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Sports Medicine: Physiotherapy: Knee injuries

The Buckling Knee

Having a sense of ‘giving way’ or ‘locking’ of the knee is a fairly common complaint by athletes who have twisted their knees in sports like netball, soccer, badminton, etc.

The sensation of ‘giving way’ is an indication that you might have torn your Anterior Cruciate Ligament (ACL) while the ‘locking’ sensation is an indication of a possible meniscus tear.

Anterior Cruciate Ligament (ACL) Injury

The ACL is a fairly strong ligament found in between the knee and its main role is to limit the anterior translation of the leg bone (tibia) on the thigh bone (femur).

In sports where a quick change of direction is required, this twisting movement of the knee inwards increases the strain on the ACL and places the ligament at risk of tearing. A common complaint from athletes who tears their ACL is that they normally hear a ‘pop’ sound on injury.

ACL injury commonly occurs when the knee is force downwards and inwards. However, the ACL is very rarely the only ligament involved in this kind of injury.

An ACL tear is normally accompanied together with a slight tear in the Medial Collateral Ligament (MCL) and either a medial or lateral meniscus tear. This is commonly known as the Triad.

Meniscal Injury

The meniscus, which is a crescent shaped cartilage between the knee, acts as a cushion to absorb the impact between the tibia and femur. The mechanism of injury for the meniscus is normally a twisting and compressing action. This would cause a tear in the meniscus and the ‘locking’ would be caused by the torn part of the meniscus blocking the movement of the knee.

Immediate swelling and severe pain in the knee are common signs of this Triad injury. There could also be occasions where there is a delay in the onset of swelling or even no swelling at all. Thus, recalling how you injured the knee is key information required by your Doctor or Physiotherapist in diagnosing this problem.

Solving the Problem

The ACL is unable heal with rest due to the poor blood supply to the ligament. It needs to be reconstructed surgically by using either your hamstring tendon or patella tendon.

Rehabilitation post-surgery would take 6-9months before subjects are able to go back to full training. The good news is that there are about 20% of people with ACL tears who are able to go about their day-to-day activity without having their ACL reconstructed.

To be able to cope without surgery, the following muscles need to have good strength and control:

· Hamstrings

· Quadriceps

· Gluteus Medius

· Gastrocneumius

Besides doing strengthening exercises, slowly getting back into sports specific training is essential. This is so that your muscles can develop an anticipatory reaction (feedforward mechanism) to prevent injury.

Sports taping of the knee to support the ACL and MCL can also be done as a temporary measure for the athlete to cope with the injury until the end of the season.