Sports medicine - Back in the game

Over the past decade, participation in sports has increased considerably in the Middle East. Concomitant with this, there has been an increase in
sports-related injuries, particularly to the lower limbs. Specifically ligamentous injuries to the knee resulting from football, basketball, tennis, cricket and squash. Dr George John, Sports Medicine Surgeon at Welcare Hospital, Dubai, looks at the causes, diagnoses and treatment of knee

Participation in sportsrelated activities increases the risk for acute injury to soft tissues. The subsequent inflammatory response to tissue damage results in pain and swelling, which limits mobility.

Initial management is based on the principles of basic first aid: rest, ice, compression, and elevation. The basic response to injury
at the tissue level is well known and consists of acute inflammatory phase, proliferative phase, and maturation and remodelling phase.

Knowing these phases, the treatment of athletes’ acute musculoskeletal injuries should use a short period of immobilisation followed by controlled and progressive mobilisation. Both experimental and clinical trials have given systematic and convincing evidence that this programme is superior to immobilisation.

Knee ligament injuries often result in a premature end to a career in sports. Moreover, the knee is more likely to be injured than any other joint in the body. We tend to ignore our knees until something happens to them that cause pain. As the saying goes, however, “an ounce of prevention is worth a pound of cure”.

The knee-joint (Articulatio genu) was formerly described as a ginglymus or hinge-joint, but is really of a much more complicated character. The knee is the largest joint in our body. It is a complex, hinge-like joint that is subject to constant pounding, bending, twisting from everyday activities especially in sports injuries, as well as the impact of falls and the effects of arthritis. A biennial census of sports orthopaedic surgeons disclosed that the knee is the most often treated anatomical site.

Anatomy and biomechanics

The knee consists of three articulations in one: two condyloid joints, one between each condyle of the femur and the corresponding meniscus and condyle of the tibia; and a third between the patella and the femur, partly arthrodial, but not completely so, since the articular surfaces are not mutually adapted to each other, so that the movement is not a simple gliding one.

The bones are connected by the following ligaments: Knee ligaments serve primarily as passive restraints to knee motion.

The anterior cruciate ligament (ACL) is the major stabilising ligament of the knee. The ACL is located in the centre of the knee joint and runs from the femur (thigh bone) to the tibia (shin bone), through the centre of the knee. In this position, it functions to prevent a buckling type of instability of the knee.

The biomechanical function of the ACL is complex for it provides both mechanical stability and proprioceptive feedback to the knee. The load to failure of ACL is about 1700 Newtons, with mechanoceptors with a proprioceptive role.

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