Knee joint (articulatio genus) is one of the most complex joints in the human body. It facilitates tilting movements (flexio), stretching (extension), and limited movement of the external and internal rotation (rotatio). It is composed of three bones with their joint surfaces: the thigh bone (femur), the shinbone (tibia) and the knee cap (patella). The articular surfaces of these three bones are covered by a solid connective membrane, the so-called articular capsule (capsula articularis) that provides firmness to the knee joint, and at the same time allows movements within the normal limits for this joint. The articular shell, on the outside, enhances the joints (ligament): the front, the patch (leaf patellae), the lateral, the outer (collateral fibulare), and the inner (leaf collateral tibial), and the back bonds that represent the tendon reinforcement of the surrounding muscles. Inside the articular cavity there are two strong crossed bonds, the front (leuces cruciatum anterius) and the latter (cruciatum posterius lei).

Anterior cruciate ligament injuries (ACL)

ACL- LCA (leucine cruciatum anterius) is the basis for the function of the quadriceps muscle. The injuries of this connection are the most frequent ligament injuries in the sport, and unfortunately one of the most difficult ones. The fact that this ligament maintains the stability of the knees by directly connecting two bones, without the support of the articular capsule, is in favor of the severity of rupture of the ACL.

How does the injury occur?

In as many as 80% of cases of rupture is the result of a non-contact injury. Common cases are that an athlete only falls into the middle of a match, although there is no one from the opposing players around him. The injury mechanism is usually the so-called valgus-external rotation when the foot remains fixed to the surface, and at the same time excessive rotation occurs in the knee joint. In rare cases, this ligament injury may be due to forced hiperextension of the knee. Rupture can be partial or complete, and unfortunately, it is very often associated with injuries of other ligaments (usually collateral tibials), capsules, cartilage, or meniscus. Injuries can be heard with an acoustic phenomenon “click” or “pop”, and athletes most often report that they feel “that something snapped in the knee,” they had a feeling “as when breaking stick” …

 

Setting diagnosis

ACL rupture is a clinical diagnosis. With physical examination can be seen intensive knee edema (haemarthrosis-joint hemorrhage). If the finger pressure in the area of the edema leaves a recess (the so-called testicular edema) and if the knee is “warm”, it can be assumed that there has been a rupture of some of the joints of the knee, which caused the outflow of blood into the joint itself. The positive Lachman test, the front drawer test and the pivot shift test are present in the injured athlete. With these tests, the knee joint instability is proven due to rupture of ACL. However, if the blood flow to the knee is too large and if the pains are intensely these tests cannot be performed in the acute phase of the injury. MRI (magnetic resonance) is one of the possible diagnostic methods, but the clinical examination still takes precedence in setting the final diagnosis. In many cases, the MRI showed one, and in “opening” the knee orthopedist sees something completely different. A definitive diagnosis is made by arthroscopy, a surgical intervention performed with local anesthesia, where a microscope is entered into the articulate cavity to clearly see which knee element is damaged.

 

 

Treatment and return to the pitch

In the acute phase of the injury, the RICE method (R-rest, I-ice, C-compression, E-elevation) is applied. Rupture ACL requires surgical treatment (reconstruction of ACL), followed by long and intensive rehabilitation (6-12 months). For every athlete with this injuries, rehabilitation represents “the most important and difficult preparation in the career”. Full return to the pitch is possible only after obtaining the full range of movement in the knee joint, as well as the return of the quadriceps muscle to the original state in terms of mass, strength and endurance. If it is known that persistent immobilization and pain after surgical intervention lead to “shortening” of all attachments and joints in the knee joint, and the inability to use the injured extremity to serious muscle atrophy, then it can be assumed how difficult it is to return to the pitch after such an injury.

Posterior cruciate ligament injuries (PCL)

The PCL comprised of a bundle of ligament fibers attaching the back of the tibia (shinbone) to the femur (thigh bone) in the knee. The injury of this ligament is significantly lower in relation to the ACL injury, and the treatment is dominantly non-operative.

How does the injury occur?

Rupture of PCL occurs either as a consequence of a direct impact in the proximal part of the tibia, or as a consequence of hyperextension of the knee.

Setting diagnosis

The diagnosis is also clinical. There is an edema (hemartros). Rear drawer test is positive. The additional diagnostic method is MRI.

Treatment and return to the pitch

In the acute phase of the injury, RICE is applied. Non-operative treatment is recommended, with intense strengthening of the quadriceps and achieving a full range of motion in the knee joint. Return to the pitch is possible after 3 to 12 weeks from the beginning of physical rehabilitation.

Medial cruciate ligament injuries (MCL)

How does the injury occur?

The ligament is sensitive to contact and non-contact injuries in the action of valgus with external rotation. Rupture can be partial and complete. Injuries may also be associated with damage to the medial meniscus.

Setting diagnosis

Diagnosis is made by physical examination. Typical pain is in the palpation of the ligament itself, in its proximal or distal attachment. There is also the edema of the knee. As additional diagnostic methods are the so-called valgus varus stress test, MRI and ultrasound are used.

Treatment and return to the field

In the isolated MCL injury, treatment is non-operative. RICE, immobilization and physical therapy are applied, with the strengthening of the quadriceps and the backbone muscles. Return to the pitch is possible after 6-12 weeks.