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THE HEALTH | MARCH-APRIL , 2022
| Column |
BONE TO PICK
BY DR JONAS FERNANDEZ
THE KNEE Is probably the most common joint injury suffered by athletes . Injuries can range from a simple bruise to complicated fractures and torn ligaments .
Many , if not all seasoned athletes , would have endured some injury in their careers . Surprisingly , these athletes can self-diagnose even before a single visit to the doctor .
I was no exception . During a national taekwondo tournament in 2004 , I endured a ruptured Anterior Cruciate Ligament ( ACL ). Right after the injury , my friends and teammates were like , “ this one surely ACL koyak ( torn ), bro ”.
And they were right . Could you really diagnose someone with torn ligaments just like that ? After all , this particular ligament is seated deep within the knee joint , so how could you say ?
So the answer is Yes . You can suspect someone to have this injury based purely on history . With physical examination , one can be almost certain . Let ’ s start with the history first .
For this , allow me to take you down memory lane on my own torn ligament . Let me set the scene . As previously mentioned , it was a taekwondo tournament . There I was , in my first fight of the day , aiming to defend the national junior title I had won the year before .
Attempting to land a kick on my opponent , I turned my body , kicking with my right leg . My left foot was firmly planted on the ground during this kicking motion .
In one swift motion , I could feel my entire body turn as I twisted my knee . In short , my left leg was not in sync with the rest of my body ’ s motion , thus resulting in a twisting injury to the knee .
Swelling is almost immediate There was an audible “ pop ” sound heard
Come on , let ’ s twist again … well , not really
One can be suspected to have a knee injury based purely on history
The ACL consists of the AM and PL bundles .
Intraoperative photo of my torn AC .
Intraoperative photo of my reconstructed ACL .
as this was happening . In agony , I fell to the ground , unable to stand up , let alone walk without assistance . As I rested , with ice on my knee , I had noticed that my knee had begun to swell up .
To summarise , the relevant history of the initial trauma includes the twisting mechanism injury , the pain , the “ pop ”
Lachman Test is the most sensitive to detect ACL rupture .
sound , the inability to continue the sporting activity , and lastly , the almost immediate swelling .
After a couple of weeks of rest and icing the knee , the pain and swelling will slowly subside . One will slowly get back to walking in a few weeks and even back to some light sports .
Now that the pain and swelling have resolved , patients ( and me at the time ) will tend to get back into their sporting activities . This is when one might start to experience another symptom , instability .
Dr Jonas Fernandez is an Orthopaedic Surgeon at Putrajaya Hospital . He is also a member of the Malaysian Arthroscopy Society ( MAS ).
Before we get into that , some light anatomy class . The ACL consists of two bundles , namely the anteromedial ( AM ) and the posterolateral ( PL ).
The AM primarily controls the knee ’ s anterior translation , whereas the PM bundle holds the pivoting ( twisting ) motion .
Symptoms of instability can vary amongst patients . They usually present with the feeling of the knee “ giving way ” when walking on slippery or uneven ground , when ascending or descending the stairs and even when crossing over something ( like a drain ).
Apart from these symptoms , the athletes may complain of instability when making sudden pivoting movements . It includes motions like making sudden changes in direction , usually seen in court sports like futsal , basketball etc .
History-taking is critical
A thorough history-taking will usually reveal these symptoms and point the treating doctor in the right direction as physical examination starts . We ’ d look out for signs like swelling , bruising , tenderness and limitation in range of motion .
More specifically , one will need to perform particular tests like the Lachman Test , the Anterior Drawer Test to try , and the Pivot Shift Test to determine if the ACL is damaged .
With the history and examination , an ACL injury can be confidently diagnosed . However , it is imperative to remember other structures in the knee that may have been injured , too , like the meniscus and cartilages .
Finally , to confirm the diagnosis of an ACL injury and look out for other possible damages , your doctor might order a Magnetic Resonance Imaging ( MRI ) scan .
This scan allows us to visualise structures like the ligaments , meniscus and cartilages that we will not be able to see on an X-ray . Treatment begins with physiotherapy to ensure adequate muscle strength is retained and maintain a good range of motion .
Surgery is indicated if there is persistent instability , whereby your doctor might advise on the ACL reconstruction . However , it should be kept in mind that the success of the surgery is very much dependent on post-operative rehabilitation .
So , there you have it , go ahead and diagnose and treat that twisted knee of yours ! — The Health
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