SPORTS KNEE INJURIES

SPORTS KNEE INJURIES 

DR. JORDI JIMÉNEZ

Collateral ligament injuries of the knee

Internal collateral ligament sprain: This is one of the most common injuries suffered by athletes. It is classified into three stages, from least to most severe. Treatment is usually conservative, involving immobilization of the knee and subsequent functional recovery through rehabilitation, with the exception of stage III when it is associated with injury to other stabilizing structures of the knee.
Lateral collateral ligament sprain: The incidence of this injury is lower than the previous one. Complete rupture can be associated with injury to one or both cruciate ligaments. Grade I and II sprains are treated conservatively with immobilization and subsequent functional recovery with rehabilitation. Complete rupture (grade III sprain) is treated surgically with subsequent rehabilitation.

Cruciate ligament injuries

The function of the anterior cruciate ligament (ACL) is to prevent excessive anterior displacement of the tibia on the femur, and the function of the posterior cruciate ligament (PCL) is to prevent excessive posterior displacement of the tibia on the femur. They are primary stabilizers of the knee. The most common injury is to the ACL.

Symptoms:

Cracking sensation in the knee with pain following direct or indirect trauma.
It is usually accompanied by swelling of the knee due to bleeding.
Pain
Sensation of knee instability

Arthroscopic surgery is often the treatment of choice to prevent chronic joint instability that can lead to damage to other structures such as the meniscus and/or cartilage and ultimately the development of osteoarthritis. Subsequent rehabilitation is critical for the patient's proper progress and functional recovery.

An assessment by a specialist is essential to offer the patient the best therapeutic alternative.

Meniscus injuries

intra-articular fibrocartilages, roughly crescent-shaped, located between the femur and tibia. There are two in the knee: the medial and the lateral. Their functions are diverse: they increase joint congruence between the femur and tibia, regulate load transmission, stabilize the knee, and aid in joint proprioception. Injury to the menisci may be accompanied by a popping sound if it occurs acutely, pain with external or internal movement, which worsens with extreme flexion or full extension. Numbness in the knee, locking, clicking, and effusion may occur.

We now know of a direct relationship between meniscus removal (meniscectomy) and the development of osteoarthritis. This condition worsens if it is also accompanied by ligament instability. Precisely for this reason, the current treatment goal is to preserve as much of the meniscus as possible or repair it, all through arthroscopic surgery.

Bursitis

There are several synovial bursae in the knee that prevent friction between bones, tendons, muscles, or the skin. These bursae are: prepatellar , deep infrapatellar , superficial infrapatellar , and pes anserine. Symptoms may include swelling, tenderness and compression, and pain at rest. Sometimes, the pain can interfere with the patient's sleep.

Iliotibial Band Syndrome or Runner´s Knee

Inflammation of the musculoskeletal structures on the lateral side of the knee. It presents as pain that increases when running. Various factors can contribute to its onset, including training errors and anatomical or dynamic problems. It manifests as tenderness on palpation of the outer margin of the knee and thigh, swelling, and pain during running.

Osgood Schlatter´s Disease

Complete or partial separation of the anterior tibial epiphysis (anterior tibial tuberosity) where the patellar tendon inserts. This injury is caused by overuse due to traction of the tendon. It usually appears in adolescence and can occur in any sport , but is particularly common in soccer. Symptoms include pain at the patellar tendon insertion that increases with palpation, swelling, and may be accompanied by a bony protuberance at the tendon insertion.

Patellar tendinitis (jumper's knee)

Inflammation of the patellar tendon that connects the kneecap (patella) to the tibia. It usually occurs in athletes who perform repetitive jumps and can occur in any sport except swimming.

Symptoms include pain in the area, swelling, and pain in the lower part of the patella are very common. It typically worsens with physical activity.

Chondromalacia patellae

Degenerative injury to the articular cartilage of the patella. It can occur due to repeated microtrauma, isolated trauma, overload from certain repetitive exercises, or anatomical alterations in the axes and angles of the knee. It can occur in any sport and in patients who do not participate in any sport. A dull, deep ache in the anterior aspect of the patella, as well as beneath and on the sides of the kneecap. There may be a sensation of "grit" under the patella. The pain may appear after sitting for a while, with maximum knee flexion (squatting), going down stairs, and running downhill. As the injury progresses, the pain always occurs when running, regardless of the slope or terrain. It may hurt even at rest.

Osteochondritis Dissecans

A disease in which a segment of cartilage and its corresponding subchondral bone become partially or completely separated from the surface. It can be bilateral and is more common in young men. It may be due to a fracture in the cartilage and the bone beneath it. The most common site of onset is the internal femoral condyle. The patient reports diffuse pain, edema, and in some cases, knee blockage if the fragment has become detached. The most important aspect of treatment is to confirm whether the osteochondral lesion is stable, which can be done in almost all cases using magnetic resonance imaging. If the injured fragment becomes detached (articular mouse), it will need to be removed by arthroscopic or open surgery. Stable lesions in children may heal spontaneously. In adults, if the lesion is unstable but still located in its bed, the most appropriate approach is to fix it. If the fragment is large and must be removed, a possible solution may be to curettage the bed. However, if the lesion is located in a weight-bearing area, it may be necessary to implant an osteochondral graft or perform a chondrocyte culture.

Patella dislocation

Patella dislocation is the dislocation of the kneecap from its normal anatomical position. This condition may resolve spontaneously by returning the patella to its normal position, or it may remain dislocated, requiring the help of a specialist for reduction. It can occur with sudden twisting of the knee, direct or indirect trauma, and can occur in combat, contact, or sliding sports. Symptoms include acute pain, functional impairment, and locking of the knee, as well as joint effusion. It is initially treated by reducing the patella and subsequent immobilization. After a few weeks of rest and immobilization, functional recovery of the limb will begin. If the injury recurs, surgical treatment will be indicated.

Make an appointment with Dr. Jordi Jiménez. He'll see you in the center of Palma and help you regain your quality of life.