How long do torn ligaments last?

The tear's clock and the pain's clock: a fortnight or for ever, and days, weeks or months by grade

How long do torn ligaments last is a question that readers ask in four different senses without noticing that they are different, and the honest page separates them because the four durations run from a fortnight to a lifetime and an answer given on the wrong clock is wrong by a factor of a thousand. The first is the tear's clock, the duration of the tear as a tear, meaning the gap between torn fibres, and it is the shortest clock and the most binary. A torn ligament whose ends are in contact or within a few millimetres of each other, which describes most sprains of the ankle's lateral ligaments, the knee's medial collateral and the fingers' side ligaments, is bridged within about two weeks: inflammatory cells clear the damaged fibres over the first days, fibroblasts multiply and lay down a scar of small, disorganised, type 3 rich collagen fibrils across the gap over the following week or so, and by day fourteen there is continuous tissue from one end to the other and the tear, as a tear, is over, which is what the day fourteen audit on the ligament in two weeks page finds done. A torn ligament whose ends are apart, the anterior cruciate retracted into the inside of the knee and washed by synovial fluid, the thumb's ulnar collateral folded back over the edge of a tendon sheet so that a layer of tissue separates its ends, the lateral collateral of the knee torn with the posterolateral corner, is never bridged, because scar does not cross a gap of a centimetre or a sheet of interposed tissue, and that tear lasts for ever unless a surgeon restores contact; the grade as a description rather than a verdict, with address deciding the fate of a grade three, is on the grade three page. So a torn ligament lasts a fortnight or for ever on the first clock, and nothing in between. The second is the pain's clock, the duration of symptoms, and it runs by grade. A grade one sprain, in which fibres are stretched and a few are torn with no laxity on examination, hurts for days: a swollen, tender joint for two or three days, pain on load for a few more, and a return to ordinary activity within a week or two. A grade two, a partial tear with some fibres gone and a little laxity on testing, hurts for weeks: swelling and bruising for a week, pain on load for two to four, a return to sport over four to eight. A grade three, a complete tear with clear laxity, hurts for months in the ligaments that heal without surgery and for the months after the operation in those that need it, with the sense of the joint being untrustworthy outlasting the pain. The order in which the symptoms leave is fixed across grades: swelling and tenderness go first, as the inflammatory phase ends; pain at rest goes next; pain on load goes as the scar strengthens enough to bear it; and last of all goes the sense of instability, the feeling that the joint might give way, which depends on the proprioceptive repair that balance training drives and which can outlast every other symptom by months if that training is not done. The pain's clock is the one readers use to decide they are healed, and it is the clock that stops first.

The scar's clock and the joint's clock: a year of maturation and decades of consequence, what modifies the long clock, and the adjunct

The third is the scar's clock, and it is the one the pain's clock hides, because the scar goes on changing for a year after the pain has gone. At two weeks the bridge across the gap is a weak tissue: small-diameter fibrils rich in type 3 collagen, poorly aligned, with a small fraction of the original ligament's failure load in the animal medial collateral studies that have measured it, so that a ligament whose tear is over on the first clock is a ligament that would re-tear under the load that tore it. By six weeks the scar has reached roughly a third to a half of normal strength, enough for walking, jogging and the early strength work, not enough for cutting, landing or contact, which is why the grade two return to sport sits at four to eight weeks and is gated by tests. Over the following months type 1 collagen slowly replaces type 3, the fibrils grow in diameter and align along the line of pull in response to the loads placed through them, cross-links form and the tissue stiffens and strengthens, and at a year the scar is still changing and has not reached the original ligament's properties, which in every study that has run long enough it never does: the healed ligament is permanently a different tissue, with smaller fibrils, more type 3, altered cross-linking, less stiffness in its substance and usually more length overall, so that it restrains the joint a little less than the original did and is the lax ligament that the balance training works around. Fully, in its three senses, is tested on the torn ligaments fully heal page, and on the scar's clock the honest word is that a torn ligament lasts for life as a scar, which is not the same as lasting as a problem. The fourth clock is the joint's, and it is the longest and the least discussed in a clinic that is dealing with this week's swelling. The consequences of a ligament tear for the joint it restrained last decades. Around half of people who tear an anterior cruciate ligament, or a meniscus, show osteoarthritis of the knee on X-ray ten to twenty years later, and the finding that surprises readers is that reconstruction does not remove the risk: the joint surface was injured at the moment of the tear, by the impact that tore the ligament and the bones striking each other as the knee gave way, and the loading of the joint changed afterward, through muscle weakness, altered movement and the ligament's altered restraint, so that the arthritis is a consequence of the injury and not only of the instability. Chronic ankle instability after repeated sprains raises the risk of ankle arthritis over the same decades through the repeated small injuries that each giving-way inflicts. What modifies the joint's clock is known and is the reader's to do: quadriceps strength after a knee ligament injury, since a strong quadriceps protects the joint surface and the weakness that follows injury is a driver of the arthritis; body weight, since each kilogram adds several across the knee with every step; continued activity, since the joint that keeps moving keeps its cartilage nourished and its muscles strong; and, for the ankle, the balance training that stops the giving way and with it the repeated injuries. Collagen's place is on the scar's clock, beside the loading that drives remodelling: the one ligament trial, 5g a day for six months in athletes with chronic ankle instability, improved a stability score and cut recurrent sprains, which is a result on the joint's clock in a small sample, and no collagen trial has measured a scar's strength or a joint's cartilage over years. The worked example is that adjunct at habit scale, stated on its true terms: two capsules, 1200mg hydrolysed type 1 marine collagen with 12mg vitamin C at 15% of its reference value plus zinc, 120 for £16.99 at 28p a day, lab tested and UK made, below the 5g trial dose, carrying vitamin C's collagen formation sentence for cartilage and bones and no ligament claim. How long do torn ligaments last: a fortnight as a tear if the ends touch, days to months as pain by grade, a year and then for life as a scar, and decades as a risk to the joint, which strength, weight and activity reduce.

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