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  • Knee, tibia and foot

    In sports, the knee is typically exposed to injuries. However, the simple act of falling may result in injuries in the form of damage to the tibia or ankle.

    Cruciate ligament rupture
    Meniscus damage
    Cartilage damage
    Patella displacement
    Tibial plateau fracture
    Ankle fracture
    Syndesmosis disruption
    Ligamentous injury

    Cruciate ligament Rupture

    The knee swells and pain arises as a result of the cruciate ligament rupture, which is brought out by either the rotary or the inclined throw, which gradually become more perceptible. There are two crosswise ligaments involved in the knee joint stabilization, where 95 % of all disruptions happen to the frontal ligament (ACL). Sport involving sharp and violent movements or stretching makes the cruciate ligament vulnerable to rupture. Examples of such possible scenarios in sports are: skiing, football, handball, volleyball, basketball, and martial arts.

    Symptoms Pain and swelling are typically accompanied by the destabilization of the knee joint in a cruciate ligament rupture. If a ligament is disrupted, there is a possibility that it will heal on its own too low.

    Diagnosis A cruciate ligament rupture is very easy to identify via simple external evidence. The tibial plateau can be moved forward and the knee automatically becomes unstable. A magnetic-resonance tomography would provide clear images of the cruciate ligament rupture. Any bone damage, such as a tibial plateau fracture or a ligament injury that caused a bones fissure (a splitting of the bone) can be revealed additionally by using X-rays.

    Treatment Is a surgical intervention necessary? This possibility is not an obligatory course of action. If everyday-life activities are not limited because of a knee joint instability, an operation is not necessary. However, athletes will most likely suffer some sort of limitation with this type of injury. In their case, having a knee joint instability could imply making the meniscus, gristles and collateral ligament more vulnerable to further injuries.

    First aid Once a cruciate ligament rupture is produced, the patient must lie down keeping the knee elevated above the rest of the body and applying a cold compress.

    Operation In special occasions a refixation of a  torn ACL is justified by a new fixation technique developed in our clinic. But most of the torn ACL must be replaced by a biologic or Polypropylene ACL replacement. Homologus (autologous) tissues can also be used, which could either be knee or hip tendons. However, the use of artificial ligament (LARS) is also possible. Each of these methods has advantages and disadvantages. When using an artificial ligament, there is no need to retrieve a tendon from the body, proving an important advantage of the former over the latter. On the other hand, an artificial ligament is a foreign tissue which can cause the organism to reject the implant. Additionally, because it is not a biological material it will also have a life time.

    Postoperative treatment If the implant is taken from the knee (1/3 of the patella tendon), the knee immediately be subject to the normal weight of a load (such as the body weight while standing). However, if the tissue is taken from the hamstrings, a recuperation period of 3 weeks would be needed. Additionally, a splint would have to be fixed on during some time and the weight applied directly onto the knee must be lessened with the help of crutches. Medical physiotherapy usually begins the day following the operation and lasts up to six weeks.

    Prophylaxis A well-trained muscular system of the legs helps to stabilize the knee during rotary throw. The right choice of equipment and careful weigh of a person’s abilities may help lower the risk of developing a cruciate ligament rupture. The risk of a ligament rupture increases without possessing a special carving technique.

     

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    Meniscus damage

    The most common damage of the knee joint takes place in and around the meniscus. Sickle-shaped gristle disks are the knee joint dampers. There are medial and lateral meniscuses in every knee. Meniscus damage occurs frequently in people who play football. This type of injury leads to fast and significant internal side wear of knee joint, which develops into typical bow leg formation or the so-called “soccer knee”.

    Symptoms It depends on the complexity of the damage, which can result in severe pain or fluid banding in the knee. Damaged meniscus may even block knee joint movement.

    First aid After trauma, the knee begins to swell. The patient must lie down, elevating the knee above the rest of the body and applying a cold compress.

    Diagnosis A doctor can identify meniscus damage with some manipulation. X-rays and a magnetic resonance imaging will provide further information on the extent of the injury.

    Treatment In the more severe cases, the knee joint used to be entirely replaced with knee prostheses. However, saving the meniscus is a priority today. The success in recovery depends largely on where exactly the meniscus is damaged. The blood supply is only in one third of meniscus, exactly at the point where meniscus joins. Sewing techniques are used successfully in this area. Usually, only one part is affected, which means that only that part of meniscus must be removed. After this type of procedure, the recovery period is considerably shorter than the interventions that suture on the meniscus, although in both cases the damaged part of meniscus is removed. 

    Operation In the majority of cases such an operation is held by the use of the endoscopic method of the knee joint treatment (athroscopy) with full or local anesthesia.

    New methods The use of collagen transplants of meniscuses (Stedman’s method) seems to be a promising alternative. About 1500 similar operations where held all over the world, in which 90% of regeneration was achieved. The most significant shortcoming of this method is the long postoperative treatment, which usually lasts up to 6 months. This is why for some professional athletes this method is not acceptable.

    Aftercare In the majority of cases, the knee can be exposed to weight shortly after the operation, and physiotherapy can be applied the day after this procedure. Special gymnastic exercises strengthen the muscular system and help speed-up the recovery period.

    Prophylaxis A well-trained muscular system of the hips helps decrease the possibility of knee injuries. The absence of exercise may increase the risk of injuries.

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    Cartilage damage

    Cartilage is the unique lubricating substance in joints which prevents friction on the ends of bones. Cartilage damage can be considered as acute (damage) or chronic (wear). Football, ski or cycle racing often leads to cartilage damage due to repeated impacts when falling. Such traumas are accompanied with cruciate ligament rupture or with meniscus damage.

    Symptom Permanent pain during climbing uphill or walking up steps can point to cartilage damage. In some cases, it can lead to knee joint block. 

    Diagnosis X-ray or magnetic-resonance tomography will help determine the scale of the cartilage damage.

    Treatment Modern medical intervention is necessary in order to avoid further progression of knee damage. Using endoscopy of joint (arthroscopy) milled pars of cartilage will be polished and joint “refined”. Without proper medical intervention cartilage damage can develop into arthrosis (see damage excessive loading).

    Prophylaxis Cartilage damage is often a sign of ligament rupture. Therefore every trauma must be treated. Amateur skiers should train the hip, abdomen and back muscular systems to avoid similar traumas (see p.66). Strong muscles provide stabilized knees and protect the cartilage during movement.

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    Patella dislocation

    The patella dislocation is a most painful trauma and is usually coupled with cartilage damage in both patella and hip. Because of the body’s anatomic features, women are more often exposed to patella displacement.

    Symptom Identification of this type of injury is quite easy, since the patella pops out of its normal position, which usually causes distress. Bandages, however, are not recommended!

    First aid It is necessary to apply a strong force in order to push the patella back into its normal position. If it can’t be done at once at the scene, it must be done in the hospital under a doctor’s supervision. At times, it is possible that the patella pops back in on its own, but regardless, a doctor’s observation is necessary. In this type of injury, a displacement of the capsule as well as cartilage damage may also result. 

    Diagnosis The use of X-rays can reveal patella displacement but only a magnetic-resonance tomography can help evaluate the extent of the cartilage damage.

    Treatment procedures If the patella displacement is a first time occurrence, it can be treated with conservative therapy in which the knee is fixed for 4 weeks. For cartilage functionality 30 degrees of flexion is allowed. Then, the muscular system recovers under the supervision of a physio therapist. 

    Operation The dislocation occurs more frequently in people who have concaved knees or obtuse-angled joints. In such cases, an operation is essential, via the invasive intervention of arthroscopy for fixing the knee. Here, the ligaments are cut on the external side of the patella, except for the ligament on the medial side is either sutured by purse-string suture or double. After intervention, the knee is immobilized with a splint for 4 weeks. Further medical physio-procedures are usually needed.

    Aftercare Regardless of whether treatment is conservative or surgical, further physiotherapy for strengthening the hip’s muscular system is very important.

    Prophylaxis Roller-skating, snowboarding and football are type of sport with have a higher risk of promoting patella displacement. Weak hip muscles increase the probability of developing this type of trauma whenever the person falls. The best prophylaxis for this type of trauma is the fortification of the hip’s system of muscles. 

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    Tibial head fracture

    A tibial head fracture is a serious knee joint injury. It can result from frequent falling (particularly when skiing, snowboarding or motor racing). This type of injury is frequently produced with water skiing, mainly because of harsh rotary and flexion throw traumas that easily developed, which lead to tibial head fracture.

    Symptoms
    Swelling of the knee and bruising. Depending on the extent and complexity of the damage, such as abrasions, the presence and strength of pain can vary.

    Diagnosis
    Fractures can easily be seen on X-rays. A 3D tomography can further aid in refining the diagnosis and in the reconstruction facet. For planning the treatment course of action, a magnetic-resonance tomography is necessary, except for those cases in which the great vessels are also injured.

    Complications
    A popliteal artery injury is a very serious complication in this type of fracture, which, unfortunately, always remains unnoticed. Because of this, a none invasive observation of the leg’s blood supply is essential.

    Medical procedures
    If the fracture is not displaced, or if it can be considered as a “micro-fracture”, a functional immobilization of the knee suffices. A splint is applied, making the knee joint move from 20º to 50º. The recovery period may be considerably shortened by applying magnetic-resonance therapy (MBST).

    Operation
    If the fracture shifted, a surgical reconstruction is possible. This more invasive type of intervention requires the use of the endoscopy method to carry out the bone reconstruction. Areas of tibial plateau imperfection may be filled in with implants which can be fastened by mounting them either with screws or with screws and plates.

    Aftercare
    In this type of serious fracture, weight bearing is strictly prohibited for a long period. Walking is allowed only with crutches. The damaged body part shouldn’t be exposed to heavy weight bearing during 6 weeks. Within the postoperative period, physiotherapy is very important. Lymph drainage promotes the separation of a congested lymph and brunched blood. During the rehabilitation period, isometric exercises focused on the muscles system fortification and coordination trainings are very important. For athletes, it is most important to avoid muscle atrophy. Any sports that involve bearing any type of weight, except for bicycling and physiotherapy exercises, are prohibited for 6 months.

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    Ankle fracture

    The most typical sport-related trauma is the ankle trauma. This type of injury is amongst the most painful around the ankle joint.

    Symptoms
    A fracture of the ankle joint results in terrible pain and rapid swelling.

    First aid
    While waiting for a doctor, the leg must be at rest. A cold compress can help ease pain and swelling.

    Diagnosis
    The use of X-ray can help recognize the fracture easily. The scale of damage can be determined with the use of magnetic-resonance tomography.

    Treatment
    Between a plaster and an operation, which would be the more suitable course of action? Athlete’s ankle fractures may always require an operation. But if the fracture is not displaced, a conservative treatment is enough. In this case, athletes loose time from their training, because of the duration of the recovery period (which can last long and may not result in full recovery). Additionally, there is a loss in muscle bulk during this time. If the injury is actually a many-fragmented fracture, it practically implies the end of any sport career. Naturally, with this type of damage, the joint’s cartilaginous tissue usually also suffers.

    Treatment
    After an operation, a “functional” postoperative treatment is possible which may allow the athlete to return to the sport very quickly. Screws and plates are used in the stabilization of the ankle joint fracture. Titanic material can be fixed in place by using steel screws. However, their extraction is essential.

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    Syndesmosis rupture

    This serious injury involves a rupture between the calf bone (fibula) and the tibia. Syndesmosis is the name of this joint, which prevents both bones from disconnecting during the movement and promotes more stability.

    Symptoms
    Swelling of the foot should be avoided at once since it may impair the task of identifying the injury. Additionally, terrible pain results during the rotary throw of the foot.

    Treatment
    An ankle fracture must be operated in any case to guarantee continual ankle stability, in which the ligament must be sutured and fixed with screws.
    The damaged leg shouldn’t bear any type of weight during 6 weeks.

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    Ligamentous injury

    Ligaments are responsible for the joint’s mobility and stability. A nonphysical movement may result in a fiber rupture. A ligament rupture of the lateral malleolus is the most occurring phenomenon. In football or so called “stop” and “go” games, like tennis and basketball, the ankle joint is subject to instability. In this case, the tendon muscle of the leg provides conventional stability only. The reoccurrence of such traumas increase the risk of cartilage damage.

    Symptoms
    The injury becomes perceivable as a simple tucking. Sudden pain accompanied by a distinct cracking sound is typical for a ligament injury. The lateral malleolus swells and turns blue.

    First aid
    Cold bandages and compresses help lower the ankle swelling. It is best to keep the leg elevated above the rest of the body. Ankle damages ascribe to complex categories so a doctor’s care is compulsory.

    Treatment
    Quite often, a ligament rupture of the lateral malleolus is taken for ligament laxity erroneously. Conservative treatment helps quite quickly; however, the consequences lead to full ankle joint instability. Athletes suffering from ankle joint instability may perform with a special plaster or splint. In small operative interventions, ligament suturing and possible reinforcement using the leg’s skin will help regain stability.

    Aftercare
    A removable splint should be used within a period of 4 to 6 weeks. The targets of physiotherapy are the coordination training and strengthening of the gastrocnemius muscle. It proves essential to wear a splint during three months after the trauma.
    In any joint-related injury, success of recovery largely depends on the immediate and individual medical care. One must always seek a doctor’s attention in such cases.

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