Contents - Sports Injuries
- What makes the knee joint so susceptible to injury?
- Common injuries to the knee
- Knee injuries need expert assessment
- Rehabilitation for anterior cruciate ligament (ACL) injury
- Knee surgery for ACL
Contents - Sports Injuries
- What makes the knee joint so susceptible to injury?
- Common injuries to the knee
- Knee injuries need expert assessment
- Rehabilitation for anterior cruciate ligament (ACL) injury
- Knee surgery for ACL injury
- What does surgical reconstruction of the ACL involve?
- Benefits of ACL reconstruction
- ACL reconstruction in children
- Treatment options for a torn meniscus
- Repairing damaged tendons
Knee injuries are common in people who participate in sport at all levels. They cause pain, prevent training and lead to lowered fitness, sometimes requiring months of recovery. The impact on budding young professional athletes can be particularly severe. Prompt treatment, including rehabilitation and/or knee surgery, can prevent an early end to a career in sport and can lessen the risk of early degenerative knee disease.
The knee joint is the body’s largest joint and it is a complex junction point. Three bones, the femur (thigh bone), tibia (shin bone) and the patella make up the knee joint, together with several strong ligaments and tendons (click on image to enlarge). The joint allows a full range of movement and flexibility. The cartilage within the knee, the meniscus, and the articular cartilage provide an effective cushion, taking the impact of walking, running and jumping.
Being fit and active has many health benefits and is to be encouraged, but the downside is the extra potential for strain and wear and tear. Virtually all sports put pressure on the knee joint and the ligaments, tendons, menisci and articular cartilage within the joint can all sustain damage. This can happen in children and young adults who are active in sport, and it becomes even more likely as athletes get into their late 20s and beyond. Knee injuries sustained during sport can mean long breaks but may also lower the potential of a promising teenage athlete.
Athletes involved in sports that are considered 'high-risk' such as rugby, football, basketball and skiing, often injure the ligaments and cartilage in the knee:
- Anterior cruciate ligament (ACL) tears - these often happen when moving fast and changing direction suddenly, or landing after a jump. ACL tears in children are becoming more common and now account for up to 3% of all ACL injuries reported.
- Medial collateral ligament (MCL) injuries - common in contact sports and caused by impact to the side of the knee.
- Posterior cruciate ligament (PCL) injuries - occur due to impact to the front of the knee or through falling awkwardly.
- Torn meniscus - tears in the menisci occur due to twisting the knee, sudden movements, or impact.
It is unusual for a sports injury to be restricted to one ligament; knee injuries often involve the ACL, a meniscal tear, an MCL injury and even damage to the bone underlying the cartilage. Not all injuries need surgery; good results can be achieved with a well-designed rehabilitation and physiotherapy programme. Some combined injuries are still difficult to treat, with not enough evidence available on whether conservative treatment with rehabilitation is better or worse than knee surgery.
Expert assessment by a Consultant Surgeon specialising in knee injuries in sport is therefore essential. If surgery is necessary, it is better to use the most suitable technique and to operate sooner rather than later to prevent further joint damage.
Physical rehabilitation should include proprioception (balance) training and exercises that specifically strengthen the hamstrings. Intensive rehabilitation should continue for 6–12 weeks. After that time, if there is no improvement or if the knee joint is still functionally unstable, then surgery is the follow up option.
Various techniques are used to reconstruct the ACL by grafting tissue from a tendon obtained from the patient (autograft). The surgery is done arthroscopically – which involves a minimally invasive technique with small incisions, also known as keyhole surgery.
- Arthroscopic ligament reconstruction using a hamstring tendon graft: this is the currently recommended surgery for any ACL injury. Part of the hamstring tendon is used to reconstruct the anterior cruciate ligament. This method gives good results, has a relatively fast recovery and produces few problems with the hamstring tendon, which heals well.
- Arthroscopic ligament reconstruction using a patellar tendon graft: this surgery is often preferred for serious athletes but can cause later problems such as pain on kneeling, stiffness and even a fracture of the bone of the kneecap.
- Other grafting techniques: these include use of the quadriceps tendon from the same patient, or donated human grafts (allografts) of the tendons from various sites (hamstring, patella, and heel).
The ultimate aim of the surgery is to restore full function and stability to the knee joint. Irrespective 