Sports Related Knee Injuries
Sports related knee injuries are very common. They include frequently, medial meniscal tears, medial ligament strains and anterior cruciate ligament injury. Injury usually results from a twisting mechanism while running or falling sideways.
If the player momentarily engages with the ground and suddenly decelerates, pivoting at the same time, then falling, he/may sustain the “Unfortunate ( O’Donoghue) triad” injury. This is usually a combination of medial meniscal tear, medial ligament and anterior cruciate ligament injuries. There is frequently posterolateral bone bruising visible on MRI. The player may immediately or subsequently develop knee instability requiring anterior cruciate ligament reconstruction.
Diagnosis is based on history and clinical examination with supportive MRI. X-ray can be helpful occasionally showing a tiny tibial plateau ( Segond ) fracture. There are several diagnostic tests for instability. A Lachmann test is frequently positive in the early stages while an anterior drawer sign may be misleading and appear negative. The pivot test is usually best undertaken under anaesthesia. The anterior drawer sign will become progressively more positive over time. The more
positive the anterior drawer sign the greater the relative instability. Beware hyperelasticity as it can confuse.
Early treatment for knee injuries involves a combination of rest, ice, compression, and elevation RICE.
Physiotherapy and water-based rehabilitation is important. Knee arthroscopy may be indicated for a meniscal tear and permit examination under anaesthetic ( EUA). The patient may need to wear a protective brace for 6 weeks if there is a grade 1-2 medial ligament injury.
A grade 3 ligament injury will require surgical repair. This is a ligament injury creating clinical knee instability. It is diagnosed easily and early intervention is important.
When the player is rehabilitated and swelling has subsided, a decision will be made as to whether anterior cruciate ligament reconstruction is indicated. Anterior cruciate ligament reconstruction is usually not undertaken for at least 6 weeks to allow knee inflammation to settle. Premature surgery can lead to post-operative dystonia/stiffness referred to as arthrofibrosis.
Anterior cruciate ligament surgery involves harvesting bone patellar tendon bone graft or hamstring graft. The harvested ligament is inserted arthroscopically along the original line of the cruciate ligament and stabilised with screws etc. Staged rehabilitation will take up to 6-8 months before return to contact