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Sports Surgery; Having the widest surface, the knee joint is the largest of the body. It is a joint that is formed by the femur, the tibia and the patella. There is an anatomical mismatch between the femur bone and the tibia bone on the lower side of the knee joint.
Therefore, the knee joint is one of the joints that are mostly injured. This mismatch is compensated by the meniscus and ligaments in the joint functionally. Therefore, the most frequently injured structures in the knee are the meniscus and anterior cruciate ligament, which try to achieve recover mismatch in the knee joint.
The anterior cruciate ligament (ACL) is adhered to the center of the tibia bone to the outer wall of the gap (notch) in the middle of the femur bone in the knee joint. The anterior cruciate ligament is one of the structures that allows the knee to move in certain directions, not slide, and remain stable. It prevents the knee joint from sliding to the foreground and turning too much.
The meniscus are flat rigid elastic cartilage and crescent shaped structures in the knee joint space between the tibia and the femur bones. It supports the joint surface as a pillow and protects the joint cartilage by distributing the loads on the joint cartilage evenly.
Anterior cruciate ligament and meniscus are injured without contact by 80% (without falling, impact). It is injured by turning the knee towards any direction when the foot is stepped in a fixed position.
For example, it is injured by moving the knee and the body on the leg which is stepped on the ground instead of other leg used for shooting the ball when shooting the ball in football game. It is injured by turning the body in one direction while the foot is fixed on one leg when dancing.
While meniscus injuries caused by extreme activities such as sports and dance at a young age, they can be caused by even with daily activities due to the deterioration of the quality of the meniscus at middle and senior ages.
They may be injured by extreme rotation of the knee after a jump in sports like basketball and volleyball or dance. This can happen to a person who doesn’t do sports or dance, even after a fall of jump from a high place or by making an adverse movement when descending a ladder.
The meniscus is subjected to maximal load especially during full knee movement (flexion). For this reason, the meniscus is often injured if it is rotated during the crouching movement.
Full squat movements are risky for meniscus. The anterior cruciate ligament is injured by contact by 20% (fall, impact, traffic accidents).
The use of unsuitable sports equipment (unsuitable knee brace, shoes), risky floors, weather, risky activities, anatomically inclination (minor anatomical changes in the body), inappropriate training can cause anterior cruciate ligament and meniscus rupture.
Pivoting (Sudden deceleration, deflection and turn) movements pose risks. The risk increases in case the floor where we make these movements on is of non-skid character.
Since the shoe holds the floor, our knee is subjected to a lot of rolling force. With this movement, the meniscus and anterior cruciate ligament can be ruptured.
The most important advice to be given is that the athlete and the dancer are not caught on the sole while he/she is on one leg, or that the athlete at the tip of his/her toe jumps and escapes from this risky position.
Making unexpected sudden movements poses a risk . Athletes are more at risk than dancers because they do unexpected sudden movements more often and there are choreographic (planned) movements in the dance. The form of descent after the jump is important.
The distance between our two knees should be more than or equal to the distance between our two feet when the feet land on the ground after the jump. The meniscus is subjected to maximal load during full knee movement (flexion).
Full squat movements are therefore inconvenient for meniscus. Instead, half squat should be preferred. When the knee is slightly bent (flexion) while the foot is stationary during movement, rotating the body on the knee can cause meniscus ruptures.
Normally, there is a slight valgus angle between the femur and the tibia bones in the knee. Persons with this angle in the knee is wide, that is to say persons those with X legs are at greater risk after the jump.
The greater the inward angle of the hip, being flat feet, outward tibia, the elasticity of the joints (joint laxity) increase the risk.
Women are at greater risk of anterior cruciate ligament injury. In women, the knee notch to which the anterior cruciate ligament adheres is narrow and the anterior cruciate ligament is shorter, which increases the risk.
Sex hormones are also acting as factors in ligament injuries. There are estrogen progesterone receptors in the anterior cruciate ligament. Therefore, women have a higher risk of anterior cruciate ligament injury during menstruation and ovulation periods.
Especially during menstruation periods, women should avoid these movements that stretch their knees. In females, lesser knee and hip flexion in sudden deceleration and turning movements, X-legs, increased introversion angle of the hip, less knee joint stiffness, predominance of the quadriceps muscle and weak Hamstring muscles increase the risk of injury.
Yes. Humid weather and dry ground are risky. Lightly soaked floors are least risky. Friction increases on artificial surfaces, performance is good, but risk is higher. The soil ground is a natural and thick pillow that absorbs our mass and reduces the load on our knees and therefore on the cartilages.
However, the treadmill is not a natural ground. Shoes with air cushion soles should be preferred when running on hard surfaces such as treadmills. The most common situation that causes injury to our knees in the astro-turf field is that our shoes are caught by the astro-turf carpet field.
Therefore, these black capsules called pellets in astro-turf fields are important; they prevent our shoes to be caught by the ground, however, if they are used unnecessarily excessive, then we can slip and fall.
The risk increases if the shoe-to-surface frictional force is high. Shoes that hold the floor too high and hard floors that hold the shoes too risky as well as very slippery floors.
By taking into account the body and muscle structure of the person, range of motion and joint looseness or stiffness, training the person with an appropriate personalized exercise program may reduce the injury.
