons
  • Significant instability, severe pain, and functional limitation
  • MRI shows discontinuity, abnormal orientation, and associated bone changes

Associated Findings:

  • Meniscus tears
  • Bone marrow edema
  • Cartilage or subchondral changes

MRI is critical for grading each injured structure and guiding therapy or surgical planning.

MRI Findings

Ligaments:

  • Partial tear: thickening or high T2 signal
  • Complete tear: discontinuity, abnormal orientation

Tendons:

  • Partial tear: focal fiber disruption or thickening
  • Complete tear: full discontinuity with retraction
  • Degenerative changes: irregular margins, increased signal

Other Findings:

  • Meniscus injury or strain
  • Bone bruising or microfractures
  • Cartilage damage in chronic cases

Non-Surgical Treatment Options

1. Physiotherapy (The Pain Relief Practice)

  • Strengthening of quadriceps, hamstrings, hip abductors, and core
  • Balance and proprioception exercises
  • Functional retraining for walking, running, and sports

Benefits:

  • Reduces instability and pain
  • Improves joint function
  • Supports safe return to daily activity and sports

2. HotHeal Therapy

  • Non-invasive radiofrequency combined with manual therapy
  • Reduces inflammation and promotes tissue healing
  • Supports ligament and tendon remodeling

3. Shockwave Therapy

  • Stimulates microcirculation and tissue regeneration
  • Reduces chronic pain and stiffness
  • Complements physiotherapy for stubborn or chronic injuries

4. Activity and Lifestyle Adjustments

  • Temporary avoidance of high-impact or twisting activities
  • Use of braces for moderate instability
  • Gradual return to sports or occupational activity

Case Scenarios

Case Scenario 1: ACL + MCL Partial Tears

A 28-year-old soccer player twists the knee during a tackle. MRI shows partial ACL tear and MCL sprain.

Treatment: Physiotherapy for knee stabilization, HotHeal Therapy for inflammation, and gradual return to activity. Full recovery in 10–12 weeks without surgery.

Case Scenario 2: PCL + Popliteus Tendon Partial Tear

A 35-year-old skier falls and hyperextends the knee. MRI reveals partial PCL tear and popliteus tendon strain.

Treatment: Physiotherapy focused on posterolateral stability, shockwave therapy for tendon healing, and activity modification. Recovery achieved in 8–10 weeks.

Case Scenario 3: Quadriceps Tendon + LCL Partial Tear

A 42-year-old patient slips while climbing stairs. MRI shows partial quadriceps tendon tear and LCL sprain.

Treatment: Physiotherapy for knee and quadriceps strengthening, HotHeal Therapy, and gradual return to daily activity. Symptoms improve over 10 weeks.

FAQs

Q1: Can combined ligament and tendon injuries heal without surgery?
Partial tears of multiple structures often respond well to physiotherapy and non-invasive therapies. Complete tears or severe instability may require surgery.

Q2: How long does non-surgical recovery take?
Recovery ranges from 6–12 weeks depending on the number of structures injured and adherence to therapy.

Q3: When is MRI recommended?
MRI is advised for persistent pain, swelling, or instability after trauma, and to evaluate complex knee injuries.

Q4: How can future injuries be prevented?
Strengthening, balance exercises, gradual return to activity, and protective strategies reduce risk of recurrence.

Key Takeaways

  • Combined ligament and tendon injuries can cause knee instability, pain, and functional limitation.
  • MRI is essential for accurate diagnosis, grading, and detection of associated injuries.
  • Non-surgical management—physiotherapy, HotHeal Therapy, shockwave therapy, and activity modification—can restore function in many partial injury cases.
  • Early intervention reduces pain, improves stability, and allows safe return to activity.

Timely care ensures patients can recover knee function, reduce pain, and maintain mobility while avoiding unnecessary surgery in suitable cases.

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