by Dr. Sanjay Patil
With more and more youngsters having athletic ambitions and being part of an era that has seen the gym bloom happen, knee injury cases have shown a steady rise in their rates. Knee injury in the young often result from sporting injuries wherein there is a sudden change in the vector of stress at the knee resulting in an unevenly loaded knee. Meaning, when a running person suddenly stops or changes direction, the osseo ligamentous structures may be loaded beyond its point of fatigue resulting in a ligament strain or even may be an avulsion fracture. Apart from sporting injuries these can happen in road traffic accidents. For example when a car suddenly comes to a halt and the front passenger impacts the dashboard with his/her knees. Overuse injuries in the young are relatively less common.
There are a myriad of conditions that occur in the knee. Ligamentous injuries are quite common amidst athletes playing contact sports. When one or more ligaments fail, the person would immediately notice a snapping like feel or a popping sound coming from the knee. This is followed by a hematoma collection in the joint. This manifests as swelling in the joint and is associated with a lot of pain. As the ligaments function to stabilise the joint, a dysfunctional ligament would result in instability or a "giving away" feeling. In the acute scenario, it is treated with simply bracing the joint and ice application, limb elevation, compression dressing and rest till pain and swelling decrease. Once the joint swelling decreases and it is less painful, few confirmatory clinical tests can be done to pinpoint which ligament is torn. Later a MRI scan would indicate the position and extent of injury.
Most common ligament tear is that of the (ACL)anterior cruciate ligament. The ACL ligament, functions to prevent anterior translation of the tibia on the femur and tears when a hyper extension, external rotation stress force hits the joint. Surgical repair of the ligament can be done arthroscopically. Those undergoing this surgery can go back to high demand sports once again after a 9 month rehabilitation period.
The two major bones of the lower limb meet in the knee joint and glide on each other over a fibro cartilaginous disc called the meniscus. This meniscus is the next most common structure to get damaged in high demand sporting activity. After an adequate period of rest if the patient is still symptomatic then arthroscopic repair of the meniscus if offered to the patient. If the patient isn't involved in high demand activity then a bracing and physiotherapy regimen may be enough.
Apart from ligament injuries, repetitive loading stress can result in inflammation of a tendon (the point where a muscle attaches to the bone). Over use of the quadriceps muscle may, lead to patella tendonitis. Also called as "jumpers knee" amidst athletes. This is seen commonly in basketball players, volley ball players. Treatment for this condition is mainly resting from the culprit activity. A course of analgesics helps tide the initial tenderness. Later with a good physiotherapy programme and with strapping/bracing the sporting activity can be continued.