Doc MacLean
Medical advances mean cruciates are no longer end game
TRAUMATIC injuries are part of everyday sport. Rule changes and the use of protective equipment can reduce the risk but the nature of the game is that serious injury is an accepted part of contact sport. Such injuries can keep a player out for a number of months, but with modern surgery and rehabilitation it is likely that the majority will return to play at their pre-injury level. One such serious injury is a cruciate ligament rupture.
So what do the cruciate ligaments do and why are they so important in top-level sport? The stability of the knee largely depends on its four ligaments – one on each side to prevent the bones moving sideways and the two cruciates (anterior – the more important – and posterior) crossing over inside the knee to prevent movement forwards and backwards.
The cruciates are particularly important to maintain the knee’s stability. In sport a cruciate ligament injury is most likely to occur with a twisting injury (commonly when the studs are caught in the pitch) or when a bent knee is forced in the opposite direction to its natural way of moving. Cruciate injuries may produce immediate pain – some players report hearing a “pop”. Internal bleeding produces swelling, which comes on rapidly. The knee feels like it is giving way beneath them. The diagnosis can be confirmed either by MRI scan or arthroscopy.
The decision on whether to undergo surgery will depend on your level of activity, age, job and how unstable the knee is when the swelling has gone down. However, all sports surgeons currently accept that the best result for active sportsmen and women follows surgical treatment.
The actual surgery is only the start of a rehabilitation process, which will take between six and nine months. It is a gradual process, best supervised by a sports physiotherapist. The initial priority is to reduce the swelling after the operation and begin gradual knee mobility exercises. The next phase involves normal walking and a gradual increase in the range of knee movement. As the knee becomes stronger swimming and gentle cycling are introduced. Finally the athlete can begin running and more sports specific work before finally returning to action.
Until relatively recently we have not been able to diagnose or treat cruciate injuries to the point where elite athletes can return to the highest level of competition – a good example of a medical advance coupled with skilled medical staff and most importantly a happy ending for the player.
■ Contact the Hampden Sports Clinic on 0141 616 6161 or hampdensportsclinic.com