The knee joint is the joint most commonly affected by sports injuries. The anatomical and ligament structure of the knee joint has a great impact on this. There are 4 ligaments in the knee joint. These are the internal collateral ligament, external collateral ligament, anterior cruciate ligament and posterior cruciate ligament. The balance of the knee joint is largely maintained thanks to these ligaments, and therefore there is a high probability of injury to these ligaments during strenuous movements during sports activities.
INTERNAL LATERAL LIGAMENT: It is the most frequently injured ligament in knee joint traumas. Internal collateral ligament injury may occur as a result of excessive load on the inner part of the knee during the force applied to the foot or knee from inside to outside. There are degrees of this ligament injury. In a first degree injury, there is only stretching in the ligament. 2nd degree is a partial tear, 3rd degree is a complete tear. Depending on the degree of internal collateral ligament injury, outward opening of the knee may occur along with pain and strain on the inner side of the knee. The blood supply of the internal collateral ligament is quite good and since it is an extra-articular ligament, the recovery rate is quite high. In the acute period, anti-edema medications, ice therapy and rest are recommended. It is recommended to use an angle-adjustable knee brace for 3-6 weeks during the recovery period, both for faster recovery and for reducing pain during the recovery period. Surgical repair may be required in patients with pain or laxity in the knee after 1.5-2 months of follow-up.
EXTERNAL collateral ligament: External collateral ligament injuries are much rarer than internal collateral ligament injuries. It may occur after trauma to the foot or knee area from the outside to the inside. Pain on the outside of the knee and difficulty in moving the knee occur. Like the internal collateral ligament, the recovery rates of the external collateral ligament are also quite high. As with medial collateral ligament injury, ice and rest are important to relieve pain in the early stages. With the use of an angle-adjustable knee brace for 3-6 weeks, recovery is possible in the majority of patients without the need for surgical treatment.
Anterior Cruciate Ligament: Unlike internal and external collateral ligament injuries, anterior cruciate ligament injuries occur when the body rotates the knee around itself rather than direct trauma. . The majority of patients describe this as rotation of the knee. Since the anterior cruciate ligament is a ligament within the joint, if it ruptures, it can occur in the knee joint. Swelling occurs within the first 24 hours. This swelling causes both limitation of movement and pain in the knee. In order to eliminate rapid swelling, the use of bandages and knee braces, rest and ice application are important in the early period. The anterior cruciate ligament is not a ligament that can heal spontaneously due to both its structure and intra-articular location. Surgical repair is required in young patients and those with active sports lives. In addition, surgical repair is recommended for patients who feel space and looseness in their knees during daily activities, although they do not have an active sports life. The anterior cruciate ligament is a functional ligament. If it tears and creates a gap in the knee, there is a possibility of wear on the knee in the early period as there will be macro and micro movements in the knee. For this reason, anterior cruciate ligament repair is recommended, especially in young patients.
Posterior Cruciate Ligament: It is a ligament that is injured much less frequently than the anterior cruciate ligament, and unlike the anterior cruciate ligament, it is usually torn after direct trauma. It typically occurs in knee injuries from front to back. An example of this is the knee hitting the front side in an in-car traffic accident. The posterior cruciate ligament is also an intra-articular ligament and it is not possible for it to heal spontaneously. However, since the surgery is more complicated and the surgical results are not as good as the anterior cruciate ligament, it is recommended to follow up posterior cruciate ligament tears as long as there is no serious laxity in the knee. In case of looseness in the knee during daily activities, posterior cruciate ligament repair should be done surgically.
MENISCES: There are 2 menisci in each knee, located on the inner (medial) and outer (lateral) sides. Menisci have important functions such as balancing the load distribution, reducing the load on the joint cartilage per unit area, and ensuring the balance of the knee. Because of these functions, menisci are very important in knee dynamics and statics. Meniscus tears are the most common problem in the knee. They can be traumatic and degenerative. Traumatic tears are tears that occur due to impact, especially sports injuries in young people. Degenerative tears are tears that may occur even during daily activities as a result of the meniscus losing its elasticity due to fluid loss in older ages.
There are 3 main complaints of meniscus tears. These; Pain, mechanical complaints such as sticking and locking, and swelling in the knee joint. The most common complaint is pain. Pain is the reason that pushes the majority of patients to seek treatment. Although the pain in meniscus tears decreases with medications or support such as physical therapy, it is not possible for the meniscus tear to heal. The most important reason for this is that the blood supply to the meniscus that will provide healing is extremely poor. Therefore, although the pain complaint decreases with supportive treatments, surgery is necessary in cases where the patient's complaint persists. Surgery for meniscus tears is performed by arthroscopy, called the closed method. In this method, if the tear is small and cannot be stitched, only the part affected by the tear is removed, and if it is stitchable, it is stitched. Although our preference is to always stitch the meniscus to protect it, this is not possible in every tear. After the torn meniscus section is removed, the patient can walk on his feet and return to his daily life after a 2-3 day rest period. In cases where the meniscus is stitched, he/she must not step on it for 6 weeks and he/she performs his/her daily movements with crutches.
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