30 January 2017
The knee is a complex pivotal hinge joint susceptible to a variety of athletic related injuries. In particular during winter sporting activities as skis or snowboards increase the lever arm effect around the knee, potentially resulting in high and complex energies. Wearing correct protective equipment and training can reduce these and many knee injuries can successfully be treated with conservative measures such as bracing and rehabilitation- but other complex injuries may require surgery.
Menisci are two wedge shaped pieces of shock absorbing cartilages (footballer’s cartilages) and can be torn during sports involving squatting and twisting. As we get older, the menisci can sustain degenerate tears. Clinical assessment and/or MRI can often pick up a meniscal tear. Small asymptomatic tears usually settle down, but larger unstable tears can give mechanical symptoms such as catching, locking or giving way of the knee. These tears can be tackled with a keyhole operation (arthroscopy).
Collateral ligament injuries
The collateral ligaments control sideways motion and brace it against unusual movement. Medial collateral ligament (MCL) is the most commonly injured knee ligament after a twisting injury or a blow from outside. Lateral collateral ligament injuries are less frequent. MCL injuries are usually diagnosed clinically by valgus stress testing and confirmed by an MRI scan. Isolated injuries usually can be managed non-operatively with a specialised knee brace, course of physiotherapy and rehabilitation. Surgical repair or reconstruction is restricted to higher grade injuries.
Anterior cruciate ligament (ACL) injuries
The ACL provides about 85% of the front to back stability of the knee and is commonly damaged during sporting activities involving pivoting e.g. football, netball and on slopes. ACL tears usually result from a twisting motion of a slightly bent knee when the foot is planted on the ground or fixed in a ski boot and is often associated with meniscal tears. The patient often feels a pop or click inside the knee which swells due to bleeding inside the joint.
Diagnosis is usually made clinically by history recall and examination to check the stability of the knee. A plain X-ray and MRI scan is often obtained to look for other injuries such as fractures or meniscal tears. The treatment plan varies depending on other concomitant injuries, how unstable the knee feels on a daily basis and the patient's sporting ambitions.
Posterior cruciate ligament (PCL) injuries and postero-lateral corner (PLC) injuries
PCL and PLC injuries usually result due to high energy trauma and can be injured in isolation or in combination with other ligaments. Low grade PCL injuries can be managed non-operatively with a specialised brace and physiotherapy. Surgical repair or reconstructive is preferred in high grade and in combined ligamentous injuries.
For appointments with Mr. Jalgaonkar, please contact 01252 895430.