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Football is one of the most traumatic sports. Injuries of professional football players as well as amateurs vary from simple bruises to severe head injuries. However, the knees suffer the most. The injuries of the knees may be acute or caused by overuse. An acute injury is a trauma that occurs at the moment of the incident (for example, fall) while the overuse injury is caused by repeated microtrauma and develops gradually over the period of time. The most often acute traumas of the knee include ligaments tears and menisci injuries.
This injury is one of the most common among football players. Also, it is one of the most severe. The ACL is strong fibrous band of tissue. It connects the front of the tibia (shin bone) with the back of the femur (thigh bone) (Fig. 1). This ligament provides stability of the knee joint by preventing the tibia from moving forward. The ACL is mostly injured by tearing. It usually occurs when a football player runs and quickly changes the direction. The majority of people who have experienced the ACL tear recall a ‘pop‘ sound at the time of the injury. The symptoms caused by the ACL tear are intensive pain, swelling and tremble of the knee.
Fig. 1. Anatomy of the right knee joint: bones and ligaments. Drake et al: Gray‘s Anatomy for Students.
The PCL is attached to the back part of the tibia and goes obliquely till the front of the femur (Fig. 1). This ligament provides stability of the knee joint by preventing the tibia from moving backwards. Injuries of the PCL are quite often left undiagnosed. The PCL tear occurs when direct strike affects the shin while the knee is bent. This type of injury is also known as a dashboard injury because it occurs when the knee strikes a dashboard in car accidents. The symptoms of the PCL tear are similar to the ACL injury.
The MCL ligament is located in the inner side of the knee joint and connects the inner side of tibia with the inner side of femur (Fig. 1). This ligament stabilizes hinge-like motion of the knee. The most common injury of the MCL is sprain. It usually occurs when somebody strikes directly into the outer side of the knee while the foot is planted. Valgus force causes overextension of the MCL. Symptoms are similar to the ACL injury but the pain is more intensive in the inner side of the knee.
Meniscus is a C-shaped cartilage attached to the joint surface at the upper end of the tibia. There are two menisci in each knee joint – one on the inner side (medial meniscus) and the other on the outer side (lateral meniscus) of the joint (Fig. 1). Menisci serve as a gasket between the bone surfaces and mitigate friction during movements of the knee. Also they buffer the energy of movement in this way preventing articular structures from wearing down. Meniscus tear occurs when the knee is bent and at the same time twisted. Symptoms depend on the severity of the torn. They vary from slight pain and swelling to the locked knee. Locked knee is a condition when a person is not able to straighten or bend the knee.
This is a group of disorders involving tendonitis (the inflammation of tendons in the knee), bursitis (the inflammation of the sac filled with lubricating fluid that mitigates friction in the knee), anterior knee pain (patellofemoral syndrome), lateral knee pain (iliotibial band friction syndrome). These injuries manifest in pain of the knee. The pain develops slowly and is not related to trauma.
Since traumas and repetitive stress applied to the joints are the risk factors for osteoarthritis, football players are at very high risk to have this disorder. Osteoarthritis is a joint disease that results in wear and tear of articular cartilages and bone surfaces. The symptoms of knee osteoarthritis include intensive pain, swelling and warmth of the knee. Also the damaged knee becomes stiff and creak occurs when the joint moves. The osteoarthritis is considered to be a major reason for many professional football players to retire.
The first aid of acute injuries is R.I.C.E. This stands for rest, ice, compression and elevation. This will reduce the symptoms and will be enough if the injury is not severe. However, if pain and swelling last longer than 2 days or the knee is unsteady, loose or locked, it is necessary to see a doctor. Surgical procedures like ACL reconstruction or meniscus repair may be required.
Further, in the treatment of overuse injuries surgery is rarely indicated. Conservative treatment, involving rest, ice, pain killers (like aspirin or ibuprofen) and strengthening of the thigh muscles bring great results in most cases.
The treatment of osteoarthritis is more difficult. At first, conservative treatment is administered. However, sooner or later knee joint replacement surgery is often necessary.