The knee joint is one of the biggest and most complex joints in the human body. This is the joint exposed to the highest load, and is most oftenly traumatized.
This is because the knee movements are in several planes. The most common knee injury in young and middle-age occur during sports. Most often this is the football and all sports requiring sudden change of direction! Then come winter sports such as skiing and snowboarding, where the feet are fixed in boots.
What we recommend: Our experience shows that in approximately 80% of these injuries only the ACL is damaged. Here we should note that the operation should not be done without making the necessary research. Often there might occur the “mistake”(lets call it this way), the knee to be subjected to diagnostic arthroscopic surgery. This is not reasonable. Operating the knee without serious arguments is not a good medical practice! The only indication for surgery is: Fractures of the bones forming the joint. Complete rupture of the LCM or LCL. Even the torn meniscus is not an indication for urgent surgery because very often this trauma may disguise a damaged LCA.
The first thing injured people feel is a click in the knee, accompanied by dislocation, climb, release of the joint. Then comes the pain. The pain’s intensity is different but generally medium to severe. It is very rare injured people to report no severe pain.
A swelling of the joint follows. Different joints react differently according to the degree of damage. Usually when there’s a tear of the LCA, the knee fills up with blood and gets swollen minutes to several hours after the trauma. The swelling is formed above the kneecap. The knee is stiff, there is a tensions in it’s rear part .There may be a sense of instability.
What should we do?
After the injury as soon as possible put ice on the knee. Cold constricts blood vessels and decreases post traumatic swelling and hemorrhage. If the pain when stepping on the injured leg is severe the right thing to do is X-ray to exclude bone fracture. The patient should be consulted by a specialist, who must examine the stability of the joint in lateral directions. If the knee is very swollen and filled with blood the doctor must evacuate it. If the knee is stable in the lateral directions it is not necessary to immobilize it. Early start of active physiotherapy and rehabilitation is highly recommended. Intake of Nonsteroidal anti-inflammatory drugs and cryotherapy help the faster recovery after the injury. Usually after 5-6 days the swelling is reduced, the knee relieved and the gait normalized. When the swelling and pain decrease significantly patients can begin active exercises in order to recover the lost muscle strength and volume. After about two weeks examination and tests of stability of the joint must be repeated.
If the damage of the LCA is confirmed, (regardless of the state of the meniscus) and the patient is willing to lead an active lifestyle associated with sports, the operation is necessary. A reconstruction of LCA is made, followed by rehabilitation and physiotherapy.
If the patient does not want a reconstructive operation and has an isolated tear of LCA without damage to the meniscus, he must be advised how to spare the injured knee. It is recommended to avoid sports requiring sudden change of direction, such as football, volleyball, basketball, tennis, skiing, etc. In absence of complaints for about 4-6 months the injured knee may not be operated. Although the patients must be advised that in case of new injury and resumption of the symptoms they should consult a specialist.