Sunday night… finals of the Euro Cup 2016! Fifteen minutes into the first half, an outstanding tackle by the French and Cristiano Ronaldo is down on the turf, tears in his eyes. Tears for two reasons: first, he had tremendous pain in his knee and second, he knew he was out of the match to fight for his country.
It is indeed devastating when sportspersons and sometimes common folk land up with such a severe knee injury. Twisting is probably the most common mechanism of injury to the knee joint. What essentially happens is that the foot stays firmly planted on the ground and the body, which is in motion, injures structures inside the knee joint because of the torque thus produced. Prevention of abnormal twisting is partly due to the presence of two disc like structures in the center of the knee- one on the inner and another on the outer side. These are called semi lunar cartilages or the menisci. The menisci act as shock absorbers between the thigh bone and the shin bone, provide nourishment as well as rotational stability to the knee joint. These menisci are probably the most important structures that allow us to bend and move our knee freely and cushion our bones from daily stresses like walking, jumping, playing etc. If we did not have the menisci, then surely the direct impact between the two joint surfaces would result in breaking down of the cartilage and resultant arthritis.
What happens when one of the cushions tear?
The rotational stability of the knee joint is disturbed and contact forces across the knee joint increase by about 15 fold than the normal. This would cause accelerated wear and tear of the smooth joint cartilage, resulting in arthritis. Hence, whenever such an injury is suspected, it is absolutely essential to seek immediate expert orthopaedic attention and get this issue sorted as soon as possible. Repair of these cartilage tissues is possible and helps prevent further degeneration of the knee joint.
How should we know that we have a torn meniscus?
If anyone were to sustain a twisting type of injury or to fall in an awkward rotational manner, followed by some swelling in the knee joint, not immediately, but say after a day or so, then you are likely to have sustained a tear in your meniscus or knee cartilage. Someone who has sustained a tear would usually experience symptoms like locking, catching, clicks in the knee joint. There would be pain which would be localised either to the inner or outer side of the knee depending on which meniscus is injured. The treatment generally consists of obtaining a good diagnosis by preferably a through clinical examination, X-rays and a high resolution MRI scan. The tear would then be graded depending upon the location, the length and the thickness of the tear. Larger and complete tear usually require a keyhole surgery with an arthroscope followed by repair of the meniscus tissue. It is important to have this repair done at an early stage since the meniscus does not have any blood supply. A delay in diagnosis and consequent delay in treatment would probably lead to a poorer outcome and may compromise the long term results.
What can I do to prevent these kind of injuries from happening?
If you are a sportsperson, the most important part is good training and a good technique of the sport, a good sport equipment and following the rules of the game. If you have good muscle strength, muscle co-ordination, proprioception and muscle conditioning, the chances of you having such injuries diminish rapidly. The muscles are able to co-ordinate themselves in case of an unfortunate fall and absorb the impact in a much better way. Technique is also important and most of the good coaches, in addition to teaching the skills of the sport would also teach how one should fall in case of a tackle and definitely how to play the sport with dignity and ethical values. Equipment such as shoes and the surface on which the sport is played cannot be over emphasised. Lacking proper foot wear and poor ground surfaces are definitely going to predispose to frequent injuries with resulting damage.
So for all my sports enthusiast brothers and sisters, make sure that you not only enjoy your sport but play it well and play it properly so that along with you, your body also enjoys the sport and enable you to perform better and longer.
Dr Sachin Tapasvi is one of India’s leading joint replacement surgeons. He practises in Pune and has been awarded several fellowships with experience garnered internationally as well as in India.
- Dr. Sachin Tapasvi, ‘A Stitch in Time Saves Nine’ - December 15, 2016
- Dr.Sachin Tapasvi: Belts & Buckles of the Ortho Kind - November 9, 2016
- Dr Sachin Tapasvi: Trigger-happy? Ouch! - October 26, 2016
