By Dr Tan Boon Cheong, MBBS (MU), MS Ortho (MU)
Irrespective of the participating level, namely recreation or professional. Injury is a constant treat. Of all the sports injuries in our body parts, sports injuries around the knee is one of the most commonly seen in orthorpeadic practice.
Sports injuries on the knee joint can involve the ligaments, meniscus, joint cartilage, bone or the muscles. But in this short article, we will discuss injuries we commonly come across namely ligaments injuries and meniscus injuries. The ligaments that usually injure are anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL) and lateral collateral ligament (LCL). (ACL and PCL are more commonly involve). We have 2 meniscus in our knee and they act as stress absorber.
Knee ligamental injury is one of the most common sport injuries. It usually happen in contact sports such as football and hockey, although other types of sports may also give rise to this injury when one fall with the knee in an arkward position. During this injury, the patient may experience the knee buckling or jumping out of space or may hear an audible “pop” sound. This patient may or may not be able to stand up or walk or he/she may need an assistant to carry him/her. The knee will swell within hours and the pain intensity will increase.
Meniscus injury are produced most commonly by rotation when the flexed knee move towards an extended position, thus it can happen during landing from a jumping position such as in badminton, basketball or volleyball game. The symptoms depends on the severity, the location and the type of the tear. It can be presented with pain, swelling and lock knee (bucket handle tear).
The initial management for knee injuries is RICE which is pneumonic for rest, ice compression and elevation. Immobilization of the affected knee may be necessary as part of pain management and also provide support to the knee. One should consult an orthopaedic surgeon for further evaluation on the extent of the injuries. A simple knee x-ray can be perform to look for any bony fracture or ligamental avulsion fracture but x-ray can not be used to visualize soft tissue such as ligaments, meniscus and cartilarge. Thus an MRI of the knee is needed as part of diagnosing ligamental and meniscus injuries. Once the diagnosis has been established, then a decision of conservative or surgical management can be made.
Irrespective of the mode of management, physiotherapist play a huge part in the management of sports injuries on the knee. During the acute phase of injury, physiotherapy helps to reduce pain and swelling. At the same time to maintain the range of motion and minimize muscle wasting and maintain muscle tone. After the acute phase, physiotherapy will help in rehabilitation of the affected knee to its pre-injury condition. For patient who undergo surgery, post surgery physiotherapy is a must for the knee to go back to its pre-injury functional or performance level.
Torn ligament can’t heal by itself neither it can be suture end to end. Thus, it needs to be reconstructed. Ligament reconstruction surgery in this modern day is done arthroscopically (key hole surgery) rather than open surgery except LCL which lie outside the joint capsule. Thus the recovery period is shorter. Arthroscopy reconstruction using hamstring tendon, allograft or patella tendon is commonly perform for ACL and PCL tear.
Not all meniscus tear need to undergo surgery and not all meniscus tear which undergo surgery can be repaired. Depending on the severity, location and type of tear. The management can be varied. Stable tear with minimal symptoms, physiotherapy will do a good job with the patient will be able to return to normal activities. Not all patient who undergo meniscus surgery can have their meniscus repair as some of the tear is irreparable thus the tear part which is not stable will be trimmed away (meniscectomy).
Having mentioned all the above, not all sports injuries will end up with ligaments or meniscus tear. Most of the time, the injuries are minor such as muscle sprain, bursitis, small tear on the muscle and etc which may be settled by good physiotherapy.