Sports injuries of Knee joint

September 16, 2020
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Knee joint is one of the most commonly injured joint during sports. Knee joint is formed by three bones femur, tibia and patella. It has two cushions inside named meniscus or shock absorbers of the knee. The most important function of the meniscus is to protect the cartilage from early degeneration. Other important functions of meniscus are load distribution, stability etc.

 

Anatomy of Knee Joint:

Knee joint has four important ligaments to control the stability and mobility of it. Two inside ligaments which criss-cross each other are called as cruciate ligaments, anterior cruciate and posterior cruciate ligament. These two ligaments control the anterio- posterior stability and rotational stability of the knee joint. The other two outside ligaments are called as collateral ligaments, medial collateral and lateral collateral ligament. These two ligaments control varus and valgus stability of the knee joint. All these four ligaments along with the meniscus plays an important role in normal biomechanics and function of knee joint.

Another important aspect of knee joint is synchronized and proper mobility of patella in trochlear groove. This is possible because of normal trochlea and normal patellofemoral ligaments. Next important aspect for normal knee his overall limb alignment from centre of Hip to centre of mean to centre of ankle. Any deviation from this normal limb alignment will have varus or valgus knee.

Let us understand how anterior cruciate ligament works and its importance for normal knee joint function. Anterior cruciate ligament is made up of collagen fibres which arise from the tibia and inserts on the femur in a relatively horizontal and twisted manner. It is made up of two bundles anterio-medial and postero-lateral,Both these bundles becomes tight and relax from flexion to extension of knee. Most important function of anterior cruciate ligament is to Provide anterior posterior and rotational stability to the knee joint.

Anterior cruciate ligament(ACL) is one of the most commonly injured ligament. It is commonly injured during contact sports like football, volleyball, basketball & cricket etc. In India, other than sports the common reasons for ACL injury is two wheeler accident.

SIGNS & SYMPTOMS:

Most common complaint of the patient after having injured anterior cruciate ligament is instability or feeling of giving way of knee joint. Second most common complaint is pain, weakness, swelling and effusion of knee joint.
After sustaining injury knee with the above symptoms you need to consult your sports injury specialist. He will clinically do some test like Lachman test, Anterior Drawer test & Pivot shift test to confirm your ligament injury. He will advise you to undergo X-ray knee in a standing position and MRI to confirm your ligament injury and any associated problems. MRI is most sensitive and specific to diagnose you are anterior cruciate ligament injury.

MANAGEMENT :

Once you have been diagnosed with ACL ligament injury the treatment options depends on you are age, activity level, your profession, sports you in, duration of symptoms, and associated knee problems. Conservative treatment is advisable in patients having sedentary lifestyle, not involved in any sports, age usually above 55 years, no instability complaints. Conservative treatment involves extensive physiotherapy in which you need to strengthen your hamstrings muscles along with quadriceps and other muscles of hip and ankle joint. Under supervision of a sports physiotherapist you need to work on balancing, proprioception and neuromuscular training to have a stable knee.

Surgical management in form of arthroscopic ACL reconstruction is gold standard for patients younger than 55 years, Sportspersons, active young individual, patients with complaints of instability. Even younger patients with sedentary life but complaints of instability will need above mentioned surgery. To reconstruct ACL ligament we use hamstring tendon Or bone patella bone tendon autograft.Both this autograft Have excellent results in providing stability, mobility and function of knee joint.This autographed ligaments are usually fixed with a loop on femoral side and bio absorbable screw on tibial side.

After surgery you have to undergo a proper programmed rehabilitation process under a supervised sports physiotherapist. Immediately after surgery knee exercise like static quadriceps, ankle pumps, active SLR and heal slides up to 30° is started. Weight-bearing with help of Walker and knee brace is started next day as tolerated by the patient. Aim is to regain full knee function by the end of one month. Walker or crutches comes out at the end of two weeks once patient doesn’t have extension leg.Open chain exercises are started at the end of two weeks. Cycling, half squads, and strengthening exercises are started after 4 to 6 weeks.

POST OPERATIVE CARE:

You are allowed to drive car or two wheeler after one month.
Complete strengthening, proprioceptive and neuromuscular training takes 3 to 4 months after surgery.
You are allowed to run and play after six months provided you have followed the physiotherapy protocol properly.
This arthroscopic ACL reconstruction surgery gives you excellent results with full stability and mobility of your knee joint.

Dr.Mukesh Laddha,
Robotic Knee Replacement Surgeon,
Arthroscopy & Sports Injury Specialist.

Categories:Blog, Sports Injuries