Anterior Cruciate Ligament
An anterior cruciate ligament injury is extreme stretching or tearing of the anterior
cruciate ligament (ACL) in the knee. An anterior cruciate ligament (ACL) unravels
like a braided rope when it's torn and does not heal on its own. This injury can be
divided into the partial or complete tearing of the ACL ligament.
ACL tears may be due to contact or non-contact injuries. A blow to the side of the
knee, such as may occur during a football tackle, may result in an ACL tear. Contrary
to popular belief, coming to a quick stop, combined with a direction change while
running, pivoting, landing from a jump, or overextending the knee joint, can also
cause injury to the ACL. One study showed that contact resulted in 93% of injuries in
a cohort of 226 patients while non-contact sport resulted in the remaining 7%.
For recreational athletes, the numbers were much more even. Basketball, football,
soccer and skiing are the most common sports in which there are ACL tears.
The ACL is widely known as the most important ligament in the knee. Therefore it is
often treated with a much more aggressive therapy, especially in competitive athletes.
In most cases, the ACL is treated by various surgeries.
For the reconstruction surgeries, portions of the Hamstring tendon autograft account
for most of the ACL surgeries performed in athletes, but the patellar tendon has been
adopted as the gold standard for ACL reconstruction therapies for competitive
In most of the sports analysed, ACL reconstruction surgery had a recovery time of
between 6 and 9 months. After this time, most athletes had returned close to their full
level of previous play. Sources showed between 80% and 100% of previous level. In
most sports, it was found that around 90% of these athletes returned to play in their
respective sports. After the first ACL injury, there is a risk of repeated injury. It is
estimated to be between 5 and 15%.
All in all, the tearing or sprain of the anterior cruciate ligament account for a large
portion of knee injuries in sports. The standard surgeries and therapies currently in
place provide good results and recovery time. A large proportion of athletes which
have undergone ACL surgery return to their respective sport at a level close to their
previous level of play.
One of the most commonly injured parts of the knee, the meniscus is a wedge-like piece of cartilage where the femur and tibia connect. Meniscal cartilage curves like the letter "C" at the inside and outside of each knee. A strong stabilizing tissue, the meniscus helps the knee joint carry weight, glide and turn in many directions. It also keeps your femur and tibia from grinding against each other.
In young athletes, most injuries to the meniscus are the result of trauma from high impact sports such as football, basketball, and soccer. In older athletes, many Meniscal tears can result from twisting the knee, squatting, or through repetitive activities like running, which stresses the knee joint. Often times in contact sports, a violent twisting of the knee, pivoting, tears the meniscus cutting or decelerating. In many instances, the meniscus is torn as well as the ACL and even another additional ligament.
The two common Meniscal tears in athletes are "bucket handle" tears or "parrot beak" tears. A bucket handle tear is a longitudinal tear that is created if the femur and tibia trap the meniscus when the knee turns. The parrot beak tear is a radial tear that forms
when the meniscus splits in two directions due to repetitive stress activities such as running.
In athletes, the best solution to a Meniscal tear is surgery. There is no known medicine or therapy that will heal or fix a torn meniscus. It is a mechanical problem that often requires a mechanical solution. This usually means either partial excision, a meniscectomy, or repair of the tear. Both procedures are performed by arthroscopy.
In repairing the meniscus, the surgeon simply sutures the torn region together. If the tear is a vertical tear at the peripheral rim of the meniscus, which is confined to the zone of Meniscal blood supply, it is possible to repair the meniscus. This technique could not be used to repair bucket handle or parrot beak tears, which are the most common in athletes.
I use Meniscal darts with an all inside repair in my practise with excellent results.
If the tear can't be repaired, the portion of cartilage around it must be excised and smoothed out. This process is referred to as a meniscectomy. For athletes, a meniscectomy is thought to be favourable because there is less of a chance of failure. In all, there is around a 20% failure rate of the meniscus healing in which case a second surgery would be performed. In addition to this, it's been found that an isolated Meniscal repair doesn't really show good results in athletes and does not prevent increasing osteoarthritic changes in athletes.
For a meniscectomy, the athlete may begin therapy to return to their respective sport right after the surgery. For Meniscal repair surgery, the athlete must wear a knee brace for 6-8 weeks after the surgery. After this time, they can begin their rehabilitation process and return to their respective sport as soon as possible. The time for rehabilitation for meniscus repair surgery is much longer than that for excision therapy.
The downside of the excision therapy is that in most cases, arthritis develops in the knee many years after surgery. Though this is usually not a problem for the athlete while they are competing, it is why the surgeon first attempts to repair the cartilage and then excises it.
The patellar tendon is a structure that attaches the quadriceps muscle group to the tibia. Patellar tendonitis, also known as jumper's knee, is the condition that arises when the patellar tendon and the tissues that surround it, become inflamed and irritated. This is usually due to overuse, especially from jumping activities. It is a common affliction of volleyball, basketball, soccer players, and runners. Rapid acceleration, deceleration, jumping, and landing concentrate a large amount of stress on the extensor mechanism of the knee.
Patellar tendonitis can be classified by the following techniques:
Stage 0 - No Pain
Stage 1 - Pain only after intense sports activity; no undue functional impairment
Stage 2 - Pain at the beginning and after sports activity; still able to perform at a satisfactory level
Stage 3 - Pain during sports activity; increasing difficulty in performing at a satisfactory level
Stage 4 - Pain during sports activity; unable to participate in sport at a satisfactory level
Stage 5 - Pain during daily activity; unable to participate in sport at any level
In mostly stages 1-4, this condition can be treated by a conservative approach. The therapy includes strengthening the muscles around the knee and continuation of non-contact aerobic exercise. The athlete is encouraged to continue exercising and working out despite the tendonitis. In addition to this, the knee should be frequently iced.
I now also offer PRP (stem cell injection ) therapy to my patients
In severe cases of tendonitis, approximately 10% of cases in athletes, surgery must be performed to alleviate the pain of tendonitis. Six weeks after the surgery in most cases, the athlete could begin their physical therapy to begin playing their respective sport again. Most cases for these surgeries are Stage 5, but many times, especially in professional athletes, surgery is requested because the patient doesn't want to deal with the non-operative therapies and the pain of tendonitis.
Medial and Lateral Collateral Ligaments
The medial collateral ligament (MCL) is a ligament extending from the upper-inside surface of the tibia to the bottom-inside surface of the femur. The MCL prevents knee injury by stabilizing the joint and preventing the knee from buckling inwards. The lateral collateral ligament (LCL) extends from the top-outside surface of the fibula (to the bottom-outside surface of the femur). The LCL is responsible for stabilizing the knee on the outside of the joint. The collateral ligaments, MCL and LCL are responsible for 25% of knee injuries in competitive athletes, though the LCL injury is much less frequent than MCL injuries in competitive athletes
In contact sports, the MCL can be damaged when an opponent applies a force to the outside aspect of the leg, just above the knee. Alternatively the medial ligament can be damaged if the studs get caught in turf and the player tries to turn to the side, away from the planted leg. (12) This stress on the inside of the knee joint is known as valgus stress. In some cases, a severe twisting motion of the knee can tear the MCL.
The LCL is usually injured by pressure placed on the knee-joint from the inside, resulting in stress on the outside of the joint. The stress on the outside of the joint is known as varus stress.
The tearing of the lateral and medial collateral ligaments can be classified in three categories
Grade I sprain: Ligament stretch, pain along ligament
Grade II sprain: Partial tear, mildly decreased stability
Grade III sprain: Complete tear, significantly abnormal stability
Tearing of either of the collateral ligaments in athletes can be met by several therapies. In Grade I and Grade II sprains, a conservative approach is usually taken. The knee is immobilized by a knee brace and iced and elevated for a period of 3-8 weeks. After this time, the athlete can usually begin playing their respective sport. The recovery time for the LCL can be from 2-6 weeks longer than that of the MCL. The long-term effects of the conservative approach led to similar results of surgery on the LCL for these kinds of sprains. The main advantage of this is that the athlete can return to their sport sooner than if they had had surgery.
In Grade III sprains, surgery is usually required for athletes. If the athlete were to not undergo the surgery, they would probably not be able to return to their previous level of play. The surgery for the collateral ligaments is comparable to the surgery for the PCL and ACL. Recovery time before the athlete can resume play has been shown to be between 3-9 months.
The fracture fixation is needed when loss of extensor function
There are various ways to do it I use fiber wire and fiber tape.
Often times, athletes, especially toward the end of their careers present with forms of arthritis. Sometimes, it is confused with a ligament injury. If the athlete has chronic pain as a result of arthritis, there are a couple therapies, which they can pursue.
First, and most commonly, they can undergo a conservative therapy known as RICE:
R - rest
I - ice
C - compression
E - elevation
This therapy is common in most sports for general soreness. For these athletes that have arthritis, it will ease the pain, swelling, and make it much easier to play on. Often times, they must take time away from their sport to allow it get a little better.
Sometimes plain steroid injection can be effective long term.
In the early stage micro fracture technique can be utilised with great advantage and can take up to 6-9 months to heal
For those athletes whose arthritis is too bad, often times a high tibial osteotomy will alleviate their pain. These patients often present with symptoms similar to ACL injury, the way to distinguish the two are that the arthritic athletes may have an altered gait, including decreased external knee flexion moments, high external adduction moments, increased external knee extension moments, and increased knee hyperextension during stance phase.
This procedure corrects the alignment of the knee of the patient, which relieves pressure on the arthritic part of the knee. This new alignment shifts the weight of the body onto a portion of the knee that has more cartilage. This procedure is great for young arthritic athletes because it can delay knee replacement for around ten yea