What Are Ligament Injuries?
Ligament injuries are among the most common sports-related injuries and range in severity from mild sprains to complete ruptures. Ligaments are fibrous structures that connect bones to one another, maintain joint stability and control the range of movement. When they are injured, joint stability is immediately compromised.
Ligament injuries are classified into three grades. A grade I injury involves minimal stretching of the fibres without instability. A grade II injury involves a partial tear, with noticeable loss of function and mild instability. A grade III injury is a complete rupture accompanied by marked instability and often requires surgical repair.
The ankle, knee—including the cruciate and collateral ligaments—and wrist are among the most affected joints.
Symptoms include:
- localised pain;
- swelling;
- bruising;
- a feeling of instability or of the joint “giving way”.
Characteristics of Ligaments
One of the most distinctive characteristics of ligaments is their limited vascular supply. Compared with muscles and bones, ligaments receive relatively little blood, which makes their natural healing process inherently slow.
This limited blood supply may be further reduced after an injury, as local swelling compresses the capillaries and further restricts blood flow to the affected tissue.
Even under favourable conditions, ligament healing produces tissue that is not identical to the original ligament. The newly formed collagen is less organised, less elastic and has lower mechanical strength.
This explains the high rate of recurrence, particularly after ankle and knee ligament injuries, and highlights the importance of high-quality rehabilitation rather than simply a rapid return to activity.
Without adequate rehabilitation, chronic ligament injuries may lead to persistent joint instability, secondary osteoarthritis and recurrent injuries that progressively compromise the joint.
Scientific Evidence
Scientific literature has highlighted the role of oxygenation in the quality of ligament healing. Studies involving ankle and knee ligament injuries have shown that hyperbaric oxygen therapy, when introduced soon after injury, may contribute to a faster reduction in swelling, improved vascularization of the ligament and the formation of more highly organized collagen during the remodeling phase.
The stimulation of growth factors, particularly TGF-β and IGF-1, by hyperbaric oxygen therapy appears to play an important role in improving the quality of newly formed ligament tissue, with a positive effect on its mechanical strength and elasticity.
The Role of Hyperbaric Oxygen Therapy
In ligament injuries, hyperbaric oxygen therapy may be used as an adjunctive intervention that directly addresses one of the main limitations of natural healing: inadequate blood supply and oxygenation of the injured ligament.
During the acute phase, within the first 48 to 72 hours, the principal aim is to reduce the haematoma and swelling. The increased amount of oxygen dissolved in the plasma helps maintain adequate oxygenation even in ischaemic areas surrounding the injured ligament, reducing the risk of secondary tissue injury and supporting progression through the inflammatory phase.
During the repair and remodelling phases, hyperbaric oxygen therapy stimulates fibroblasts to produce more highly organised and mechanically resilient type I collagen. The neovascularisation it promotes may also improve the ligament’s long-term blood supply and reduce the risk of recurrence.
Treatment is planned alongside a proprioceptive rehabilitation programme and, where clinically indicated, the use of a stabilizing brace.
A typical treatment course consists of 15 to 25 sessions.