Athletic Injuries

Injuries of the knee in athletes vary somewhat from injuries in other patients. This is due to several factors. The degree of conditioning and quality of the tissues in athletic knees are higher. The types of injury are more sports specific (for example, anterior cruciate ligament tears). Finally, the expectations of the athletes for post treatment functional outcome tend to be higher due to their sporting interests. Thus, surgical techniques have evolved in the last 10 to 20 years that have allowed for less invasive repair and reconstruction of knee injuries in the athlete to allow a high level of return to function with minimal invasiveness.

Ligament Sprains:

The term "sprain" refers to a partial or complete tear of ligament substance. Ligaments are made up of millions of fibers of "collagen", somewhat like a woven rope. When a ligament is sprained, a portion of the fibers is dredged or torn. In low-grade sprains, only a few fibers are torn, and patients have pain without much in the way of instability from the ligament being too loose. In high-grade or complete sprains, a large portion of the fibers is torn and the ligament ends may be fully separated from either other. In this setting, there will be pain as well as instability of the knee. Low-grade sprains are usually treated with activity modification, physical therapy, anti-inflammatory medications, and time. High-grade sprains (or tears) of ligaments may require a surgical treatment, such as an anterior cruciate ligament tear.

Muscle Strain:

Muscle strains are similar to ligament sprains, except that they occur in muscle tissue rather than in the collagenous ligament substance. This is what occurs, for example, when an athlete has a "hamstring pull". The same rating of muscle strains is used from low-grade strains in which a few of the muscle fibers are torn, and the athlete has pain without much weakness, to high-grade complete tears of the muscle when severe pain and weakness are present. As in ligaments sprains, the treatment is based upon the type of strain and the degree of injury.

Cartilage Tears:

There are two forms of cartilage in the knee. One is a surface, or "articular" cartilage, which is the white, glistening cartilage on the surface of the bone. This is very smooth and designed to glide
without any friction. The second type of cartilage is the "meniscus" cartilage. This is more of a "bumper cushion" cartilage, which sits between the thigh and shin bones, providing a shock-absorbing effect during athletics. When the knee is violently twisted or other injuries occur, the meniscus cartilage can be torn. If this is a small tear and does not have much in the way of symptoms, it can be treated without surgery. If it is a large tear, with a loose fragment that flips up into the joint and blocks or limits motion, surgery is indicated. The advance of arthroscopic surgery has made removal or repair of these tears much easier, and is associated with very little in the way of surgical trauma. Patients can recover quite quickly and be back to sports within a matter of days or weeks.

If injury occurs to the articular cartilage of the knee, treatment can be more problematic. There is no widely used, well proven way to regenerate surface cartilage of significant damage has occurred. However, treatment with activity modification, anti-inflammatory medications, occasionally cortisone injections, and a variety of developing arthroscopic surgical techniques is useful in the majority of patients.

Anterior Cruciate Ligament Injuries:

The anterior cruciate ligament is the main central stabilizer of the knee during sports. It prevents the shin bone from sliding forward on the femur bone, especially when the knee is out straight. This ligament can be torn during twisting or other types of loading maneuvers of the knee. Usually the athlete feels a pop, and has significant pain associated with moderate to severe swelling of the knee. This can occur in conjunction with other injuries, such as meniscal tears. Diagnosis of the tear is made either by physical examination by the physician, or by magnetic resonance imaging (MRI) scan.
If the ligament is completely disrupted, surgery to reconstruct the ligament is recommended in athletes who wish to return to cutting, pivoting, or jumping sports. This is because you know that athletes who lack this ligament and who are engaged in those types of sports will continue to have "giving out" of their knee, which can irreparably damage the cartilage surfaces and lead to early arthritis. The surgery is performed an athletes can usually return to play within 6 to 12 months following injury, depending upon their recovery course.

Posterior Cruciate Ligament Injuries:

The posterior cruciate ligament is another central stabilizer of the knee and prevents the shin bone from sliding backwards on the femur bone during sports. It is more important when the knee is flexed. Injury to this ligament is much more rare than to the anterior cruciate ligament.!105BO32.GIF (4620 bytes) In addition, the mechanics of the ligament are such that unless other ligaments are injured at the time of PCL tear, non-operative treatment is usually pursued. Most patients do very well if only the posterior cruciate ligament is torn without having surgery. However, in patients who have significant symptoms or other ligament damage, reconstruction is again performed similar to that for the anterior cruciate ligament.

Collateral Ligament Injuries:

The medial (inner side of the knee) and lateral (outer side of the knee) collateral ligaments are additional ligament structures that prevent the knee from going into a knock-kneed or bowlegged posture. Twisting injuries or being struck on the side of the knee can partially or completely tear these ligaments. Low-grade injuries are treated without surgery. High-grade injuries, especially if associated with other ligaments or cartilage damage, may require surgical treatment.

Kneecap Dislocations:

Kneecap Dislocations are a relatively common injury in the young athlete. The rate of dislocation is higher in women than men. First time dislocations are usually treated with initial immobilization followed by rehabilitation therapy. Recurrent (multiple) dislocations may require surgical treatment to repair the torn tissue that allows the kneecap to keep dislocating it.

Chondromalacia Patella:

This is a term chopic.GIF (4016 bytes)used to describe wear and tear of the smooth articular cartilage on the under surface of the kneecap. This occurs due to overuse or kneecap dislocations in athletes. Symptoms involve pain in the anterior knee with grinding or catching in the kneecap, especially with climbing of stairs or hills, or with jumping and running. Treatment is often challenging. Initially, non-operative treatment, including activity modification, oral anti-inflammatory medications, and physical therapy, is undertaken. For patients in whom this treatment does not work, occasionally surgery can be of benefit.

Osgood Schlatter's Syndrome:

This is a condition of young athletes, usually male, in which the insertion of the kneecap tendon into the shin bone becomes very sore and inflamed. Often a large bump develops in the bone as well ÃƒÂ¾ Treatment is usually aimed at reducing pain and modifying activity until the symptoms subside. Surgery is rarely needed.

Arthoscopy:

In General Arthroscopy is the art of performing surgery in joints with the use of a small fiberoptic telescope placed into the joint through small, quarter- inch incisions. Instruments are also passed through these incisions to allow the surgeon to work inside the knee and perform fine manipulation of structures in the knee.
The surgeon (and sometimes the patient) watch the procedure on a television screen. The use of arthroscopy has expanded significantly in the last 10 to 15 years. Currently, we are able to perform a wide variety of surgical procedures in both athletes and non-athletes through the "scope". The advantages of arthroscopic surgery include the small incisions, decreased postoperative pain, and, in some cases, a superior result of that obtained through a larger "open" incision.
Some procedures in the knee that are performed arthroscopically include:

Removal of cartilage tears
Removal of loose bodies in the knee
Diagnosis of obscure problems of the knee

Athletic Injuries

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