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TODAY’S focus is on knee injuries. Injuries to the knee are among the most common problems seen in football. It is important to make an accurate diagnosis as the treatment of knee injuries can vary widely.

Types of knee injuries

Ligament injuries to the anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament and lateral collateral ligament. Meniscus injuries to the medial and lateral meniscus.

Articular cartilage injuries to the tibia, femur and patella.

Fractures of the tibia, femur and patella.

Mechanism of knee injuries

Most knee injuries in football are caused by either body contact or direct impact, transferring extrinsic forces to the player, or by intrinsic forces without contact, generated by the player himself when running, accelerating, decelerating, cutting, twisting and turning. The two most common causes occur during tackling; in the first one, the impact hits the lateral side of the knee, forcing the knee into valgus and the tibia into external rotation, causing a sequence of injuries with progressive severity. The same mechanism of sudden enforced valgus is found, for example, when two players hit the ball at the same time with the inside of their foot. The second important cause in tackling is an impact hitting the medial side of the knee, forcing the knee into varus and the tibia into internal rotation.

Risk factors

Joint laxity, muscle weakness and fatigue, inadequate rehabilitation after previous injury, poor fitness and foul play with tackle on the lateral or medial side of the knee. In female players, inadequate landing after jumping may cause injuries of the anterior cruciate ligament.

On-field management

The aim of on field assessment is to determine whether there is a significant injury to the knee either skeletal, ligamentous or to the soft tissues. In order to evaluate whether a serious injury has occurred, one needs to find out exactly what has happened. Was there body contact or not? What was the character of the forces involved? What was the direction of these forces and at what speed did the impact take place? Was there deceleration or acceleration at the moment of injury? Was there a jump and landing followed by twisting of the knee? The answers to these questions will provide a preliminary appraisal of the seriousness and the location of the injury.

The next step is a quick examination of the knee. Is there pain felt along the bones, ligaments or other soft tissues? Does moving the knee elicit pain and, if so, where? Is the player able to contract the quadriceps muscle? Is the Lachman test negative or positive? Is there medial or lateral tenderness over the collateral ligaments? Is there a swelling of the joint indicating internal bleeding? Once the initial assessment is complete, the team medic must take the following decisions:

1. Is this a significant knee injury requiring the player to be removed from the field of play?

2. Is a secondary evaluation required off the field? After secondary examination at the sideline or in the changing room, acute treatment should start as early as possible. Rest, ice, compression and elevation (RICE) will reduce swelling and pain. The RICE treatment should be continued for 24-48 hours. The nature of the further evaluation and treatment depends on the follow-up examination and assessment. More specific treatment is applied as soon as the definite diagnosis has been established.