SYMPTOMS There is a gradual or acute on set of effusion and exercise-induced pain often combined with mechanical problems of locking, clicking, clunking or discomfort on impact (compression and rotation). This injury is common in sports such as football, rugby and other high-intensity contact sports but can also occur gradually in sports where hypermobility is important, such as ballet, gymnastics and martial arts. AETIOLOGY In many cases this injury occurs from direct or indirect trauma or in association with other ligament injuries.
CLINICAL FINDINGS There is effusion in most cases. The compression rotation test is positive. There is often tenderness on palpation of the affected joint line and there are complementary tests for the same purpose. Since there are often associated injuries, examination must also include tests for ligaments, menisci and capsular structures. INVESTIGATIONS Clinical examination is the most important tool for diagnosis and should include tests for all ligaments and other structures in
Fig. 94 Compression rotation test eliciting pain reflects a cartilage or meniscus injury
the knee. X-ray is valuable to rule out fractures, in particular in growing or elderly athletes. Note! MRI can sometimes miss significant cartilage injuries but is valuable for evaluating associated injuries. TREATMENT An athlete with effusion and suspected cartilage injuries should be seen by an orthopaedic surgeon to consider arthroscopy. This procedure can not only verify the diagnosis but also
deal with associated injuries. Minor cartilage injuries are debrided or vaporised and loose bodies excised. Full-thickness cartilage injuries on weight-bearing surfaces can be micro-fractured to stimulate growth of fibro-cartilage, which fills the gap and provides reasonable support. Other, more complicated cartilage procedures, such as cell transplant
Fig. 99 Micro-fracture is done by drilling or punching small holes through the cortical bone to the subchondral area so bleeding can occur. This brings new cartilage producing cells to the surface procedures, are still experimental and their long-term outcomes are not superior to micro-fracture. REFERRALS Refer to orthopaedic surgeon for further investigations to verify the extent of the injury. Physiotherapists will be involved in close collaboration with the surgeon.
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