Knee

Pain in the Coronary Ligaments of the Knee: How Regenerative Therapies Can Help?

By Last updated on April 5th, 2020 Last updated on April 5th, 2020 No Comments

The coronary ligaments of the knee are tiny, very fragile connective tissues which help create healthy interaction between all of the tissues which make up the knee.

By controlling the outward and inward movements of the knee, coronary ligaments help to ensure that the knee’s biomechanics are not awkward or damaging to its soft tissues.

Coronary ligament injuries can result in pain, reduction of range of motion, and instability in the knee. There are many treatment options available to a person suffering from coronary ligament issues and regenerative therapies can help to boost the results of all of these treatment options.

Anatomy of the Coronary Ligaments of the Knee

Ligaments are bands of fibrous tissue which connect joints and stabilize them in relation to one another. By connecting various tissues in the knee to the bone, the ligaments of the knee ensure that there is healthy interaction between the soft tissues, bones, and muscles during movement.

Awkward or irregular interaction can be due to damaged ligaments and can cause soft tissue, muscle, or bone damage which may lead to chronic pain if left unchecked.

When we talk about the coronary ligaments of the knee, we are referring to two small bands that connect the menisci to the edges of the tibial plateaus. The menisci are pieces of cartilage that cushion and protect the bone ends.

In the knee, the menisci are sandwiched between the upper (femur) and lower (tibia) leg bones. The coronary ligaments are found on the sides of either knee. The coronary ligaments which are on the inside of the knee (inner thigh) are referred to as the medial coronary ligaments.

Those which are found on the outside portion (outer thigh) of the knee are known as the lateral coronary ligaments. There are only two of each found in each knee.

Signs and Symptoms of Injury to the Coronary Ligaments of the Knee

Due to their relative location to each other, coronary ligament injury has very similar symptoms to issues associated with the menisci. It can be difficult for doctors to differentiate between the more common cartilage meniscus damage and thus, coronary ligament injury is often incorrectly diagnosed.

Some signs to watch out for are:

  • Tenderness along the outsides of the knee.
  • Sharp pain during flexion of the knee, especially twisting movements.
  • Discomfort at the end of the range of motion of the knee.
  • Minor stability issues while side-stepping.
  • Placing one leg over the other exacerbates the signs and symptoms above.

Coronary ligament pain is not only difficult to diagnose due to much more common problems with similar symptoms, but also due to lack of swelling and only minor pain at the onset of an issue.

Most knee issues typically induce a swelling reaction, create difficulty bearing a load, or decrease the range of motion of the knee. Coronary ligaments sit on the lateral and medial portion of the knee and are there to provide stability more than anything else.

Causes of Pain in the Coronary Ligaments of the Knee

Like many other knee injuries, coronary ligament pain typically comes from overexertion of the tissue. While coronary ligaments are protected by a deep nest of other tissues, they are especially susceptible to injury due to their small size and thus, reduced capacity to handle trauma. Some typical inciting events for chronic coronary ligament pain include:

  • Lateral and medial sprains of the knee (hyperextension of the knee towards the inside or outside of the body)
  • Trauma to the inside or outside of the knee
  • Damaged neighboring tissues

Though these events are typically the cause of coronary ligament injury, something as simple as sleeping on the knee awkwardly can be enough to upset its fragile biomechanics and add unnecessary strain to the coronary ligaments. Over time, these new biomechanics can exacerbate the coronary ligaments and reduce the quality of the tissue, inciting pain or any of the other signs and symptoms listed above.

Diagnosis of Injury to the Coronary Ligaments of the Knee

A typical consultation for a patient who is thought to have injured their coronary ligaments will begin with a physical examination. The doctor will begin their physical examination by palpating the areas around the knee. They will apply pressure to the sides of the knee in order to try to pinpoint the most tender areas.

Once the tenderest areas are located, the doctor will have their patient perform a series of stretches that target specific portions of the knee in order to further evaluate the cause of the issue. For coronary ligament pain, these stretches will try to flex the inner and outer portions of the knee. This is known as McMurray’s test.

McMurray’s Test

McMurray’s test is a simple way to check the tissues of the knee for any problems. The procedure involves a series of stretches meant to induce a state of flexion in various portions of the knee.

  • A patient will lay on their back with the legs outstretched.
  • The doctor will grab ahold of the foot, and upper portion of the knee while pushing the lower leg towards the upper body.
  • The doctor will rotate the lower leg using the knee as an origin point for the movements.
  • Finally, the doctor will pull on the foot as they lower the leg to be parallel with the rest of the body.

As the doctor performs these motions, they will ask their patients if they are experiencing any pain and will listen for pops and cracks in the knee. The doctor will look out for a reduced range of motion or tenderness in certain positions as well.

McMurray’s test can help a doctor further pinpoint the site of an injury, but in order to be completely sure that the issue stems from the coronary ligaments, they will have to use one of the various imaging technologies. X-rays, CAT scans, and MRIs are used to view the state of the bones, muscles, and soft tissues within the knee to identify the problem area. Once the doctor is satisfied with their diagnosis, they will typically move on to recommending one of several conventional treatment options.

Conventional Treatments for Injured Coronary Ligaments of the Knee

Doctors are trained to recommend only the most studied treatment options. Typically, they will stay within the boundaries that insurance providers have set forth. Conventional treatment options for pain caused by the coronary ligaments of the knee include:

  • RICE therapy
  • Physical Therapy
  • Medication
  • Surgery

RICE Therapy

RICE is a proven method for helping flare-ups of pain throughout the body. RICE stands for Rest, Ice, Compression, and Elevation. A patient is asked to rest the injured area.

They can either reduce the load placed on the area using one of several tools such as a knee brace, splint, or cane, or the patient will be asked to stop moving completely. Applying ice to the area desensitizes the nerves thereby reducing the pain and calming any inflammation which may be causing it.

Compression helps provide further stability to the affected area and elevation reduces the blood flow which may cause throbbing pain.

Physical Therapy

Physical therapy involves a guided course meant to help retrain the patient to move in ways that do not induce a pain response. Alongside this restructuring of a patient’s biomechanics, physical therapists will also try to strengthen the muscles which surround the affected area.

By strengthening these anterior muscles, the load which is placed on the coronary ligaments and the tissues they help to connect is reduced. By reducing the load that these ligaments have to bear, a patient can feel more comfortable performing their day to day activities.

Medication

Over-the-counter medications are typically the first line of defense against problems involving the knee. By reducing swelling, these medications can eliminate most of the inciting problems which cause pain.

This is not the case with coronary ligament issues. While over the counter medication may help some of the symptoms, coronary ligament pain is not typically caused by swelling, but by the movement in the knee.

Doctors can prescribe stronger medication meant to reduce the nerve response in their patients, but these medications come with dangers of their own.

Surgery

Most ligament problems do not require surgery, though if these ligaments are completely torn or stretched beyond repair, reconstructive knee surgery may be the only option. Along with being costly, surgery will often require long recovery periods and the use of medication and a physical therapy routine. Surgery is typically the last resort for any type of ligament injury.

While conventional treatments do have their place in the world of medicine, oftentimes, patients do not have the resources to cope with the long recovery periods and expensive medications being used.

Additionally, most of these treatments only help to treat the pain and do not treat the causal issues. When conventional treatment options do not seem the correct route, patients seek out alternative treatments such as Regenerative Therapy.

Regenerative Therapy and Coronary Ligaments of the Knee

By repairing the degenerated tissues in the knee, regenerative therapies not only treat the inciting pain but the cause of it as well. These types of treatments have been around for over a half a century and have been used the world over to treat soft tissue, muscle, and bone ailments.

By using the body’s own healing factors and amplifying them, regenerative therapies can help reconstruct almost any tissue in the human body. At Cellaxys, we apply to types of regenerative therapy – Platelet Rich Plasma (PRP) and Stem Cell therapy.

PRP Therapy

By harvesting blood, processing it, and reinjecting the processed blood into a site of injury, PRP helps incite the body’s natural healing systems to repair damaged tissues. First, blood is harvested from a patient.

It is processed in a centrifuge in order to separate out the platelets and other growth factors. Platelets in the blood are heavily involved in the healing of any tissue.

Once isolated and reinjected into the site of injury, platelets send out chemical signals which help the body locate an injury and repair it more than it naturally could.

Stem Cell Therapy

The same mechanics which are used in PRP are used in stem cell therapy. Tissues are extracted from the patient (either fat or bone marrow) then they are processed and reinjected into the site of an injury.

By processing the extracted tissues, doctors are able to extract cells known as mesenchymal stem cells. Mesenchymal stem cells are multipotent cells that can differentiate into any soft tissue in the body.

Not only do these cells provide the building blocks for the repairs, but they also create an environment suitable for repair once injected into the body.

This extra cushion acts as a buffer from further injury and allows the body’s healing mechanisms to work more quickly than if left alone. Results from stem cells typically last from 6 months to upwards of a year.

Both of these therapies are outpatient procedures with minimal recovery periods and side effects. Patients typically experience swelling and soreness after an injection through this goes away within a week. Once the swelling goes does, the therapies are believed to continue repairing and rejuvenating damaged tissues for upwards of 6 months. When used in unison, these therapies have been known to relieve pain for upwards of a year.

Conclusion

Pain caused by the coronary ligaments of the knee can be disabling. These ligaments are responsible for providing stability to the outward movements of the knee and help to hold its tissues in place.

Injury to the coronary ligaments can not only cause pain but can also reduce the stability of the knee and reduce an individual’s range of motion. While conventional treatment options are often the most recommended, the side effects and long recovery periods can be enough to dissuade an individual from going this route.

Alternative medicines such as Regenerative Therapy may be the only course of action in specific cases. Stem cell and PRP therapy hold promise for advancing the treatments for those experiencing coronary ligament pain.

Dr. Matthew HC Otten

Dr. Matthew HC Otten

Director of Orthopedic & Orthobiologics
Fellowship-trained & Board Certified in Sports medicine
Director Angiography at Harvard Clinical Research Institute
Michigan Stage University Alumni